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Kaplan SA, Molnar GC, Shen J, Eure GR. The Role of Remote Diagnostics to Better Assess Uroflow Variability: Insights From Combining at Home Uroflows and Frequency Volume Charts From 19,868 Voids Using a Novel, Hand Held, Cellular Embedded Device. Urology 2024; 190:71-76. [PMID: 38677375 DOI: 10.1016/j.urology.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To examine how representative 24-hour data collection is of the overall patient experience utilizing a home uroflow device in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Home uroflow data were collected with the iO Urology CarePath device from men at a single urology clinic and retrospectively analyzed. Void characteristics were summarized for data collected over 24 hours compared to data collected over several days or weeks with the device (overall study excludes the 24-hour data). A linear mixed-effects model was used to evaluate differences in average Qmax from voids collected during a single 24-hour period compared to the overall study. RESULTS A total of 486 men (mean age 67.4) used the device resulting in 465 included in the analysis with a total of 15,521 voids in the overall study and 4347 voids in the single-day analysis. Average Qmax from the model was 11.2 mL/s (95% CI: 10.80, 11.65) and 11.2 mL/s (95% CI: 10.81, 11.64) in the 24-hour and overall study groups, respectively. Both groups had similar between (20.3% vs 20.4%) and within-subject (12.0% vs 11.9%) variance. The difference in Qmax was not significantly different (P = .970). A subgroup analysis including voids >150 mL yielded similar results. CONCLUSION Data show variability in voiding parameters, but similar average Qmax collected in 24 hours as compared to several days/weeks. The combination of home uroflowmetry with frequency-volume chart information can provide objective data and a unique perspective on uroflow variability (UFV) for clinician review to support the development of individualized patient treatment plans.
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Affiliation(s)
- Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Negoro H, Nakamoto I, Uiji S, Matsushima Y, Mathis BJ, Kanikowska D, Wakamura T. Diurnal differences in urine flow in healthy young men in a light-controlled environment: a randomized crossover design. J Physiol Anthropol 2023; 42:27. [PMID: 37978565 PMCID: PMC10655426 DOI: 10.1186/s40101-023-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Older men often experience nocturnal urination difficulties, reflected by diurnal differences in maximum urine flow (Qmax). Since lower urinary tract symptoms and pathological comorbidities are frequent in older men, it remains unclear whether this diurnal variation is a physiological or pathological phenomenon. Our aim was to quantify the diurnal variability of Qmax in healthy young participants under varying daylight conditions in a stable environment to discern potential underlying causes of nocturnal urination difficulties. METHODS Twenty-one healthy young men were recruited in a 4-day study utilizing daytime (08:00-18:00) exposure with two light conditions in randomized order: dim (< 50 lx) or bright (~2500 lx). Day 1 was for acclimation, and urine flow was assessed from day 2. The participants urinated ad libitum during day 2 and then at fixed 3-4-h intervals thereafter (days 3-4). Regular urination Qmax at late night (04:00) on day 4 was compared with the nearest voided volume during daytime of day 3 (mDay). RESULTS Morning Qmax scores (after bed-11:00) on day 2 were significantly lower than evening (17:00-before pre-sleep) in bright conditions and those of daytime (11:00-17:00), evening (17:00-before pre-sleep), and pre-sleep in dim conditions. Pre-sleep Qmax during the ad libitum period was significantly higher in dim than bright conditions. Late-night Qmax values (04:00) on day 4 were significantly lower than Qmax scores of mDay on day 3 in both light conditions. CONCLUSIONS Healthy young men had a clear diurnal Qmax difference that decreased during late night and morning. In addition, the pre-sleep Qmax values in dim daylight were significantly higher than in bright daylight. Taken together, we conclude that late-night and morning decreases in Qmax are an instinctive physiological phenomenon in humans, and the diurnal difference of Qmax can be influenced by daylight conditions.
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Affiliation(s)
- Hiromitsu Negoro
- Department of Urology, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
| | - Isuzu Nakamoto
- Department of Gerontological and Home Healthcare Nursing, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Sayaka Uiji
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiko Matsushima
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Affiliated Hospital, Ibaraki, Japan
| | - Dominika Kanikowska
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomoko Wakamura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Bladt L, Kashtiara A, Platteau W, De Wachter S, De Win G. First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis. JMIR Form Res 2023; 7:e51019. [PMID: 37847531 PMCID: PMC10618888 DOI: 10.2196/51019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations. OBJECTIVE In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow). METHODS A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis. RESULTS The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual's plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29% for pediatric patients and 24/50, 48% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was -3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of -19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions. CONCLUSIONS Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow.
