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Mobile phone applications in management of enuresis: The good, the bad, and the unreliable!

Michael Myint, Ahmed Adam, Sampath Herath, Grahame Smith

Journal of Pediatric Urology, Volume 12, Issue 2, April 2016, Pages 112.e1-112.e6

Commented by Guy Bogaert

There is an app for almost everything today, so there should be probably some for nocturnal enuresis as well.  Smith et al have investigated several app stores and investigated “some good, some bad and lots of unreliable” as they state in their title. They have found (in 2014) 1041 apps when searching for the following search terms “bladder, bedwetting, bladder diary, enuresis, incontinence, wetting”.  However, only apps with a bladder diary function, follow-up and treatment options were included.  Only 24/1041 fulfilled these criteria.  These apps were further evaluated by the design, the usability, language, instructions, history, security, the use of ICCS definitions, bowel habits, possibility of transferring data and printing.  Only three were withhold: “My Dryness Tracker”, “Bedwetting Tracker” and “HapPee”.  The authors have focused on an important issue in the modern IT technology as medical information, also for bladder diary apps can eliminate the compliance problems of written diaries in the management of nocturnal enuresis.  However, it is important that medical associations should collaborate with app developers to improve the quality in several aspects.  

Abstract

INTRODUCTION:

The proliferation of medical-type applications or 'apps' on smartphones is a typical example of the impact technology has had on medical practice. Maintaining a bladder diary is a recommended part of evaluating the effect of interventions for patients suffering from enuresis. Traditional pen-and-paper bladder diaries have poor completion rates, inconsistent patterns in data entry, and are deficient in validation. Electronic bladder diaries have been proposed to overcome these obstacles. With increasing numbers of smartphone apps available to the general public, it is important to distinguish well-designed apps for childhood enuresis.

PURPOSE:

To identify, evaluate, and rank all available mobile-phone apps for the management of childhood enuresis.

METHODS:

On August 21, 2014, a search was conducted on iTunes, Android Play Store, and BlackBerry World for smartphone apps using the following search terms: bladder, bedwetting, bladder diary, enuresis, incontinence, and wetting. Apps that did not have a bladder diary function and that were unrelated to the investigation, follow-up, and treatment of childhood enuresis were excluded. Apps were rated by a paediatric urology consultant, fellow, registrar, and resident medical officer using standardised criteria including: design; ease of use; languages; quality of instructions; security; accordance with ICCS definition of enuresis; and ability to store histories; record bowel habits; transfer data to other devices; and print data.

RESULTS:

Across all three search platforms, a total of 1041 apps were identified. Only 24 were included and reviewed based on exclusion criteria. Average ratings for apps ranged from 10 to 30.75 out of 50 based on standardised criteria.

DISCUSSION:

Smartphone apps are playing an increasingly significant role in the management of enuresis in place of pen-and-paper bladder diaries. Apps available to the general public vary in quality and it can be difficult for patients to identify one appropriate for use. We found apps with higher ratings consistently had engaging interfaces, were easy to use, and defined the primary purpose clearly. Lower ratings and performance often was caused by poor quality of experience through "freezing"/"crashing."

CONCLUSION:

Bladder diary apps can eliminate disadvantages of pen-and-paper diaries in the management of enuresis. Currently, apps available vary in quality. The three best-rated apps currently available are My Dryness Tracker, Bedwetting Tracker, and HapPee Time. There is room for medical associations to collaborate with developers for further app development.

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

Download the CMT


Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.