We are failing as a specialty. Why, because no effort is being made to prevent dysfunctional disorders afflicting the bladder with aging.  Void problems evolve over time. Void patterns early in life can predispose to void dysfunction later in life. Roughly 30% of children are dysfunctional toileters going into puberty. Learning plasticity narrows dramatically through puberty leaving toileting inefficiencies locked in as the default behavior going into adolescence and adulthood. Circumstances of Life then compound the adverse consequences of chronic dysfunction. People just wait too long, or rush through their voids, or terminate their voids prematurely. Years of such inefficient behavior, is potentially destructive to the Lower urinary tract over time.  Screening of void behavior therefore seems logical and necessary. A Void Diary is useful for several reasons  a) It allows for early identification of toileting dysfunction  and hence the opportunity to institute early corrective measures. b) Quantification of void behavior via comparisons to normal standards and use of dysfunctional scoring c)  assessment of the efficacy of treatments applied d) and periodic screening and monitoring  of Void Integrity over time.

Methods:   The following unique diary format is presented. A patient reference profile is created prior to entry of the diary data. Void behavior (time, volume, urge, leakage are tabulated in separate diary days. Voids are then categorized into three 8-hour time blocks (over night, active day, evening) and the 24 hour time frame.  Void data is then  presented in both Graphic and Table formats.  A basic Computor analysis is provided as a guideline to any variance from normal. Scoring is used as a severity index to allow comparisons of treatments a patient receives .

Analysis consists of
1.	Preemptive Urinary frequency: a) as recorded by the patient and b) standardized by converting to a 2000cc output. (This allows comparison of different frequencies obtained with varying volumes. e.g., two diaries both show  void frequencies of 10x. One has an output of 4000cc and one an output of 1000cc. Their standardized frequencies at a 2000cc output  would be 5 x and 20 x, respectfully )

2. Recorded Voids are tabulated into three 8-hour time block, and for the 24hr day. Variances in hydration and outputs can be       identified during the 24 hr timeframe

3. 24 hour and average void volume data is compared to a reference target

4. Each Void Volume is penalty scored. These can be summed up to reflect a degree of daily deviation from normal 

5. Void volumes are separated in 100cc categories to assess pattern consistency and variance from normal

6. Void Volumes and Hydration efficiency is calculated relative to a target 

7. A computer interpretation of the data provides immediate relevance significance of the diary data

A challenge of collecting void diaries is to make the information meaningful a) relative to an accepted normal and b) for comparison with other diaries.

Diary behavior is tabulated in both Graphic and Table format. Graphic format can present single diary data, or  3 graphically  stacked                           diaries for visual comparisons. 

A Computor comparison of the void diary against accepted normal standards is provided to make the dairy data meaningful

Search capability via Age , Diagnosis, Treatment,  Medication, etc

The diary is in two formats , a) a simplified diary for direct patient use and b) a more in-depth diary for physician use.

The Diary is in Mobile and Laptop format.

Conclusion: The void diary has both diagnostic and education benefits. Most people have no idea whatsoever if their void behavior is normal or not. Patients learn from doing a void diary and can subsequently self correct faulty habits. Physicians presently have no easy objective way to quantify void behabvior and  treatments provided.    Evolving pathological consequences of chronic urinary tract dysfunction can be identified early and treatments can be objectively compared to baseline. The bottom line is that repeat diaries with aging can tract the integrity and  health of the lower urinary tract.  In sum, a void diary is a powerful tool for both the patient and the physician.