A Practical Phenotyping Framework for Male Lower Urinary Tract Symptoms Using Remote Multi-day Urinary Diagnostics.

OBJECTIVE

To describe the distribution of predefined Index Symptoms and Diagnostic Profiles in a cohort of men undergoing Remote multi-day urinary diagnostics (RMUD) for lower urinary tract symptoms (LUTS).

METHODS

We retrospectively analyzed 1047 RMUD performed with CarePath in men referred for LUTS across 18 sites. RMUD combined multi-day frequency-volume and uroflowmetry data with the IPSS. Six Index Symptoms were operationalized as follows: (1) low flow with elevated IPSS (device trial criteria), (2) overactivity, (3) primary overactivity (overactivity without obstructive RMUD findings), (4) nocturia, (5) nocturnal polyuria (NP) using the ICS NP index, and 6) no qualifying voids. Combinations of the Index Symptoms were used to define non-overlapping Diagnostic Profiles.

RESULTS

Median age was 70 years and median IPSS was 14. Patients produced a median of 15 voids across a 2-day study and 92.8% produced at least 1 qualifying void ≥150mL. Obstructive criteria were met in 37.6% of men, while 33.5% demonstrated overactivity and 13.9% had primary/idiopathic overactivity without RMUD evidence of obstruction. Nocturia >2 per night occurred in 67.3%, and NP in 46.8% of patients. Across the cohort, the 6 Index Symptoms combined into 21 discrete, non-overlapping Diagnostic Profiles, most of which reflected mixed storage-voiding-NP phenotypes rather than isolated obstruction.

CONCLUSION

RMUD-enabled phenotyping with Index Symptoms reveals substantial heterogeneity among men with LUTS and identifies patterns of obstruction, overactivity, and NP. This LUTS phenotyping framework supports more precise counseling, treatment selection, and identification of patients who warrant further evaluation.