Prostate Symptom Score in Male Lower Urinary Tract Symptoms
Aims: To investigate the diagnostic value of the International Prostate Symptom Score (IPSS) voiding-to-storage subscore ratio (IPSS-V/S) in male lower urinary tract symptoms (LUTS).
Methods: A total of 253 men with LUTS were enrolled from January 2005 to July 2010. The voiding (IPSS-V) and storage IPSS (IPSS-S) subscores were recorded separately by the patients themselves. The IPSS-V/S was calculated and compared among various aetiologies based on videourodynamic studies. Receiver operating characteristics (ROC) curves were constructed for comparing the diagnostic value of various non-invasive methods for predicting failure to voiding and storage lower urinary tract dysfunction (LUTD).
Results: Patients with failure to voiding LUTD, including benign prostatic obstruction (n = 72), bladder neck dysfunction (n = 19), urethral stricture (n = 3) and poor relaxation of the urethral sphincter (n = 32), had mean IPSS-V/S scores > 1. In contrast, patients who were urodynamically normal (n = 2) or had failure to storage LUTD, including idiopathic detrusor overactivity (n = 84), increased bladder sensation (n = 37), and detrusor overactivity and impaired contractility (n = 4), had IPSS-V/S scores ≤ 1. When IPSS-V/S was used to differentiate male LUTS, failure to voiding LUTD was found in 81.2% of patients with IPSS scores > 1, while failure to storage LUTD was found in 75.7% of patients with IPSS-V/S ≤ 1. The area under ROC curve of IPSS-V/S was higher than for other non-invasive methods for predicting failure to voiding and storage LUTD.
Conclusion: Measuring IPSS subscores and calculating IPSS-V/S is a simple and useful method to differentiate failure to voiding and failure to storage LUTD in men with LUTS. IPSS-V/S may provide a guide for the initial treatment, especially for primary care physicians without access to urological studies.
The syndrome known as 'lower urinary tract symptoms' (LUTS) is a non-sex-specific and non-organ-specific symptom syndrome that includes storage, voiding and postmicturition symptoms. Although LUTS may have many causes, the symptoms caused by lower urinary tract dysfunction (LUTD) can be divided into 'failure to voiding LUTD' and 'failure to storage LUTD'. The most common initial treatments are the α-adrenoceptor antagonists and antimuscarinics, respectively. Traditionally, LUTS in men is usually attributed to benign prostatic hyperplasia (BPH) and is treated with α-adrenoceptor antagonists. However, some men who receive treatment for prostate conditions may have persistent storage symptoms.
The focus of male LUTS recently has shifted from the prostate to the bladder as the source of LUTS and also as a therapeutic target (). However, some physicians may be concerned that the inhibitory effect of antimuscarinics could aggravate voiding difficulties or cause urinary retention and, in most reports, antimuscarinics are usually reserved for second-line treatment. In addition, it is difficult to distinguish the causes of male LUTS merely based on clinical symptoms. Detailed urological investigation is mandatory for an exact diagnosis of LUTD. Therefore, choosing the medication that should be used first for men with LUTS seems to be a challenge for many primary care physicians (PCPs), especially for non-urologists without urological diagnostic equipment for uroflowmetry, bladder scanning, or transrectal ultrasound.
The International Prostate Symptom Score (IPSS) questionnaire has been used for decades to evaluate the severity of LUTS/BPH and also has been applied to conditions other than BPH that cause LUTS. The IPSS consists of a total of seven questions that deal with voiding symptoms (incomplete empty, intermittency, weak stream and straining to void) and storage symptoms (frequency, urgency and nocturia). Patients with predominant voiding LUTD may have a greater voiding subscore (IPSS-V), and those with predominant storage LUTD may have a greater storage subscore (IPSS-S). Although IPSS total score (IPSS-T) cannot differentiate voiding vs. storage LUTD, the ratio of IPSS subscores might be able to achieve this goal. In this study, we sought to investigate if the ratio of IPSS-V to IPSS-S (IPSS-V/S) could help to differentiate male LUTD and provide a guide for the initial treatment. To our knowledge, this is the first study to evaluate the role of IPSS-V/S in male LUTS.
