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There was a lot of pee on the CES 2023 show floor

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A swallow doesn’t make a summer, and I don’t know if you can count four examples of a product as a trend, but it’s certainly an interesting thread at this year’s CES. At this year’s show, a quarter of companies are showcasing urinalysis tools designed for home use by the general public. These are positioned as a natural evolution of the fitness tracker, a device you can use to keep an even closer eye on your health and fitness. Most of them are designed for your toilet, testing your pee for a number of easily identified diseases. But is this the next big frontier in consumer health tracking? Rather, it depends on the audience’s desire to delve deep into their own bladder.

My cynical take: I suspect the reason we’re seeing these pop-ups is because the world of wearables is now played out. in 2019, I wrote that we had reached the point where there were no more new features that could be installed on a smartwatch, fitness tracker or ring. Or, at least, none were as valid, efficient, or accurate as what you now expect from every device on the market. Once it was possible to fit a single lead ECG into a watch, there were no new health tracking worlds to conquer that didn’t involve breaking skin.

Dr. Audrey Bowden is Dorothy J. Wingfield Philips Chancellor Faculty Fellow, Associate Professor of Biomedical Engineering at Vanderbilt University and Director of the Bowden Biomedical Optics Laboratory. Dr. Bowden tells Engadget that clinical urinalysis is used as a “first-line screening for many diseases and conditions such as diabetes and kidney disease”, but added that it can “also play a role in ordinary routine examinations, such as during pregnancy”.

You may have seen your doctor ask you for a urine sample and then stir a gauge dotted with colored squares of test paper in the liquid you just produced. In addition to visually checking for cloudy urine (an obvious sign of trouble), these squares can perform a wide variety of tests as part of this front-line screening process.

Each square corresponds to a different test, looking for factors like pH as well as the presence of blood or white blood cells. Blood, for example, can indicate kidney stones or cancer, while white blood cells are a clue that your body is fighting an infection. If there is excess glucose in the urine, it is likely that diabetes is the cause. Ketones would indicate ketosis, nitrites could indicate bacteria in the urinary tract, etc.

Dr. Bowden added that for many conditions, urinalysis is not a “definitive diagnosis, but rather serves as an initial prompt to perform a more thorough investigation.” And that since the clinical procedure is to test urine when there is already evidence of a problem, it is unclear how effective daily testing can be.

A medical professional I interviewed, who requested anonymity for fear of compromising his professional status, expressed skepticism about both the accuracy of these tests and their usefulness. They said that if people took home tests regularly, it might provide hypochondriacs with another reason to clog up healthcare centres.

Dr. Shubha K. De (MD) is a Urological Surgeon who is currently working on a PhD in Biomedical Engineering. He expressed concern that, in primary care settings, medical staff know how to validate the data presented to them and weed out false positives. This may not be the case at home, and added that the accuracy of some tests varies wildly – a dipstick test for identifying a bladder infection is around 80% accurate, but for diagnosing bladder cancer bladder, it drops to just 3 percent.

Perhaps the most talked about gadget at CES is Withings U-Scanwhich even Jimmy Kimmel joked about in his opening monologue Thursday. Given that Withings is already such a big name in the world of health tracking, it’s no surprise that it’s caught the eye. The company introduced a device that sits on the dry end of your toilet bowl and takes a portion of your net as you urinate. Once this fluid is captured inside the device, it runs a sample through a microfluidic cartridge (with reaction paper) and uses a reader to examine the result. Once complete, the results are sent to your phone, along with suggestions on what you could do to improve your health.

When it is finally released, U-Scan will offer a cartridge for tracking the menstrual cycle, as well as another to monitor your hydration and nutrition levels. It was this last cartridge that I tried while in Vegas this week, and it looked at the pH of my urine as well as the specific gravity (relative density) of my pee. But the company promises that it will eventually be able to identify nutrient levels, fat metabolism, ketones and vitamin C amounts.

