Voiding diaries are instruments recommended by the International Continence Society (ICS) for evaluation of Lower Urinary Tract Symptoms (LUTS), such as urinary incontinence (UI) and Overactive Bladder Syndrome (OAB) symptoms (1). LUTS can negatively affect the quality of life, and the clinical assessment works as an indicator for treatment plans in each given condition. The voiding diary is regarded as a useful tool for evaluation, diagnosis, and treatment of LUTS because it is a non-invasive, low-cost, and easy-to-apply tool, which allows to evaluate the severity of symptoms reported by the patients in an objective manner (2). However voiding diary vary according to each specific practical reality in relation to types and designs (printed or digital), duration in days, and content. Studies have investigated the development and validation of several types of voiding diary, which should be based on the evaluation of its measurement properties, to guarantee good methodological quality. It is therefore recommended that the reliability, validity and responsiveness be evaluated and considered suitable and relevant for the target audience. Thus, the aim of this review is identifying the bladder diary characteristics on its contents, format, and duration; in addition to describing the tested measurement properties of the voiding diaries.

A systematic search was carried out on online databases: US NATIONAL LIBRARY OF MEDICINE NATIONAL INSTITUTES OF HEALTH (PubMed), Excerpta Medica dataBASE (Embase), Scopus, and Web of Science. The following controlled descriptors were applied, according to “Health Sciences Descriptors” (DeCS) or Medical Subject Headings (MESH) terms and their variations and synonymous: “Lower Urinary Tract Symptoms”; “bladder diary”, and “validation”. They were applied with the Boolean operators “AND” and “OR”, according to the following search strategy, adapted for each database: (“lower urinary tract symptoms” OR “urinary incontinence” OR “overactive bladder” OR micturition) AND (“bladder diary” OR “voiding diary” OR “urinary diary” OR “frequency-volume chart” OR “micturition chart”) AND (validation OR validity). We selected original studies, whether observational or methodological, which investigated voiding diary application as a LUTS diagnosis or assessment instrument, in Portuguese, English, or Spanish and without publication date restrictions. The study selection was developed by two independent reviewers. The included studies were summarized and analyzed, considering bladder diary’s contents, format, duration, and the measurement properties adopted. The measurement properties were described according to the Consensus‐based standards for the selection of health status measurement instruments (COSMIN) terminology. This checklist is intended to rate the methodological quality of Patient-reported Measurement Instruments (PROMs) which contemplate the following measurement properties: internal consistency, reliability, measurement mistakes, content validity (including face validity), construct validity (including structural validity, hypothesis testing, and cross-cultural validity), criterion validity, responsiveness, and interpretability, organized into ten standard boxes. These instruments made it possible to identify which properties were tested in each bladder diaries and how it was performed.

Literature search initially resulted in 903 articles, and a total of 16 studies were included for analyses. Ten types of bladder diary were identified as some studies published different stages of development and validation of the same bladder diary. In addition, four studies have published the translation and validation processes of the same diary (ternational consultation on incontinence questionnaire - ICIQ Bladder Diary) Seven diaries were in a printed format and three were in an electronic format. Symptoms related to bladder storage (incontinence episodes, frequency, urgency and nocturia) were the most investigated ones, only one of the bladder diaries included dysuria and pain intensity before and after micturition as bladder voiding symptoms to be investigated, since this diary was developed for patients with bladder pain syndrome. most bladder diaries also evaluated habits related to fluid intake, urinary frequency, and urine volume, as well as the need to use incontinence and/or sanitary pads and the number of changes. A three-day period was the most observed and two bladder diaries used a longer duration, of 5 and 7 days. The measurement properties were described in eight bladder diaries. The content validity index (CVI) and Delphi Method based on the patients’ opinions with LUTS and experts were the most frequent techniques used to evaluate content validity. Reliability was tested in four bladder diaries evaluated using the test-retest method with application intervals ranging from two to three weeks. Pre-and post-treatment responsiveness was evaluated in only the versions of ICIQ bladder diary (3).

Although technology advances, it seems that the preferred voiding diary formats are still paper-based models by patients. A three-day bladder diary is the most recommended period as it has the same reliability as the seven-day duration bladder diary, while reducing the patient's burden. The contents of bladder diaries investigate generally bladder storage symptoms, such as IU and OAB symptoms. In addition. Thus, the bladder diary characteristics should be consonant with specific characteristics of each target population and measurement properties should be tested for accuracy. The effectiveness of the bladder diary as a self-reported assessment instrument can be related to aspects beyond the understanding of how to fill it out, which refer to the patient’s feeling of identification with the tool, as it should make sense for those who will complete it, thus acknowledging the value of patients’ participation and contribution. According to the three domains of the COSMIN taxonomy (validity, reliability and responsiveness), we observed that face validity and/or concurrent validity are the main measurement properties tested for validation.

Numerous of voiding diaries are found in the literature. Printed voiding diaries with a duration of three days are still the preferred models. Bladder storage symptoms are the most investigated ones. The bladder diary should be in consonance with specific characteristics of each target population and measurement properties validation and reliability should be tested for accuracy.

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