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Affiliation(s)
- Lola Bladt
- Product Development, Faculty of Design Sciences, University of Antwerp, Antwerp, Belgium
| | - Ardavan Kashtiara
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wouter Platteau
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
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Yoshiyama A, Tsujimura A, Hiramatsu I, Morino J, Anno Y, Kurosawa M, Kure A, Uesaka Y, Nozaki T, Shirai M, Kiuchi H, Horie S. Circadian Rhythm of Voided Volume, Maximum Flow Rate, and Voiding Time Evaluated by Toilet Uroflowmetry in Hospitalized Women With Nocturia. Urology 2023; 179:50-57. [PMID: 37353090 DOI: 10.1016/j.urology.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change. METHODS We evaluated 2602 urinations of 58 female patients (age, 68.4 ± 15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years. RESULTS VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6 ± 11.7 ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8 ± 0.93 ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction = .0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old. CONCLUSION The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.
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Affiliation(s)
- Azusa Yoshiyama
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Ippei Hiramatsu
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Junki Morino
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuta Anno
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Makoto Kurosawa
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akimasa Kure
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuka Uesaka
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Taiji Nozaki
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Masato Shirai
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hiroshi Kiuchi
- Osaka University Graduate School of Medicine Department of Urology, Suita, Osaka, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Pandolfo SD, Crauso F, Aveta A, Cilio S, Barone B, Napolitano L, Scarpato A, Mirto BF, Serino F, Del Giudice F, Chung BI, Crocerossa F, Di Zazzo E, Trama F, Vaglio R, Wu Z, Verze P, Imbimbo C, Crocetto F. A Novel Low-Cost Uroflowmetry for Patient Telemonitoring. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3287. [PMID: 36833979 PMCID: PMC9960409 DOI: 10.3390/ijerph20043287] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Uroflowmetry (UF) is a crucial guideline-recommended tool for men with benign prostatic obstruction (BPO). Moreover, UF is a helpful decision-making tool for the management of patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). In the last few years, telemedicine and telehealth have increased exponentially as cost-effective treatment options for both patients and physicians. Telemedicine and telehealth have been well positioned during the COVID-19 pandemic to prevent healthcare system overload and to ensure adequate management of patients through screening, diagnosis, and follow-up at home. In the present manuscript, the main characteristics and performance of a novel and low-cost device for home-based UF have been analyzed. The simple weight-transducer method has been applied to perform UF. An inexpensive load cell connected to a 24 bit analogic digital converter (ADC) sends data to a cloud server via SIM card or home Wi-Fi. Data are processed and shown in graphics with both volume and flow rate as a function of time, allowing for measurement of average flow rate, maximum flow rate, voided volume, and voiding time. A numerical algorithm allows for filtering of the dynamic effect due to the urine gravity acceleration and for removing the funnel to simplify the home measurement procedure. Through an online platform, the physician can see and compare each UF data. The device's reliability has been validated in a first laboratory setting and showed excellent performance. This approach based on domiciliary tests and an online platform can revolutionize the urologic clinic landscape by offering a constant patient cost-effective follow-up, eliminating the time wasted waiting in the office setting.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA 23298, USA
| | - Federica Crauso
- Department of Public Health, University of Naples “Federico II”, 80125 Naples, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Scarpato
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Benito Fabio Mirto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | | | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA 94305, USA
| | - Benjamin I. Chung
- Department of Urology, Stanford Medical Center, Stanford, CA 94305, USA
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Trama
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy
| | - Ruggero Vaglio
- Department of Physics, University of Naples “Federico II”, and CNR SPIN, 80125 Naples, Italy
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
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Long Depaquit T, Michel F, Gaillet S, Savoie PH, Karsenty G. [Home uroflowmetry technics and clinical relevance: A narrative review]. Prog Urol 2022; 32:1531-1542. [PMID: 35961806 DOI: 10.1016/j.purol.2022.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/12/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Urine flowmetry (UF) is a key non-invasive urodynamic test for the evaluation of the voiding phase in patients with lower urinary tract symptoms (LUTS). Traditional free urodynamic testing (FUT) performed on a one-time basis in the office is limited by difficulty in capturing normal voiding and high intrapatient variability in urine flow parameters. Home measurement of urine flow by the patient could be a way to obtain multiple data in real-life conditions, addressing its limitations. The objective of this article was to review the literature on the different techniques of home uroflowmetry (HUF) and their clinical interest in comparison with FUT. MATERIAL AND METHODS A search on the PubMed database using the key words "Urodynamics, Uroflowmetry, non-invasive urodynamics, Ambulatory urodynamics, bladder outlet obstruction, male LUTS" was performed to find articles in English or French that had been published with no time limit and March 2022. The sorting by reading the abstract allowed the selection of all articles describing and/or evaluating a HUF technique that were read entirely according to the same collection grid to propose a narrative synthesis. RESULTS Thirty-one articles were identified, selected, and analyzed. Simple and inexpensive techniques by timing or use of funnels reliably and reproducibly estimate the average and maximum urine flow in relation to the FUT, without providing a complete flow curve. More sophisticated electronic or sonometric methods, some using connected mobile applications, present results that are more consistent with ICS recommendations for flow measurement. With the possibility of studying the average of several values of the maximum urinary flow (Qmax) captured during micturition in physiological conditions, some studies suggest a gain in diagnostic value in the evaluation of the emptying phase and lower urinary tract symptoms in men. However, the literature is sparse, old and the clinical benefits are not yet proven. CONCLUSION There is a wide range of techniques for measuring urine flow in the patient's home, all of which aim to fill the gaps in conventional urine flow measurement. Further studies are needed to demonstrate the acceptability of this type of measurement by patients, the existence of a real clinical benefit, to assess the cost/benefit balance and finally to define a possible place for home uroflowmetry in daily practice, compared with traditional free flowmetry and invasive urodynamics (pressure-flow test).
