In the Japanese guidelines for the treatment of nocturia, a bladder diary is listed as an essential basic evaluation tool. However, a number of older patients and patients with low activities of daily living are unable to maintain a handwritten bladder diary. An electronic bladder diary (Enda medical industry corporation, Tokyo) was launched in 2018 and introduced to our hospital in 2023. An electronic bladder diary is a device that transfers the time and volume of urination to an iPad by placing a cup of collected urine in the device. The electronic bladder diary is expected to enable patients who have difficulty documenting their urinary output in a handwritten bladder diary to use the device. However, there have been no reports on the effectiveness of electronic bladder diaries. Therefore, in this study, we examined the effectiveness of electronic diaries in clinical practice.

The study included 127 hospitalized patients who provided consent. An electronic bladder diary was recorded for 2–3 days along with a traditional handwritten bladder diary. The effectiveness of the electronic bladder diary was examined based on whether the patients were able to use the electronic bladder diary, its consistency with the traditional handwritten bladder diary (number of urinations, amount of urination, nocturnal polyuria index (NPi) and time to urinate), and the feeling of use.

The mean age of the patients was 72.6 (range, 39–89) years. Daily voiding volume was significantly lower in the electronic bladder diary group (p＜0.0001). In particular, daytime voiding volume was lower in the electronic bladder diary, and NPi was correspondingly higher in the electronic bladder diary (p<0.0001). Although the frequency of urination did not differ significantly between the two groups, 27% of the patients had a different daily urination frequency (9.2% differed by two or more voids). Fewer patients were unable to use an electronic bladder diary than those unable to use a handwritten bladder diary. The main reasons for not being able to use a handwritten bladder diary were either an inability to measure urine output owing to poor vision or inability to record urine output because of an inability to write. The majority of patients (57.3%) expressed a preference for using an electronic bladder diary the next time they used a bladder diary.

Urine volumes measured using the electronic bladder diary were significantly lower than those recorded in the handwritten bladder diary. The nocturnal polyuria index was correspondingly higher in the electronic bladder diary, suggesting that there may be many potential patients with nocturnal polyuria, considering that urine volume is more accurately measured using the electronic bladder diary. The results showed that more patients preferred electronic bladder diaries and that some patients who were unable to use handwritten bladder diaries were able to use electronic bladder diaries. An electronic bladder diary may enable therapeutic intervention with drugs such as desmopressin in older patients who are difficult to treat because of their inability to record the handwritten bladder diary. Additionally, the time required to calculate the bladder diary could be significantly improved, reducing the burden on medical staff.

In this study, an electronic bladder diary was shown to be useful for nocturia treatment. An electronic bladder diary can be used for patients who are unable to record their urination in a handwritten bladder diary, reducing the time and effort required by healthcare providers to calculate urine volumes. Further detailed analyses are required to identify the target patient population for electronic bladder diaries.

Kyoda Y, Ichihara K and Muranaka I et al: Efficacy of cognitive behavioral therapy using self-check sheet for patients with nocturia in real-world clinical practice. Low Urin Tract Symptoms 15(6): 225-230, 2023.
Yap TL, Cromwell DC and Emberton M: A systematic review of the reliability of frequency-volume charts in urological research and its implications for the optimum chart duration. BJU Int 99(1): 9-16, 2007.
van Haarst EP and Bosch JL: The optimal duration of frequency-volume charts related to compliance and reliability. Neurourol Urodyn 33(3): 296-301, 2014