These two elements have raised red flags with professionals who fear that these analyzes do not fit a single model. Dr. Bowden said menstrual cycle tracking based on “‘normalization’ curves may have been developed with too narrow a demographic to capture all interested users.”

Dr. Bowden was also reluctant that nutritional information could be extracted since clinical urinalysis does not provide data on these markers. She said urine samples don’t “really provide reliable information over a given window of time”, and added that a “daily analysis of the nutritional content of foods may be overkill”. Although she said it may be possible to detect “accumulated nutritional deficiencies”.

Dr. De, however, says it may be possible to extrapolate nutritional information to a person’s diet using urinalysis. They said doctors currently have patients collect urine around the clock, and the fluid is then examined for specific substances – like uric acid – to make inferences about food intake. . “It’s not always perfect and currently requires some correlation to his eating history,” but added that it’s plausible to imagine that with a “user-friendly app and some AI” it could well function.

Withings is looking to develop more clinical tests and said it is already working on a way to screen for bladder cancer markers. This is where my source who asked not to be named thinks it would provide real value to groups at risk of contracting the disease. They said a targeted surveillance program could help identify cancer cases at an early stage, which should significantly increase survival rates.

Image of the Yellosis Cym Seat urinalysis device.

Daniel Cooper

Korean company Yellosis graduated from Samsung’s startup incubator a few years ago and is already producing the Cym Boat personal urine test kit. Cym Boat offers a small stick with reaction paper squares, which you then place inside a boat-shaped piece of cardboard lined with colored calibration squares. Take a photo on your smartphone and you can observe blood, protein, ketones, pH and glucose levels in your urine.

At the show, it also showcased its next-generation product, Cym Seat, which uses a metal arm to hold a stick of paper under a person while they pee. When done, he slides the strip past an optical scanner, and after a minute the results are pushed to your phone. But this device, which is expected to launch by the end of 2023 and cost around $1,000, automates the existing process rather than adding anything new.

Image of Vivoo's toilet-mounted urinalysis device.

Daniel Cooper

similar, Vivoo, which also features a reaction – a paper stick that can be analyzed by a smartphone app, builds its own toilet-mounted hardware, which pushes a pee stick into the toilet bowl, then pulls it out once it collected a urine sample. An optical scanner then reads the reaction squares before depositing the stick in a collection bin for later disposal.

Image of Olive's urinalysis toilet

Daniel Cooper

Complete the group is olive, which takes a radically different path. The device harnesses spectroscopy rather than reaction paper, with hardware that sits under your toilet seat and a bank of LEDs flashing to rear-mounted photodiodes. The potential of such technology is far greater than that of test paper, and there are studies who reported being able to identify the infection with it.

Olive is currently used in many places in the Netherlands, including an assisted living facility. Co-founder Corey Katz told Engadget that one of the most surprising uses of the technology was for staff to keep accurate records of patients’ bathroom visits. Katz added that work is currently underway to find a way to measure protein levels in urine to identify cases of preeclampsia.

The company says there are a large number of conditions that spectroscopy could be used to test for. This includes hydration and ketosis through to stress, creatinine levels, and electrolyte balances. The hope is that a final version of the hardware will be ready to go by the end of 2023, although it will only be sold to business customers.

There are issues, especially around data security, especially for menstrual cycle tracking in countries like the United States. Companies that may expose fertility data will need to be aware of the legal context currently in place following theDeer.

If Dr. De has one final concern, it’s the concern that these home devices encourage patients to take charge of medical affairs without the supervision of a doctor. “Whether [urine analysis systems] directing you to take supplements that compromise pre-existing medical conditions,” for example, “then that could be quite dangerous.”

Of course, there are other things independent experts (and journalists) will need to test when these devices hit the real world. Dr. Bowden expressed concern that urinalysis tests can be “affected by a number of external factors”, which clinical settings strive to control. Will these devices be accurate enough for the jobs they were purchased for? And will the conclusions they provide be valid? There’s a lot to be done before these products become ubiquitous in bathrooms around the world.

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