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Affiliation(s)
- T Long Depaquit
- Service d'urologie, HIA Sainte-Anne, 2 boulevard Sainte-Anne BP600, 83000 Toulon, France; Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France.
| | - F Michel
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France
| | - S Gaillet
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France
| | - P-H Savoie
- Service d'urologie, HIA Sainte-Anne, 2 boulevard Sainte-Anne BP600, 83000 Toulon, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France
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Kato S, Watanabe H, Yamasue K. Freeflow: The novel portable uroflowmeter can help to realize practical urinary conditions at home. Low Urin Tract Symptoms 2022; 14:208-213. [PMID: 35080131 DOI: 10.1111/luts.12426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a novel portable urine flowmeter, Freeflow, for examining the actual state of urination at home. METHODS Forty-three patients with benign prostatic hyperplasia used the Freeflow uroflowmeter in the hospital and at home without accumulating urine. We created a nomogram for each patient's urine volume and maximal urinary flow rate (Qmax). Furthermore, we investigated the actual state of each patient's urination. We also investigated the differences in the micturition status between daytime and nighttime. RESULTS Of the 43 patients, 40 were able to provide the necessary data in the hospital, and all patients provided data measured at home. The trial period of the home assessment was 2-7 days. Regarding the average urine volume, no significant difference was observed between in-hospital and at-home patients; however, Qmax and mean flow rate (Qave) were significantly higher at home. The average coefficient of variation was very large. The relationship between daytime and nighttime was observed in 30 patients; urine volume increased significantly at nighttime; however, no significant difference was observed in Qmax and Qave. The nomogram for several days and a completed urinary diary helped to display daytime and nighttime urination characteristics. CONCLUSIONS Freeflow, the newly developed uroflowmeter, enabled us to determine the fluctuations in the measurements recorded at home and the differences between daytime and nighttime. Thus, creating a nomogram for objectively examining nighttime urination status and utilizing a urination diary was found to be effective for providing correct diagnosis and treatment of lower urinary tract symptoms.
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Affiliation(s)
- Shinobu Kato
- Medical Cooperation Kato Urological Clinic, Hiratsuka, Japan
| | - Hajime Watanabe
- Medical Cooperation Kato Urological Clinic, Hiratsuka, Japan
| | - Kotaro Yamasue
- Public Health and Preventive Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Vredeveld T, van Benten E, Beekmans REPM, Koops MP, Ket JCF, Mollema J, Ramaekers SPJ, Pool JJM, Coppieters MW, Pool-Goudzwaard AL. Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review. BMJ Open 2022; 12:e056234. [PMID: 35487713 PMCID: PMC9058800 DOI: 10.1136/bmjopen-2021-056234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). DESIGN Systematic review with best evidence synthesis. SETTING Primary care. PARTICIPANTS Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. REVIEW METHODS PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. RESULTS Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. CONCLUSION Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
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Affiliation(s)
- Tom Vredeveld
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Esther van Benten
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | | | - M Patrick Koops
- Physiotherapy Practice De Werfheegde, Haaksbergen, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Mollema
- Medical Library, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Stephan P J Ramaekers
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | - Michel W Coppieters
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - Annelies L Pool-Goudzwaard
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
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Development of an Automatic Interpretation Algorithm for Uroflowmetry Results: Application of Artificial Intelligence. Int Neurourol J 2022; 26:69-77. [PMID: 35368187 PMCID: PMC8984688 DOI: 10.5213/inj.2244052.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop an automatic interpretation system for uroflowmetry (UFM) results using machine learning (ML), a form of artificial intelligence (AI). Methods A prospectively collected 1,574 UFM results (1,031 males, 543 females) with voided volume>150 mL was labelled as normal, borderline, or abnormal by 3 urologists. If the 3 experts disagreed, the majority decision was accepted. Abnormality was defined as a condition in which a urologist judges from the UFM results that further evaluation is required and that the patient should visit a urology clinic. To develop the optimal automatic interpretation system, we applied 4 ML algorithms and 2 deep learning (DL) algorithms. ML models were trained with all UFM parameters. DL models were trained to digitally analyze 2-dimensional images of UFM curves. Results The automatic interpretation algorithm achieved a maximum accuracy of 88.9% in males and 90.8% in females when using 6 parameters: voided volume, maximum flow rate, time to maximal flow rate, average flow rate, flow time, and voiding time. In females, the DL models showed a dramatic improvement in accuracy over the other models, reaching 95.4% accuracy in the convolutional neural network model. The performance of the DL models in clinical discrimination was outstanding in both genders, with an area under the curve of up to 0.957 in males and 0.974 in females. Conclusions We developed an automatic interpretation algorithm for UFM results by training AI models using 6 key parameters and the shape of the curve; this algorithm agreed closely with the decisions of urology specialists.
