"Quality of life" assessment of urination in elderly Japanese men and women with some medical problems using International Prostate Symptom Score and King's Health Questionnaire

OBJECTIVES: To investigate the relationships among lower urinary tract symptoms (LUTS), satisfaction at urination, and quality of life (QoL) in elderly Japanese men and women, who attended physicians for their medical problems. METHODS: A total of 437 Japanese men and 196 women, aged 50 or older, responded to a questionnaire, which included seven questions regarding urination, one question about bothersomeness (QoL index) from the International Prostate Symptom Score (IPSS), two questions about frequency of urinary incontinence and 16 questions from the King's Health Questionnaire (KHQ). RESULTS: Of 401 patients who completed the IPSS and KHQ questionnaires, 235 (72.3%) men and 85 (64.7%) women had moderate to severe LUTS. In both genders, LUTS severity was significantly correlated with satisfaction status and KHQ-QoL domain scores. Satisfaction status also correlated with KHQ-QoL scores. Thirty-eight (13.5%) men and 27 (22.7%) women had frequent incontinence episodes. When excluding the patients with frequent incontinence episodes, KHQ-QoL scores of severe LUTS decreased in the domains of role, physical and social limitations, personal relationships and sleep/energy in women alone. CONCLUSIONS: Urination problems and related QoL status could be easily assessed by IPSS and QoL index in the elderly. Urinary incontinence appeared to be more associated with QoL in elderly women. The KHQ may be useful to assess the detailed urination-related QoL status of elderly men and women with LUTS or urinary incontinence.     

Variability of the International Prostate Symptom Score in men with lower urinary tract symptoms

OBJECTIVE: The variability of the International Prostate Symptom Score (I-PSS) was tested in patients with benign prostatic hyperplasia (BPH) by comparing questionnaire results obtained in the physician's office and, 1 week later, in the patient's home. MATERIAL AND METHODS: A total of 210 consecutive men with lower urinary tract symptoms (LUTS) completed the I-PSS questionnaire in the physician's office. One week later the questionnaire was mailed to each patient's home, completed by the patient and then returned. Scores were compared specifically in terms of clinically significant differences defined by a total symptom score difference of > or = 6 points and/or a difference of > or = 2 points in the quality-of-life (QOL) measure. RESULTS: The mean patient age was 67 years. Questionnaires were completed and returned by 127/210 (60%) men. Pearson's correlation coefficient for the I-PSS and QOL results was 0.81 and 0.74, respectively. Clinically significant differences in results were seen in 33/127 (26%) patients. When grouping patients into mild, moderate and severe symptom categories based on the I-PSS results, 31/127 (24%) changed categories when comparing "office" and "home" results. CONCLUSIONS: Clinically significant variations in I-PSS and QOL results may exist and may affect treatment decisions in > 25% of men.     

Linguistic validation of Japanese version of International Prostate Symptom Score and BPH impact index

PURPOSE: To evaluate linguistic validity of the Japanese version of International Prostate Symptom Score (IPSS) and BPH Impact Index (BII). METHODS: The translation was performed through multi-step procedure. Forward translation was created through the discussion by 5 urologists, 2 Japanese translators and 1 nurse on independent translations of the discussants and the translation published in the Guideline in Japan. Back translation was made by 2 native speakers of American English, and negotiated with the original developers. A person-to-person in-depth interview was carried out on 20 patients with benign prostatic hyperplasia. RESULTS: The developers generally approved our translation, but had 2 major concerns in the Japanese version; 1) "how often" in every sentence of English version was not translated into Japanese, and 2) the Japanese expression in the response choices of QOL index should be more emotional. The former concern was compromised by placing a sentence at the beginning of the questionnaire explaining that the response should be considered in frequency. The latter concern was examined in a pre-test involving additional 88 patients and compromised by making the translation of some response choices more emotional. CONCLUSION: We evaluated linguistic validity of Japanese translations of IPSS and BII, and proposed a valid Japanese version of these questionnaires.     

Long-term follow-up of International Prostate Symptom Score (IPSS) in men following prostate brachytherapy

Objective

To investigate variation in the International Prostate Symptom Score (IPSS) in men following prostate brachytherapy.

