In the ever-evolving field of benign prostate hyperplasia management, minimally invasive treatment options have seen significant advancements over the recent decade. However, the diagnostic landscape has remained relatively stagnant with traditional urodynamics and office-based uroflowmetry. Despite the focus on treatment, the critical aspect of accurately diagnosing male lower urinary tract symptoms has not kept pace. Now, a surge of innovation in remote diagnostics is promising to improve accurate data collection and foster patient implication in the benign prostate hyperplasia journey.

Traditionally, uroflowmetry has been confined to office settings, often leading to significant intraindividual variability and questioning the validity of single office-based measurement plagued with inadequate urine volumes to give an accurate diagnosis. However, new uroflowmetry devices equipped to allow noninvasive methods to diagnose bladder outlet obstruction and the use of wireless communication are changing the game. The use of ambulatory urodynamics and noninvasive urodynamics improves the patient experience, and home-based devices allow for multiple measurements, thereby improving the reliability of repeated measurement for uroflowmetry.¹ The ability to perform repeated measurements in a patient’s natural environment reduces variability and enhances diagnostic accuracy. This shift toward home-based testing could potentially lead to better treatment outcomes by providing more reliable data for clinical decision-making.

The advent of sound-based mobile apps for uroflowmetry represents an exciting development. These apps, designed to measure urine flow using smartphone microphones, have demonstrated comparable findings to conventional uroflowmetry in clinical studies.¹ However, a quiet surrounding environment is crucial to exclude background noise and ensure test accuracy. Smartphone-based repeated uroflowmetry measurements have also shown promise in revealing archetypal voiding categories that correlate closely with the International Prostate Symptom Score,¹ providing a more nuanced understanding of a patient’s symptoms and aiding in more personalized treatment planning.

Several home-based uroflowmetry tests are already available. ProudP (Soundable Health Inc., San Jose, California) has a user-friendly interface, and the device analyzes “urine sounds” to generate uroflow parameters,¹ making it a popular choice among patients and clinicians. MenHealth is intended to monitor and track the urinary health of men. In a validation trial, 56% of users reported that they would test their uroflow every week or several times per week, and 77% reported that they would conduct self-testing once per month or more.¹

Sonouroflowmetry records urinary flow patterns by capturing the sound generated when the urine stream hits the water level in the toilet bowl and uses a web-based algorithm to store the sound file in a digital form on a secure website for subsequent analysis. This method adopts physical principles from technologies developed for estimating rainfall intensity or flow through hydroelectric turbines.¹ CarePath (I-O Urology, Knoxville, Tennessee) combines an at-home uroflow device with a digital health platform for patient navigation and education.

In-office testing has been improved with the use of the penile cuff test, UroCuff (SRS Medical North Billerica, Massachusetts), a noninvasive approach to uroflowmetry that was shown in a recent systematic review of the current literature assessing penile cuff tests in diagnosing bladder outlet obstruction to be sufficient for diagnosing bladder outlet obstruction.¹ Although the BrightUro (Irvine, California) Glean system is not commercially available, this system features a wireless, catheter-free approach for performing urodynamic evaluations. The small sensor, inserted into the bladder, records pressure data, which can be easily removed using the removal string. Data is available via an app for clinicians to analyze.

The field of urodynamic testing is undergoing a significant transformation. The integration of digital uroflowmetry devices and sound-based apps into clinical practice heralds a promising future for improving diagnostic accuracy and patient care. As these innovations gain traction, it is crucial for urologists to stay informed and adapt to new technologies, ensuring the best possible outcomes for their patients. Home-based apps provide extensive data points, helping to reduce the reliance on nondiagnostic flow tests conducted in clinical settings. This improvement enhances the detection of bladder health issues and enriches the patient experience by uncovering the underlying causes of lower urinary tract symptoms more effectively.

Improving diagnostic accuracy is expected to lead to earlier intervention coupled with improved patient compliance and outcomes. However, ongoing research is essential to fully understand the impact of these advanced diagnostics on treatment decisions and long-term patient health. As we continue to integrate these technologies, the ultimate goal remains clear: to offer more precise diagnoses and tailored treatments, thus enhancing the overall quality of urological care.