You have accessJournal of UrologyCME1 Apr 2023MP24-11 REAL-WORLD ASSESSMENT OF THE 2-SECOND RULE FOR QMAX MEASUREMENT DURING UROFLOWMETRY BASED ON PATIENT-GENERATED DATA USING AN AUDIO-BASED SMARTPHONE APPLICATION John Sung, Min Gyeong Kim, Catherine Song, Karen Doo, Kenneth Goldberg, Claus Roehrborn, and Ramy Goueli John SungJohn Sung More articles by this author , Min Gyeong KimMin Gyeong Kim More articles by this author , Catherine SongCatherine Song More articles by this author , Karen DooKaren Doo More articles by this author , Kenneth GoldbergKenneth Goldberg More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , and Ramy GoueliRamy Goueli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Maximum flow rate (Qmax) is a key measurement during uroflowmetry workup for lower urinary tract symptoms. However, it is well known that artifacts occurring during urination introduce errors in Qmax. The “2-second rule” is a method to correct artifact and measure the highest flow rate maintained for at least 2 seconds (Qmax_2 Sec). We attempt to analyze the impact of adjusted Qmax in patient diagnosis by comparing Qmax_2 Sec and conventional Qmax (Qmax_Con) based on a large set of data generated using an audio-based uroflowmetry smartphone application. METHODS: 510 men who visited the urology clinic at University of Texas Southwestern Medical Center between Aug 2020 and May 2022 downloaded the “proudP'' application on their smartphones. During urination, the patient places his phone 3 feet away from the toilet and urinates directly into the toilet. The device captures sound and generates a uroflowmetry flow curve and parameters including Qmax, using a proprietary algorithm. Qmax_2 Sec is computed from the flow curve in accordance with the definition of the 2-second rule. A total of 24,225 proudP results from 475 volunteers were analyzed after excluding 21 subjects with unknown birth dates, 1,869 inapplicable recordings, and 5,137 recordings with voided volume (VV) less than 150 mL. RESULTS: Among 24,225 proudP cases, 49.6% of cases demonstrated artifact (ΔQmax_Con-Qmax_2 Sec) greater than 1mL/sec. Most were in the range of Δ1.0-1.9 mL/s (41.2%) while 8.5% and 2.4% of cases showed artifact of >2 mL/s and >3 mL/s, respectively. Application of Qmax_2 Sec downgraded 18.8% of cases to a category worse than that determined by Qmax_Con, suggesting potential under-diagnosis of obstruction. While application of Qmax_Con identified 33.9% and 10.5% of potentially obstructed (10 mL/s-15 mL/s) or obstructed (<10 mL/s) cases, respectively, those increased to 37.2% and 15.5%, respectively, when Qmax_2 Sec was applied. CONCLUSIONS: An innovative audio-based uroflowmetry application is subject to similar artifacts as with in-office uroflowmeters. This leads to overestimation of Qmax and false increases in the mean/median which may impact clinical care. In the case of the application, the artifact can be electronically corrected applying the 2-second rule. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e322 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sung More articles by this author Min Gyeong Kim More articles by this author Catherine Song More articles by this author Karen Doo More articles by this author Kenneth Goldberg More articles by this author Claus Roehrborn More articles by this author Ramy Goueli More articles by this author Expand All Advertisement PDF downloadLoading ...