Methods

From January 2004 to November 2009, 524 consecutive patients underwent prostate brachytherapy either alone or in combination with external beam radiation therapy for T1c–T3b prostate cancer. The IPSS was assessed preimplant and at 1, 6, 12, 24, 36, and 48 months after treatment. Clinical and treatment-related factors were assessed for correlations with the IPSS increase.

Results

The mean preimplant IPSS was 7.4, with the greatest mean score of 16.0 at 1 month. At 6 months, the mean total IPSS had decreased to 11.5, but it was still statistically significantly greater than that at baseline (<0.001). At 12 months, the IPSS was decreased to 8.6, slightly greater than baseline (p = 0.001). The IPSS of 45.4 % (69/152) patients gradually returned to preimplant levels and that of 71.1 % (108/152) patients returned to within 3 points of the baseline at 24 months. At 24, 36, and 48 months after seed implantation, the IPSS was 8.6, 7.7, and 8.2, respectively, and none of these values differed statistically significantly from baseline (p > 0.05). Sixteen patients (3.1 %) showed AUR, and 11 patients required catheterization. On univariate and multivariate analyses, the IPSS increase was best predicted by lower preimplant IPSS.

Conclusion

In our series, IPSS after prostate brachytherapy peaked at 1 month and gradually returned to approximately baseline at 24 months. The IPSS increase was best predicted by lower preimplant IPSS.     

Visual analog scale questionnaire to assess quality of life specific to each symptom of the International Prostate Symptom Score

PURPOSE: We assessed patient quality of life specific to each of the 7 items on the International Prostate Symptom Score, as evaluated with a novel visual analog scale questionnaire. MATERIALS AND METHODS: A total of 246 male patients with a chief complaint of lower urinary tract symptom were asked to complete the International Prostate Symptom Score and visual analog scale questionnaires to assess bother or satisfaction regarding patient quality of life specific to each of the 7 items on the International Prostate Symptom Score. RESULTS: An item with the maximum visual analog scale measure matched the chief complaint in 169 patients (69%). In contrast, the chief complaint failed to match to an item with the most severe International Prostate Symptom Score in 104 patients (42%) (p = 0.012). Multiple regression analysis to define the best predictor of International Prostate Symptom Score quality of life score of the 14 items, including International Prostate Symptom Score and visual analog scale, revealed that the best predictor was the visual analog scale measure for nocturia (p = 0.0003), followed by visual analog scale measures for frequency (p = 0.0004) and incomplete emptying (p = 0.01). After alpha-blocker treatment improvement in the visual analog scale measure for the chief complaint correlated better with improvement in the International Prostate Symptom Score quality of life score than the change in International Prostate Symptom Score. The overall test-retest correlation for the visual analog scale questionnaire in 55 healthy elderly men and 44 patients with lower urinary tract symptoms was 0.772 and 0.742, respectively (p <0.00001). CONCLUSIONS: The novel visual analog scale measure of quality of life specific to each of the 7 items on the International Prostate Symptom Score has a significant impact on identifying the patient chief complaint as well as on patient specific quality of life. Our study supports the concomitant use of the International Prostate Symptom Score and visual analog scale questionnaires.     

The evaluation of urination status and International Prostate Symptom Score following radical prostatectomy

PURPOSE: We evaluated condition of urination and International Prostate Symptom Score (I-PSS) after radical prostatectomy. PATIENTS AND METHODS: Forty-three men with prostatic cancer underwent radical prostatectomy between October 1993 and October 2002. Mean patients age was 66 years (range 56 to 79) and clinical follow-up averaged 38.6 months (range 3 to 84). Urodynamics studies including uroflowmetry, cystometry and evaluation of I-PSS were performed before and 1, 3, 6, 12 months after the operation. After 12 months these studies were performed every year. The status of postoperative urinary incontinence was based on patients' report. RESULTS: First desire to void, maximum desire to void and maximal flow rate was decrease temporarily after radical prostatectomy. However most patients had normal uroflowmetorogram and normal cystometrogram at 6 months. I-PSS and QOL index was improved during postoperative 12 months. CONCLUSIONS: Postoperatively urodynamics studies was improved from 3 to 6 months, but evaluation of I-PSS and QOL index was improved from 6 to 12 months. The difference was formed to both.     