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Maximum Flow Rate Is Lowest in the Early Morning in Hospitalized Men With Nocturia Evaluated Over 24 Hours by Toilet Uroflowmetry. Urology 2022; 166:196-201. [DOI: 10.1016/j.urology.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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11
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Dogan S. Comparison of Self-Conducted and Assistant-Supervised Uroflowmetry Methods. Cureus 2022; 14:e22030. [PMID: 35282527 PMCID: PMC8911527 DOI: 10.7759/cureus.22030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aims to compare the results and patient satisfaction scores between uroflowmetry performed under the patient's control and assistant-supervised conventional uroflowmetry. Methods A total of 120 patients who had previous experience with uroflowmetry were included in the study. Patients were evaluated in two even groups of 60 patients each - those not receiving medical treatment (group 1) and those receiving medical treatment (group 2). Maximum flow rate (Qmax), average flow rate (Qave), voided volume, voiding time, post-void residual volume (PVR), and patient satisfaction survey scores were compared between the two separate uroflowmetry methods. Results There was a significant difference between assistant-supervised and self-conducted uroflowmetry in terms of Qmax, Qave, voiding time, and patient satisfaction scores. While comparing all patients, no significant difference was found in terms of PVR and voiding volume values. There was a significant difference in Qave, Qmax, PVR, and voiding time in both assistant-supervised and self-conducted uroflowmetry. As for voided volume, there was no significant difference between the groups in either procedure. When groups were evaluated within themselves, in group 1, there was a significant difference in voided volume, Qave, and PVR, while there was no significant difference in Qmax and voiding time. In Group 2, there was a significant difference in voided volume, Qave, and PVR, although there was no significant difference in Qmax and voiding time. Conclusion Maximum urine flow rate and mean urine flow rate measured by self-conducted uroflowmetry are higher than assistant-supervised (conventional) uroflowmetry, which can ensure patient privacy.
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A Prospective Comparative Study of Mobile Acoustic Uroflowmetry and Conventional Uroflowmetry. Int Neurourol J 2022; 25:355-363. [PMID: 34991305 PMCID: PMC8748308 DOI: 10.5213/inj.2142154.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study was to assess the performance of a mobile acoustic Uroflowmetry (UFM) application compared with standard UFM in the pediatric population. METHODS A mobile acoustic UFM application represents a noninvasive method to estimate the urine flow rate by recording voiding sounds with a smartphone. Male pediatric patients who were undergoing UFM testing were prospectively recruited, and the voiding sounds were recorded and analyzed. The intraclass correlation coefficient (ICC) was used to compare the maximum flow rate (Qmax), average flow rate (Qavg), voiding time (VT), and voiding volume (VV) as estimated by acoustic UFM with those calculated by standard UFM. Differences in Qmax, Qavg, VT, and VV between the 2 UFM tests were determined using 95% Bland-Altman limits of agreement. RESULTS A total of 16 male patients were evaluated. Their median age was 9 years. With standard UFM, the median Qmax, Qavg, VT, and VV were 18.7 mL/sec, 11.1 mL/sec, 15.2 seconds, and 157.8 mL, respectively. Strong correlations were observed between the 2 methods for Qmax (ICC=0.755, P=0.005), VT (ICC=0.974, P<0.001), and VV (ICC=0.930, P<0.001), but not for Qavg (ICC=0.442, P=0.135). The Bland-Altman plot showed good agreement between the 2 UFM tests. Flow patterns recorded by acoustic UFM and conventional UFM showed good visual correlations. CONCLUSION Acoustic UFM was comparable to standard UFM for male pediatric patients. Further validation of its performance in different toilet settings is necessary for broader use.
