Male Voiding Behavior: Insight from 19,824 At-Home Uroflow Profiles

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.

Keywords: prostate; prostatic hyperplasia.

Figure 1.

Sample patient tracing for 28 voiding profiles over 7-day period showing significant variability with each void. The dotted line shows the mathematical average of all voiding curves.

Figure 2.

Intra-patient variability as measured by the RSE_pd for voiding parameters stratified by time of day. RSE_pd was calculated for each patient for each study day and time period and plotted by study day. Error bars indicate standard errors at each time point. Time of day had the greatest impact on maximum volume, where the >2pm-10pm time period exhibited reduced intra-patient variability relative to the other time periods.