Voiding diaries are an essential diagnostic tool for assessing for assessing lower urinary tract symptoms (LUTS) (1).  Paper diaries were introduced over 50 years ago and remain the gold standard for guiding the management of functional urological issues. In the absence of a universal scoring system, the bladder diary remains the most accurate method of quantifying LUTS (2). Despite the clinical utility, recording an accurate voiding diary remains time-consuming and tedious to record. Inaccurate, incomplete and low compliance data potentiates misdiagnosis and poor outcomes. 

The iUFlow is a compact bladder-monitoring device that is placed over the toilet bowl and connects to the patient’s smartphone. It provides automated capturing and recording of frequency, volumes as well as uroflowmetry data at home. This is done by an arrangement of sensors under a urine container producing acoustic signals that can be recorded, processed and analysed via the patient’s mobile device. The objective of this pilot study was to examine the data accuracy and patient compliance of a fully automated bladder diary (iUFlow). We compared patient satisfaction and preference of the iUFlow platform to a traditional paper diary.

A pilot study was performed with healthy volunteers over 18 years old and were fluent in English. Participants who did not have access to a smartphone were excluded. No controls were placed on an individual’s technological proficiency. Participants were consented to complete two diaries over two discreet 24-hour periods. An anonymous online survey powered by Google forms was used to assess experience with smartphone technology, previous exposure to e-health devices and attitudes towards voiding diaries. Participants then completed a 24-hour period using the fully automated iUFlow device and smartphone application followed by a pre-formatted traditional paper voiding diary. 

A post study survey examined preference of device, mean number of missed data entries for each group, mean length of time taken to complete the diary and rating of difficulty in usage of each diary including sleep disturbance. Responses were then correlated to investigate the accuracy and perceived ease of use for each modality.

13 participants were included in the study ranging from ages 22 to 59 with a mean age of 35. None of the participants stated previous use or experience with a voiding diary. At initial survey 6 of the 13 patients stated their preference for a paper diary over an automated diary. After completion of both diary types, 12 out of 13 patients preferred to use the electronic diary (92% of participants). Reasons stated for this preference included “easier to use,” “portable device for recording drinks” and various responses for not having to handle and measure urine. 

Reported missed urination events differed between the two groups with an average of 1 missed event for the automated diary and 2.4 missed events for the paper diary. The mean number of reported missed oral intake events was 1.7 for automated diary and 2.9 for the paper diary.

During the 24-hour period participants took an average of 13 minutes to enter data into the automated diary and 28 minutes to fill out the paper diary. 2 participants reported some difficulty in returning to sleep after nocturnal events when using the automated diary compared with 5 patients in the paper diary group.

In previous studies patients have displayed a clear preference for electronic diaries over paper diaries. 92% of the participants in this study displayed their preference for an automated system due to its ease of use. On average, the automated iUflow platform took 15 minutes less to complete which decreases demand on patients.  

Limitations of this patient study relate to the size of the participant sample and the nature of the participants being healthy volunteers. Furthermore, the length of time for use of each diary was shorter than the currently recommended 3-day duration for traditional voiding diary diagnostic accuracy

The iUFlow automated bladder diary has the potential to improve compliance and quality of voiding data as well as enhance patient experience. Further studies are required in a broader sample of patients in order to fully classify the clinical utility of this new technology.

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Jones C, Hill J, Chapple C, Guideline Development G. Management of lower urinary tract symptoms in men: summary of NICE guidance. Bmj. 2010;340:c2354.
Quinn P, Goka J, Richardson H. Assessment of an electronic daily diary in patients with overactive bladder. BJU international. 2003;91(7):647-52.