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Classification of Bladder Emptying Patterns by LSTM Neural Network Trained Using Acoustic Signatures. SENSORS 2021; 21:s21165328. [PMID: 34450769 PMCID: PMC8400043 DOI: 10.3390/s21165328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 12/01/2022]
Abstract
(1) Background: Non-invasive uroflowmetry is used in clinical practice for diagnosing lower urinary tract symptoms (LUTS) and the health status of a patient. To establish a smart system for measuring the flowrate during urination without any temporospatial constraints for patients with a urinary disorder, the acoustic signatures from the uroflow of patients being treated for LUTS at a tertiary hospital were utilized. (2) Methods: Uroflowmetry data were collected for construction and verification of a long short-term memory (LSTM) deep-learning algorithm. The initial sample size comprised 34 patients; 27 patients were included in the final analysis. Uroflow sounds generated from flow impacts on a structure were analyzed by loudness and roughness parameters. (3) Results: A similar signal pattern to the clinical urological measurements was observed and applied for health diagnosis. (4) Conclusions: Consistent flowrate values were obtained by applying the uroflow sound samples from the randomly selected patients to the constructed model for validation. The flowrate predicted using the acoustic signature accurately demonstrated actual physical characteristics. This could be used for developing a new smart flowmetry device applicable in everyday life with minimal constraints from settings and enable remote diagnosis of urinary system diseases by objective continuous measurements of bladder emptying function.
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Misrai V, Pradere B, Herrmann T, Cornu JN. The Sound of Noise in Decision-making: An Illustration with Management of Male Lower Urinary Tract Symptoms. Eur Urol 2021; 80:529-530. [PMID: 34334222 DOI: 10.1016/j.eururo.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
High-quality patient care depends on the accuracy and efficacy of clinical decision-making, which can be affected by both cognitive bias and the risk of judgment variability, which is called noise. Deep learning algorithms, artificial intelligence, and robots could improve the reliability of decision-making, but until these become a reality, clinical practice guidelines are of great value in reducing this noise.
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Affiliation(s)
- Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France.
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen, France
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Abstract
PURPOSE Benign prostatic hyperplasia is one of the most common conditions seen by a general urologist. Validated questionnaires provide insight into patient symptoms, however office based uroflow devices are limited by the variability of voiding behavior. Using a home uroflow device, we assessed individual voiding variability, temporal distribution of voiding parameters and the impact of age on voiding. MATERIALS AND METHODS Between April 2019 and June 2020, 19,824 unique voiding profiles were captured using the Stream Dx Uroflowmeter and retrospectively analyzed. Age and number of voids were summarized by mean±standard deviation. We used mixed effects models to compare average values and intrapatient variability of voiding parameters to time of day and age. The coefficient of variation was used to assess intrapatient variability. RESULTS A total of 637 patients were identified with 625 meeting inclusion criteria, producing 19,824 voids. Mean age was 67 (±10.2) years old, and each patient provided on average 5 (±3.3) voids a day through 7 days. Average intrapatient voiding parameters showed notable variability, where the coefficient of variation for maximum flow was 27.6% (95% CI 26.6-28.6). Early morning voids were associated with higher volume and lower number of voids. As age progressed, voiding profiles worsened in a linear fashion. Afternoon and evening voids were associated with reduced intrapatient variability relative to early morning voids. CONCLUSIONS Assessment of 19,824 uroflows using an accurate and precise home uroflow device demonstrates that an individual's voiding parameters vary greatly from day to day, throughout the day, and worsen with age. Multiple measurements performed at home provides a more realistic assessment of true voiding behavior by capturing individual voiding variability and can help urologists make better decisions in patient care.
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Matsumoto S, Kasamo S, Horie S. Voiding time as a predictor for urinary tract function and health status. Geriatr Gerontol Int 2020; 20:670-673. [PMID: 32400935 DOI: 10.1111/ggi.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
Abstract
AIM In this study, we investigated self-measured voiding time in the Japanese population. METHODS A survey questionnaire was used to determine self-measured voiding time in Japanese participants aged ≥20 years. In addition to demographic data such as age and sex, relevant medical conditions, including hypertension, diabetes mellitus, renal impairment and other disorders, were also recorded. Voiding time was measured whenever the participant had the urge to void. RESULTS In total, 2493 healthy individuals (1347 men, mean ± SD, age 60.50 ± 12.16 years, and 1146 women, 51.16 ± 12.97 years) participated in the survey. Self-measured voiding time was 27.71 ± 20.25 s for men, and 17.49 ± 11.87 s for women. Additionally, 1227 participants with certain diseases were included (1026 men, aged 67.12 ± 9.93 years, and 201 women, 60.26 ± 11.02 years). In this group, self-measured voiding time was significantly longer at P < 0.01 (30.71 ± 20.98 s in men, 21.28 ± 15.56 s in women). In men whose international prostate symptom score (IPSS) was >7, voiding time was significantly longer (healthy men: IPSS ≤7 n = 868, 23.9 ± 14.88 s, IPSS ≥8 n = 479, 34.6 ± 26.05 s, P < 0.05, men with comorbidities: IPSS ≤7: n = 504, 25.64 ± 15.63 s, IPSS ≥8: n = 522, 35.6 ± 24.11 s, P < 0.05). CONCLUSIONS This self-reported internet survey revealed that self-measured voiding time was longer in men than women regardless of age, and was significantly prolonged with age regardless of sex. Furthermore, self-measured voiding time could be a good screening tool to predict urinary function and health status. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Seiji Matsumoto
