Bladder diary is an important tool in evaluation of female patients with lower urinary tract symptoms(LUTS) as recommended by EAU,ICS and AUA guidelines (1). Completing 3 days of bladder diary maybe cumbersome and studies have found that only 50% of the participants could perfectly complete the diary (2). In this study we aim to compare the reliability of 1 day bladder diary (1dBD) to 3 days bladder diary (3dBD) in evaluation of females with lower urinary tract symptoms (LUTS).

It was a descriptive cross-sectional study conducted over 11 months. 100 females with LUTS requiring bladder diary for evaluation were included. Inclusion criteria were age 18-80 years and able to read and write in English or local language. Illiterate women, those with psychiatric illness and those unwilling to participate were excluded.  All were given printed bladder diaries and explained how to complete them. In the 1st week after hospital visit, they were asked to fill diary for 3 days, consecutive or non-consecutive including both work and leisure days. After wash out period of 4 to 7 days, in 2nd week, they were asked to fill diary on any one day and were called for review with the diaries to OPD after 2 weeks. Total number of voids, nocturia episodes, average voided volume, maximum voided volume, total intake of liquids, episodes of severe urgency, episodes of leak associated with urgency and activity were noted. Mean of all the above outcome measures in a 3dBD were compared to those from 1dBD for each patient to determine how effective was 1dBD compared to 3dBD. To determine the completeness of diaries, they were divided into four categories: no diary submitted, unusable (>40% missing void or intake volumes), usable but not complete, and complete.  To determine patient compliance and preference, Likert Scale was used.

100 female patients with LUTS were included. Average age of participants was 43.45 ± 15.33 years. 37% presented with symptoms of urinary urgency and urge urinary incontinence, 34% had mixed urinary incontinence, 18% stress urinary incontinence while 11% had nocturia. 
7 women did not submit either 3dBD or 1dBD. 9% of 3dBD and 5% of 1dBD
were unusable. 22% of 3dBD and 3% of 1dBD were usable but not complete while 62% of 3dBD and 85% of 1 dBD were complete. Only diaries in the categories usable but not complete and complete (total 84) were included for final comparison. 
Mean of various parameters in 3dBD and 1dBD is as mentioned in Table 1. 
Interclass correlation coefficient (ICC) was calculated to evaluate the agreement between different parameters in 3dBD and 1dBD, with value >0.7 suggestive of good concordance. Total voids, nocturia episodes, average voided volume, maximum voided volume, total intake of liquids, episodes of severe urgency, leaks with urge and leak with activities all showed excellent concordance with ICC being 0.95, 0.87, 0.96, 0.86, 0.97, 0.98, 0.99, 0.98 respectively.
All patients who submitted the diaries (n=93) were asked about the difficulty level in filling the 3 days bladder diary compared to 1 day bladder diary. Out of them, 12 women (12.90%) reported it to be very difficult, 44 women (47.31%) reported it to be difficult and 37 women (39.78%) found it to be neutral.

1dBD is easier, faster to complete and has better patient compliance compared to 3dBD. 1dBD shows excellent concordance with 3dBD in all parameters included in bladder diary.

1dBD may be adequate in initial evaluation of LUTS along with being less cumbersome to the patient. 3dBD maybe useful for comprehensive evaluation of females with complex history. We recommend 1dBD as simplified tool in initial evaluation of females with LUTS.

Cameron AP, Chung DE, Dielubanza EJ, Enemchukwu E, Ginsberg DA, Helfand BT, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. J Urol. 2024 Jul;212(1):11–20.
Cameron AP, Wiseman JB, Smith AR, Merion RM, Gillespie BW, Bradley CS, et al. Are three-day voiding diaries feasible and reliable? Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) cohort. Neurourol Urodyn. 2019 Nov;38(8):2185–93.