Abstract and Introduction
Abstract
Aims: To investigate the diagnostic value of the International Prostate Symptom Score (IPSS) voiding-to-storage subscore ratio (IPSS-V/S) in male lower urinary tract symptoms (LUTS).
Methods: A total of 253 men with LUTS were enrolled from January 2005 to July 2010. The voiding (IPSS-V) and storage IPSS (IPSS-S) subscores were recorded separately by the patients themselves. The IPSS-V/S was calculated and compared among various aetiologies based on videourodynamic studies. Receiver operating characteristics (ROC) curves were constructed for comparing the diagnostic value of various non-invasive methods for predicting failure to voiding and storage lower urinary tract dysfunction (LUTD).
Results: Patients with failure to voiding LUTD, including benign prostatic obstruction (n = 72), bladder neck dysfunction (n = 19), urethral stricture (n = 3) and poor relaxation of the urethral sphincter (n = 32), had mean IPSS-V/S scores > 1. In contrast, patients who were urodynamically normal (n = 2) or had failure to storage LUTD, including idiopathic detrusor overactivity (n = 84), increased bladder sensation (n = 37), and detrusor overactivity and impaired contractility (n = 4), had IPSS-V/S scores ≤ 1. When IPSS-V/S was used to differentiate male LUTS, failure to voiding LUTD was found in 81.2% of patients with IPSS scores > 1, while failure to storage LUTD was found in 75.7% of patients with IPSS-V/S ≤ 1. The area under ROC curve of IPSS-V/S was higher than for other non-invasive methods for predicting failure to voiding and storage LUTD.
Conclusion: Measuring IPSS subscores and calculating IPSS-V/S is a simple and useful method to differentiate failure to voiding and failure to storage LUTD in men with LUTS. IPSS-V/S may provide a guide for the initial treatment, especially for primary care physicians without access to urological studies.
Introduction
The syndrome known as 'lower urinary tract symptoms' (LUTS) is a non-sex-specific and non-organ-specific symptom syndrome that includes storage, voiding and postmicturition symptoms. Although LUTS may have many causes, the symptoms caused by lower urinary tract dysfunction (LUTD) can be divided into 'failure to voiding LUTD' and 'failure to storage LUTD'. The most common initial treatments are the α-adrenoceptor antagonists and antimuscarinics, respectively. Traditionally, LUTS in men is usually attributed to benign prostatic hyperplasia (BPH) and is treated with α-adrenoceptor antagonists. However, some men who receive treatment for prostate conditions may have persistent storage symptoms.
The focus of male LUTS recently has shifted from the prostate to the bladder as the source of LUTS and also as a therapeutic target (). However, some physicians may be concerned that the inhibitory effect of antimuscarinics could aggravate voiding difficulties or cause urinary retention and, in most reports, antimuscarinics are usually reserved for second-line treatment. In addition, it is difficult to distinguish the causes of male LUTS merely based on clinical symptoms. Detailed urological investigation is mandatory for an exact diagnosis of LUTD. Therefore, choosing the medication that should be used first for men with LUTS seems to be a challenge for many primary care physicians (PCPs), especially for non-urologists without urological diagnostic equipment for uroflowmetry, bladder scanning, or transrectal ultrasound.
The International Prostate Symptom Score (IPSS) questionnaire has been used for decades to evaluate the severity of LUTS/BPH and also has been applied to conditions other than BPH that cause LUTS. The IPSS consists of a total of seven questions that deal with voiding symptoms (incomplete empty, intermittency, weak stream and straining to void) and storage symptoms (frequency, urgency and nocturia). Patients with predominant voiding LUTD may have a greater voiding subscore (IPSS-V), and those with predominant storage LUTD may have a greater storage subscore (IPSS-S). Although IPSS total score (IPSS-T) cannot differentiate voiding vs. storage LUTD, the ratio of IPSS subscores might be able to achieve this goal. In this study, we sought to investigate if the ratio of IPSS-V to IPSS-S (IPSS-V/S) could help to differentiate male LUTD and provide a guide for the initial treatment. To our knowledge, this is the first study to evaluate the role of IPSS-V/S in male LUTS.
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