Dr. Borofsky began by defining a scope of mobile health encompassing technology including devices, sensors, apps and wearables. He highlighted that urology is currently very early in the uptake of these technologies and approaches. However, telemedicine has existed long prior to the current impetus for this approach as a result of the COVID-19 pandemic.
Dr. Borofsky highlighted recent guidelines from the European Association of Urology (EAU) emphasizing that physicians should keep up to date with evolving and innovation strategies and platform; be familiar with the variety of options for telehealth and teleconferencing; remain scientifically up to date utilizing virtual conferences, webinars, and other venues; and arrange updates and scientific meetings via videoconferencing. A recently published systematic review highlighted 45 studies including 12 randomized controlled trials assessing the role of telehealth in urology, encompassing a range of urologic conditions.
In addition to the utilization of telehealth interactions, there has been a rise in mobile health applications, with many urology-specific apps available. He highlighted examples including Stone MD which allows patients to track fluid intake, dietary intake, and urinary pH. He also emphasized that the EAU app provides useful patient counseling including surgical guidance. He also gave the example of a “smart water bottle” which is able to track a patient’s fluid intake remotely. This can allow for longitudinal assessment and provide long-term data monitoring. For patients with benign prostatic hypertrophy (BPH), Dr. Borofsky highlighted an app called My UroFlow which detects urinary flow rate on the basis of audible clues during voiding and the potential for digital urinalysis in which urine strips are scanned by a smartphone application. Perhaps more interestingly, he suggested that in the near future, microfluidic smartphone quantification may allow the remote diagnosis of urinary tract infection. Already, there are available home semen analysis platforms that can accurately measure sperm concentration and motility using a smartphone and special microscope attachment. He further highlighted the potential for “smart toilet” which could capture a variety of parameters.
An interesting development for urologists’ practice structure is the potential for tele-cystoscopy, an approach which was published recently in the Journal of Urology. In this model, the cystoscopy is performed in person by an advanced practice provider while a urologist interprets the images remotely but in real-time. This was reported to have somewhat worse image quality but an equivocal change in the ability to identify abnormalities.
Dr. Borofsky concluded that mobile health is evolving rapidly and has been expedited by the COVID-19 pandemic. However, despite the enthusiasm, data are often lacking.
Presented by: Michael Borofsky, MD, Assistant Professor, Associate Residency Program Director, Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
Written by: Christopher J.D. Wallis, MD, PhD, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, Tennessee, Twitter: @WallisCJD at the 2020 Société Internationale d'Urologie Virtual Congress (#SIU2020), October 10th - October 11th, 2020