- Center for Advanced Research and Education, Asahikawa Medical University, Asahikawa, Japan.,Clinical Research Support Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Sachiko Kasamo
- Clinical Research Support Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Miyazato M, Yonemoto K, Ashikari A, Saito S, Yamashiro K, Uehara M, Masuzaki H, Ishida H, Matsushita M. Validation of a novel digital health monitoring system to measure the volume of voided urine. Neurourol Urodyn 2019; 38:1106-1110. [PMID: 30848839 DOI: 10.1002/nau.23965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/19/2019] [Accepted: 02/14/2019] [Indexed: 11/08/2022]
Abstract
AIM To validate a novel digital health monitoring system to measure the volume of voided urine. METHODS Micturition volume was calculated using our novel digital self-health monitoring system of urine excretion (s-HMSU) in 18 participants (16 women and 2 men; average age, 40.8 years), without a history of voiding symptoms. Participants completed a self-reported questionnaire regarding their medical history and water intake during the period of observation, as well as the Core Lower Urinary Tract Symptom Score (CLSS) questionnaire. To assess the reliability of the voided volumes measured using the s-HMSU, the intraclass correlation coefficient (ICC) was calculated between the volume and the change in body weight before and after micturition. RESULTS The CLSS questionnaire confirmed the absence of urinary system diseases in all participants. The medical history was also negative with the exception of hypertension in one participant. The ICC (1,1) between the measured volume of urine excretion using the s-HMSU and the change in body weight was 0.972 (95% confidence interval, 0.957-0.982). CONCLUSIONS The s-HMSU system provides a reliable measure of voiding volume and is appropriate for home use. It has the potential to facilitate large-scale clinical research to examine the relationship between medical diseases and voiding dysfunction.
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Affiliation(s)
- Minoru Miyazato
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Koji Yonemoto
- Advanced Medical Research Center, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.,Division of Biostatistics, School of Health Sciences, Okinawa, Japan
| | - Asuka Ashikari
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kiyoto Yamashiro
- Kumejima Public Hospital, Okinawa, Japan.,Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Okinawa, Japan
| | - Moriyuki Uehara
- Kumejima Public Hospital, Okinawa, Japan.,Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Okinawa, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Okinawa, Japan
| | - Hajime Ishida
- Department of Human Biology and Anatomy, University of the Ryukyus, Okinawa, Japan
| | - Masayuki Matsushita
- Department of Molecular and Cellular Physiology, University of the Ryukyus, Okinawa, Japan
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Gärtner M, Krhut J, Hurtik P, Burda M, Zvarova K, Zvara P. Evaluation of Voiding Parameters in Healthy Women Using Sound Analysis. Low Urin Tract Symptoms 2016; 10:12-16. [PMID: 27291645 DOI: 10.1111/luts.12134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Sonouroflowmetry represents a novel method for estimating urinary flow parameters. The aim of this study was to compare the urinary flow parameters acquired using sonouroflowmetry with those of standard uroflowmetry in healthy female volunteers. METHODS Thirty-six healthy female volunteers (aged 25-54 years) were subjected to standard uroflowmetry. Simultaneously, subjects dialed a dedicated number on a mobile phone and kept recording until urination was finished. Sound data were analyzed and compared to the uroflowmetry data. Of 218 recordings, 183 were included in the final analysis. Thirty-four measurements were excluded for voided volume <150 mL or technical problems during the recording. A linear model was fitted to calculate the urinary flow parameters and the voided volume from data obtained by sonouroflowmetry. Subsequently the matching datasets of UF and SUF were compared with respect to flow time, voided volume, maximum (Qmax ) and average (Qave ) flow rate. Pearson's correlation coefficient (PCC) was used to compare parameters recorded by uroflowmetry with those calculated based on sonouroflowmetry recordings. RESULTS A strong correlation (PCC = 0.95) was noted between uroflowmetry recorded flow time and duration of the sonouroflowmetry sound signal. The voided volume measured by uroflowmetry showed a moderate correlation (PCC = 0.68) with the calculated area under the sonouroflowmetry curve. Qmax recorded using uroflowmetry and sonouroflowmetry recorded peak sound intensity showed a weak correlation (PCC = 0.38). CONCLUSIONS This study validates the basic concept of using sound analysis to estimate urinary flow parameters and voided volume.