Development and validation of an Arabic version of the International Prostate Symptom Score

OBJECTIVE

To develop and validate an Arabic version of the International Prostate Symptom Score (IPSS).

PATIENTS, SUBJECTS AND METHODS

An Arabic version of the IPSS (IPSS‐Arb) was developed through a series of translations and modifications which involved the authors, urology and non‐urology medical and nursing staff. The validity and reliability were assessed in 76 patients with urinary symptoms due to benign prostatic hyperplasia (BPH) and in 63 control subjects without BPH; 25 patients had transurethral resection of prostate (TURP) whereas the remaining 51 patients were treated with terazosin. The reliability of the IPSS‐Arb was assessed by determining the internal consistency (Cronbach’s α coefficient) and by assessing the test‐retest reliability (intraclass correlation coefficient, ICC). Construct validity was assessed by determining the correlation between the IPSS‐Arb scores and the quality‐of‐life question (QoL‐Arb), and by determining the ability of the IPSS‐Arb to discriminate between the patients and controls by calculating the area under the receiver operating characteristic (ROC) curve.

RESULTS

The Cronbach’s α coefficient (internal consistency) for the IPSS‐Arb was 0.85, and 0.78–0.88 for the individual items. The test‐retest reliability (ICC) was 0.88 (P < 0.001). In addition, the IPSS‐Arb had a high correlation with the QoL‐Arb (Spearman rank correlation coefficient 0.82, P = 0.01). The mean (sem , 95% confidence interval) area under the ROC curve for the IPSS‐Arb was 0.93 (0.09, 0.89–0.97), whereas the area for its individual questions was 0.79–0.90. The IPSS‐Arb also showed a high sensitivity to change. The mean (sd ) IPSS‐Arb scores before and after TURP were 23.1 (6.4) and 6.9 (1.8), respectively (P < 0.001); in the terazosin group, the scores were 12.6 (7.4) and 8.2 (4.0), respectively (P < 0.001).

CONCLUSIONS

The IPSS‐Arb was shown to be a reliable and valid instrument for patients with BPH. We recommend using it for patient assessment and follow‐up, and as a research tool in Arabic‐speaking patients both in the Middle East and worldwide. In addition, this study provided another proof of the wide suitability of the IPSS among various nations worldwide.     

Reliability and validity of the International Prostate Symptom Score in a Malaysian population.

OBJECTIVE: To validate the English version of the International Prostate Symptom Score (IPSS) in patients with and without urinary symptoms in a Malaysian population. PATIENTS AND METHODS: Validity and reliability were assessed in patients with lower urinary tract symptoms (LUTS) and in patients with no LUTS. Reliability was evaluated using the test-retest method and internal consistency using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the score before and after intervention in additional patients with LUTS who underwent transurethral resection of the prostate (TURP). RESULTS: Internal consistency was excellent; there was a high degree of internal consistency for each of the seven domains and for the total score (Cronbach's alpha > or = 0.60 and > or = 0.79, respectively) in the populations studied. The test-retest correlation coefficient for the seven domain scores was highly significant. The intra-class correlation coefficient was high (> or = 0.59). There was a high level of sensitivity and specificity for the effects of treatment, with a very significant change between the seven scores domains in the treated group but not in the control group. CONCLUSIONS: The IPSS is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.     

