First-year Experience Of Managing Urology Patients With Home Uroflowmetry: a Descriptive Retrospective Analysis (Preprint)

Abstract

Lower Urinary Tract Symptoms (LUTS) affect a large number of people, including all genders and age groups. Evaluation of LUTS typically involves a bladder diary and uroflowmetry assessment. Conventional paper-based diaries often suffer from low patient compliance, while in-clinic uroflowmetry measurements face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations.

In this report, we present our first-year experience of managing urological patients using Minze Homeflow®, which combines home uroflowmetry and automated bladder diaries. Our objective was twofold: 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).

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, patient smartphone application, and cloud-based clinician portal. Descriptive statistics and Bland-Altman plots were utilized for data analysis.

The device was offered to 166 patients, including 91 paediatric and 75 adult patients. A total of 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 35.5% of pediatric patients and 44.0% of adult patients exhibited multiple types of flow curves in their homeflow registrations. Furthermore, homeflow offers the advantage of providing an individual's Q-max/V-void plot, as well as an average or median result. Our findings revealed that a considerable percentage of patients (29.0% for paediatric and 48.0% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy can be attributed to the unnatural bladder volumes often associated with hospiflow measurements, resulting in non-representative 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 (LoA) of 13.0 ml/s and a lower LoA of -19.2 ml/s, further supporting the non-equivalence between the methods. 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 post-operative and recurrent interventions.

Our first-year experience with Minze Homeflow® demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Hospiflow often failed to accurately represent natural voiding. In contrast, homeflow provided more reliable and comprehensive voiding data. These findings support the continued use of Minze Homeflow® in our clinic.