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Affiliation(s)
- Marcel Gärtner
- Department of Obstetrics and Gynecology, University Hospital, Ostrava, Czech Republic
| | - Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic.,Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Petr Hurtik
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava, Czech Republic
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava, Czech Republic
| | - Katarina Zvarova
- Department of Physiology, Slovak Medical University, Bratislava, Slovak Republic
| | - Peter Zvara
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.,Department of Surgery, University of Vermont, Burlington, Vermont, USA
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19
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Krhut J, Gärtner M, Sýkora R, Hurtík P, Burda M, Luňáček L, Zvarová K, Zvara P. Comparison between uroflowmetry and sonouroflowmetry in recording of urinary flow in healthy men. Int J Urol 2015; 22:761-5. [PMID: 25988672 DOI: 10.1111/iju.12796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 03/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the accuracy of sonouroflowmetry in recording urinary flow parameters and voided volume. METHODS A total of 25 healthy male volunteers (age 18-63 years) were included in the study. All participants were asked to carry out uroflowmetry synchronous with recording of the sound generated by the urine stream hitting the water level in the urine collection receptacle, using a dedicated cell phone. From 188 recordings, 34 were excluded, because of voided volume <150 mL or technical problems during recording. Sonouroflowmetry recording was visualized in a form of a trace, representing sound intensity over time. Subsequently, the matching datasets of uroflowmetry and sonouroflowmetry were compared with respect to flow time, voided volume, maximum flow rate and average flow rate. Pearson's correlation coefficient was used to compare parameters recorded by uroflowmetry with those calculated based on sonouroflowmetry recordings. RESULTS The flow pattern recorded by sonouroflowmetry showed a good correlation with the uroflowmetry trace. A strong correlation (Pearson's correlation coefficient 0.87) was documented between uroflowmetry-recorded flow time and duration of the sound signal recorded with sonouroflowmetry. A moderate correlation was observed in voided volume (Pearson's correlation coefficient 0.68) and average flow rate (Pearson's correlation coefficient 0.57). A weak correlation (Pearson's correlation coefficient 0.38) between maximum flow rate recorded using uroflowmetry and sonouroflowmetry-recorded peak sound intensity was documented. CONCLUSIONS The present study shows that the basic concept utilizing sound analysis for estimation of urinary flow parameters and voided volume is valid. However, further development of this technology and standardization of recording algorithm are required.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic.,Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Marcel Gärtner
- Department of Obstetrics and Gynecology, University Hospital, Ostrava, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Petr Hurtík
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, Ostrava University, Ostrava, Czech Republic
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, Ostrava University, Ostrava, Czech Republic
| | - Libor Luňáček
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Katarína Zvarová
- Department of Physiology, Slovak Medical University, Bratislava, Slovakia
| | - Peter Zvara
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.,Department of Surgery, University of Vermont, Burlington, Vermont, USA
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Veeratterapillay R, Pickard RS, Harding C. The role of uroflowmetry in the assessment and management of men with lower urinary tract symptoms – revisiting the evidence. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813498874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uroflowmetry is variably used for the assessment of men with lower urinary tract symptoms (LUTS). There is discrepancy in practice guidelines regarding recommendations for use of uroflowmetry in the initial assessment of men with LUTS. To explain this discrepancy, we systematically reviewed relevant literature to detail currently available evidence and identify evidence gaps requiring further research. PubMED, EMBASE and Medline literature databases were searched for the period between January 1970 and July 2012 to identify articles pertaining to uroflowmetry and outcomes of treatment for men with LUTS. We identified 30 studies for inclusion – none of which had a randomised design. The majority of the studies were prospective or retrospective cohort studies with some cross-sectional and observational reports. The methodology of measurement and reporting urine flow rate has been standardised by reports from the International Continence Society. The current available literature on the reproducibility of urine flow rate is inconclusive and suggests that there may be variability between measurements for a number of different reasons and that repeated tests could be of value clinically. There is also general agreement that a Qmax cut-off of 10 ml/s−1 is suggestive of bladder outlet obstruction. Despite guideline recommendations, there remains a lack of high-quality evidence from studies with robust design to fully ascertain the clinical utility of uroflowmetry and its place in the care pathway for men with LUTS. Future well-designed studies should focus on this evidence gap.
