The value of home urodiagnostics in the assessment of men with lower urinary tract symptoms

Abstract

A third of all men experience unpleasant lower urinary tract symptoms (LUTS) such as a poor stream and being unable to postpone urination, usually later in life. Two important investigations for these men are: a one-o clinic-based measurement of urine ow rate, and the patient's hand written record of volumes passed over the course of several days. Well acknowledged deficiencies in these tests have spurred research into home-based alternatives. `Home urodiagnostic' devices have been developed that obtain multiple measurements of flow rate and an electronic voiding diary. However, little conclusive evidence exists as to their clinical utility. The aim of this thesis is to investigate the value of home urodiagnostics in the assessment of men with LUTS. First, the improvement in clinical performance of an average rather than single flow rate measurement is calculated based upon the theory of combining variance, predicting benefit for thousands of men per year. Next, finding existing devices deficient, the characteristics and technical performance of a novel device are presented. Despite its low cost, it is found to meet the required standard. In a study of conventional versus home urodiagnostics in men with LUTS, the latter is better tolerated, less likely to fail and gave more reliable measurement of flow rate. A study in which home urodiagnostics was performed before and after prostate surgery reveals large variation in the response of flow rate to surgery. Subtle changes within an individual are demonstrable. Finally, home urodiagnostics is piloted within primary care, where the resulting data suggests benefit from a change in the management strategy of over a third of patients studied. In conclusion, home urodiagnostics shows promise for improving the assessment of men with LUTS. The next step is to evaluate the effect on patient reported outcomes in a large scale trial.