Monitoring urinary flow patterns of our patients remain a paramount function of the urologist. Over the years, there have been many devices and techniques available in health care facilities and some are home-based. Recent interest in audio-based uroflowmetry applications(1,2,3) make telemedicine and smartphone technologies potential drivers for self-empowerment, improved access, homebased care and digital health. Between 15 June 2021 and February 18,2022, we evaluated the use of a publicly available e-uroflow App among residents of some  rural communities in our region  to determine if the participants are able to download the App, generate data and send to the urologist for review and treatment decisions

A prospective ‘mixed’ study with inclusion criteria: adults > 18 years; owns smartphone, internet access; referred with a urological condition.  Excluded were: no smart phone ownership, urinary retention, non-consenting.  Informed consent was in English/French.  Following a telemedicine assessment, a unique ID # was generated to enable participant download the App, use it on 4 consecutive days for all urination activities and send data (IPSS, Uroflow tracings) to the urologist. Follow up telemedicine visit/virtual care to review data and treatment options. Feedback by online survey followed. Data collection and analysis was by Excel spread sheet and descriptive statistics. Study was approved by the local Ethics Review Board. A government sponsored  telemedicine  network provided platform for virtual video visits.

Out of the 40 participants, 28 (70%) were men and 12 (30%) were women aged between 22 and 75, average 64 years.36/40 (90%), completed the trial. Urological conditions include BPH, prostate cancer, voiding dysfunction, OAB, hematuria, Stones, kidney cancer, bladder cancer. Most participants continued to use the App and send data after 4 days. The highest 60 average 12.9.  Most of  the participants found the App easy to use and generate data. It was easy, provided convenient, multiple urination data points at ‘homes’ comfort for individualized care.  Few had some technical issues that were resolved. There were no comparative studies with the conventional uro-flowmeters. Other limitations include small numbers and lack of participants who had no urinary voiding symptoms.

This study suggests that the use of sound waves through smartphone to monitor the urination activities of the participants  was possible. It provided the participants opportunity to document their urination at the 'call of nature' in the convenience of their homes .There was no anxiety usually encountered in the health care professional's office and/or the hospitals where uroflowmetry is usually performed.
As smartphones are ubiquitous and internet access is reaching more distant  and remote communities, sound based uroflowmetry is bound to provide  an alternate, convenient, easy ,cost-effective method in the management of individuals with urinary voiding disorders.
Individualized ,multi-point ,e-uroflow data generated  over a specified period could be transmitted electronically for review by the practitioner prior to a virtual or 'face-to-face ' visit
If this technique of uroflowmetry is better developed and validated, it is most likely to result in patient empowerment and may improve access and patient communication with care givers. We may learn more from multiple urination data  collected at the convenience and comfort of our patients compared with one single urination episode in the office ,most of the time with the participant under stress .Multi-centre trials are required to enhance this as a digital health strategy.
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Sound waves through the smartphone App, used in individuals, appear to be simple, convenient, generating a large amount of e-urination data potential for monitoring, therapeutic and surveillance purposes. A digital health strategy is here to be grown. Further multi-centre trials and comparative studies with the conventional devices are recommended

Lee Y.J et al A novel mobile acoustic uroflowmetry :Comparison with contemporary . J. Korean Continence Soc..https://doi.org/10.5213/inj.2040250.125(2021)
El Helou E et al Mobile sonouroflowmetry using voiding sound and volume Scientific Reports (2021) 11:11250 https://doi.org/10.1038/s41598-021-90659-9
Dawidek M.T. et al Clinical validation of an audio-based uroflowmetry application in adult males. Can Urol Assoc J. 2022 Mar;16(3):E -125 doi: 10.5489/cuaj.7362 ;16(