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Affiliation(s)
- R Veeratterapillay
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, UK
| | - RS Pickard
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, UK
| | - C Harding
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, UK
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21
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Bray A, Griffiths C, Drinnan M, Pickard R. Methods and value of home uroflowmetry in the assessment of men with lower urinary tract symptoms: A literature review. Neurourol Urodyn 2011; 31:7-12. [PMID: 22038511 DOI: 10.1002/nau.21197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/30/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Bray
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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22
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Effects of electroacupuncture on benign prostate hyperplasia patients with lower urinary tract symptoms: a single-blinded, randomized controlled trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:303198. [PMID: 21584227 PMCID: PMC3092516 DOI: 10.1155/2011/303198] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/05/2011] [Accepted: 01/20/2011] [Indexed: 11/18/2022]
Abstract
We tested the effect of electroacupuncture (EA) on lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) patients. A total of 42 BPH patients with LUTS were randomly assigned to either the EA group (EG), received 2 Hz EA for 20 min twice/week for a total of twelve treatments, or a sham EA group (CG), received sham EA. The increase of voiding volume, average flow rate, and maximal flow rate in the EG were 32.2 ± 104.4 mL, 1.2 ± 1.6 mL/sec, and 2.3 ± 3.7 mL/sec, respectively, from baseline value (before EA) using the measurement of an uroflowmetry. These increases were greater than -37.9 ± 120.4, -0.22 ± 2.7, and -0.3 ± 4.3, respectively, in the CG (P = .038, .026, and .030, resp.). The changes of prostate special antigen and international prostatic symptom score were not significantly different between two groups (P = .573, .175, resp.), suggesting the clinical improvement of 2 Hz EA was quite limited to the LUTS of patients with BPH.
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McClurg D, Ashe RG, Lowe-Strong AS. Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis— A double blind, placebo controlled, randomised clinical trial. Neurourol Urodyn 2008; 27:231-7. [PMID: 17705160 DOI: 10.1002/nau.20486] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Lower urinary tract dysfunction affects up to 75% of the multiple sclerosis population. Results from our recent Pilot Study (McClurg et al., 2006) indicated that a combined programme of pelvic floor muscle training, electromyography biofeedback and neuromuscular electrical stimulation modalities may alleviate some of the distressing symptoms within this population. This clinical trial aimed to evaluate further the efficacy of these interventions and to establish the benefit of neuromuscular electrical stimulation above and beyond that of EMG biofeedback and pelvic floor muscle training. METHODS 74 multiple sclerosis patients who presented with lower urinary tract dysfunction were randomly allocated to one of two groups - Group 1 received Pelvic Floor Muscle Training, Electromyography Biofeedback and Placebo Neuromuscular Electrical Stimulation (n=37), and Group 2 which received Pelvic Floor Muscle Training, Electromyography Biofeedback, and Active Neuromuscular Electrical Stimulation (n=37). Treatment was for nine weeks with outcome measures recorded at weeks 0, 9, 16 and 24. The Primary Outcome Measure was the number of leakage episodes. Within group analysis was by Paired Samples t-test. Group differences were analysed using Repeated Measures Analysis of Variance and Post-hoc tests were used to determine the significance of differences between Groups at each time point. RESULTS The mean number of incontinence episodes were reduced in Group 2 by 85% (p=0.001) whereas in Group 1 a lesser reduction of 47% (p=0.001) was observed. However, there was a statistically superior benefit in Group 2 when compared to Group 1 (p=0.0028). This superior benefit was evident in all other outcome measures. CONCLUSIONS The addition of Active Neuromuscular Electrical Stimulation to a programme of Pelvic Floor Muscle Training and Electromyography Biofeedback should be considered as a first-line option in alleviating some of the symptoms of lower urinary tract dysfunction associated with multiple sclerosis.
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Affiliation(s)
- D McClurg
- Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland, UK.
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Caffarel J, Robson W, Pickard R, Griffiths C, Drinnan M. Flow measurements: can several "wrongs" make a "right"? Neurourol Urodyn 2007; 26:474-480. [PMID: 17245778 DOI: 10.1002/nau.20383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Although measurement of maximum flow rate (Qmax) is a standard and straightforward test, it is often difficult to obtain reliable readings. We obtained multiple measurements using a simple home uroflow device which categorizes Qmax into ranges. We hypothesize that the average of a series of relatively coarse measurements of Qmax would be more repeatable and therefore more representative of an individual's voiding function than a single, albeit more precise measurement. METHODS We studied 22 male volunteers with a wide range of Qmax. They were asked to record flow category (<10 ml/sec; 10-15 ml/sec; 15-20 ml/sec; >20 ml/sec) and voided volume twice daily for 12 days using the home flow device. In addition, a clinic-based flow recording using a spinning-disc uroflowmeter was obtained at both the start and the end of the 12-day period. RESULTS Good agreement between mean home flow and mean clinic flow was seen with mean (SD) difference of 1.3 (5) ml/sec. The mean for consecutive halves of an individual's home flow data showed excellent agreement (-0.2 (1.3) ml/sec). The two clinic readings showed poorer agreement (2.3 (6.8) ml/sec) than the home readings, and poorer agreement even than between clinic and home flows. CONCLUSIONS Although simple in design, the home flowmeter actually shows greater accuracy than might be expected when used repeatedly to study the flow rates of men. Simple flow devices such as this could be used in conjunction with voiding diaries to give a more representative picture of patients' day-to-day voiding function.
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Affiliation(s)
- Jennifer Caffarel
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- School of Clinical and Laboratory Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Wendy Robson
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Robert Pickard
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Clive Griffiths
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Michael Drinnan
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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