To evaluate voiding diary use in NPH patients undergoing tap testing.

Voiding diaries are commonly used in urology but are rarely applied for neurological disorders with features of urinary dysfunction. Normal Pressure Hydrocephalus (NPH) is a neurological disorder caused by the accumulation of cerebrospinal fluid (CSF) in the ventricles. Common symptoms include mental impairment, gait disturbance, and urinary incontinence. NPH patients often undergo a CSF tap test (TT) to assess candidacy for a CSF diversion surgical procedure. This project investigated the feasibility of voiding diary use by measuring diary completion and compliance amongst patients undergoing TT in UConn Health’s NPH Clinic. 

We retrospectively analyzed the charts of NPH patients who completed a TT and were offered a voiding diary between June 2020-Jan 2025. Diaries were classified as Complete (all 3 pre-TT and post-TT days recorded), Incomplete but Usable (≥1 day pre-TT and post-TT with frequency and/or urgency data), or Incomplete and Unusable. Feasibility was defined as >60% of diaries meeting “usable” criteria.

Of 57 patients, 26 were Complete (45.6%), 12 were Incomplete but Usable (21.1%), and 19 were Incomplete and Unusable (33.3%). Thus, 66.7% of diaries were usable and surpassed the feasibility threshold. Additionally, 37 or 65% of patients logged all 6 instructed days. Every patient completed at least 2 total recorded days, with the rest of the cohort mostly having between 3 to 5 days logged (17 out of 57 or 29.8%).

Voiding diary use was found to be feasible in this NPH cohort, with two thirds of patients providing “usable” diaries with strong compliance.

These results provoke further analysis into the precision of voiding diaries in detecting bladder changes in patients, not only post TT but also after CSF diversion surgeries. If validated, voiding diaries can offer a simple, patient-centered tool for assessing disease severity and progression.