Bladder diary (BD) is a fundamental tool for LUTS evaluation. Two groups have produced studies validating existing bladder diaries [1,2]. Nevertheless, patients often misinterpret Patient Perception of Intensity of Urgency Scale (PPIUS) and the reason of leaking urine. With the intention to better communicate with the patient, we have designed icons to evoke bladder sensations. The goal of our study is to determine the capacity of each of the new designed icons to evoke the sensation of urgency, urgency incontinence (UI), stress incontinence (SI) and incontinence by unknown reason (IUR).

A professional designer depicted icons for urgency, UI, SI and IUR (Figure 1). We designed a new format for a validated BD (Figure 2) [1]. This new design avoided free text by the use of check boxes and icorporated the icons with a short evokative word beneath. 
Twenty two male and female patients with LUTS entered the study. 
A self-administered questionnaire was also given to check for icon adequacy.
We analyzed how many patients checked on each of the icons and whether or not they understood them.

-Nineteen out of the 22 patients completed the BD. 
-Sixteen patients filled up the questionnaire.
25% patients found it difficult to complete the BD.
-Seven patients found incontinence the most difficult part to fill in, 3 micturition desire and 1 micturition volume.
-Urgency icon: 13/16 (81.2%) understood it, 13 patients (81.2%) checked it, 11 of which (84.6%) interpreted it correctly. 
-UI icon: 11/16 (68.8%) understood it, 6 (37.5%) checked it and 5 of them (83.3%) interpreted it correctly.
-IUE icon: 13/16 (81.2%) understood it, 5 (31.2%) checked it and 4 of them (80%) interpreted it correctly. 
-IUR icon: 11/16 (68.8%) understood it, 7 (43.7%) checked it and 5 of them (71.4%) interpreted it correctly.

The icons designed to evoke LUTS could be interpreted correctly by most patients.
A lot of patients feels that there is no clear reason for urine leaks. This type of incontinence is not given as an option in current validated bladder diaries.

To our knowledge, these are the first icons that represent specific LUTS.

Jimenez-Cidre MA, Lopez-Fando L, Esteban-Fuertes M, Prieto-Chaparro L, Llorens-Martinez FJ, Salinas-Casado J, et al. The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women. Neurourology and urodynamics [Internet]. 2015 [cited 2016 Feb 11];34(2):128–132. Available from: http://onlinelibrary.wiley.com/doi/10.1002/nau.22530/full
Bright E, Cotterill N, Drake M, Abrams P. Developing and Validating the International Consultation on Incontinence Questionnaire Bladder Diary. European Urology [Internet]. 2014 [cited 2015 Jan 7];66(2):294–300. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0302283814001869