The valuation of the International Prostate Symptom Score (IPSS) for use in economic evaluations

OBJECTIVE: Lower Urinary Tract Symptoms (LUTS) suggestive of Benign Prostatic Obstruction (BPO) cause a reduction in quality of life, but the magnitude of that reduction cannot be estimated empirically. This is because survey instruments currently available merely sum the symptoms found, but do not value their impact on quality of life. It is therefore difficult to determine whether the effects of treatments for LUTS suggestive of BPO justify the costs. This complicates economic evaluations. METHODS: We valued the impact on quality of life of patients with LUTS suggestive of BPO, by valuing health states defined by the International Prostate Symptom Score (IPSS) using the time trade-off (TTO). TTO values ranged from 1.0 for perfect health to 0.0 for the value of death, and can be used to calculate Quality-Adjusted Life Years (QALYs), the preferred outcome measure in health economics. RESULTS: We reduced the number of health states defined by the IPSS using factor analysis. The resulting nine health states were valued by a representative sample of the general public (N=170) using TTO. The worst IPSS health state was valued at 0.87. CONCLUSION: The values for health states defined by the IPSS revealed that LUTS suggestive of BPO has a mild impact on quality of life. The valuation of the IPSS facilitates economic evaluations of treatments for LUTS suggestive of BPO, because QALYs (the preferred outcome measure in health economics) can be determined empirically.     

Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia.

PURPOSE: We studied the relationship of nocturia with the International Prostate Symptom Score in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Baseline symptom score and the change in the score by treatment were analyzed in 219 consecutive Japanese men with BPH using basic statistics, and correlation, cluster and principal component analyses. RESULTS: The average nocturia score was the middle of that of the 7 symptoms at baseline and by far the highest after treatment. Hence, the score change was the smallest. Analysis of baseline scores demonstrated that all symptoms were the initial component in principal component analysis with individual symptom scores correlating with the total symptom score and quality of life index. However, the correlation was least for nocturia. Observations were similar when analyzing the score change by treatment. These results indicate that the nocturia score is least specific to symptoms associated with BPH or least sensitive to the therapeutic effect on symptoms. This finding may be related to the high nocturia score in the age matched control population. CONCLUSIONS: The nocturia score of the International Prostate Symptom Score behaves differently in the symptom complex of BPH in Japanese men, partially because it is most confounded by the aging factor.     

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

OBJECTIVE: To determine if the International Prostate Symptom Score (IPSS) before seed implantation, stratified into mild (0-7), moderate (8-19) and severe (>20) categories, predicts brachytherapy-related morbidity in terms of IPSS resolution, catheter dependency and the need for surgical intervention after brachytherapy. PATIENTS AND METHODS: From January 1998 to September 2003, 1034 consecutive patients had permanent interstitial brachytherapy for clinical stage T1b-T3a NXM0 (2002 system) prostate cancer. Of the 1034 patients, 739 (71.5%) presented with an IPSS of 0-7, 287 (27.7%) of 8-19, and eight (0.8%) of > or = 20. The IPSS 8-19 cohort was further stratified into 8-14 (237 men) and 15-19 (50 men) subgroups. The median follow-up was 38.2 months. In all patients, an alpha-blocker was initiated before brachytherapy and continued at least until the IPSS normalized, the latter defined as a return to within 1 point of that before implantation. A median of 21 IPSS questionnaires were obtained per patient. Several clinical, treatment and dosimetric variables were evaluated as predictors of urinary morbidity. RESULTS: For the entire cohort, the IPSS peaked at a mean of 0.5 months after implantation and resolved at a mean of 1.7 months. At 5 years after brachytherapy, 90.1% of patients at risk (88.8%, 95.5%, and four of eight patients with a pre-implant IPSS of 0-7, 8-19 and > or = 20, respectively) were within the IPSS 0-7 category. Compared to the pre-implant IPSS, 13 patients (8%) were assigned to a higher IPSS severity category. Neither prolonged urinary catheter dependency (>5 days; 16 patients, 1.5%) or transurethral resection of the prostate (TURP, 17 patients, 1.6%) depended on the pre-implant IPSS subgroup. In Cox regression analysis, IPSS resolution was best predicted by pre-implant IPSS, prolonged catheter dependency by patient age, and TURP by any catheter dependency, the maximum IPSS increase and the maximum urethral dose. CONCLUSIONS: The IPSS before implantation predicted the resolution of IPSS after brachytherapy, but did not correlate with substantial urinary morbidity, including catheter dependency or the need for TURP. At 5 years after brachytherapy, 90.1% of patients at risk were assigned to the IPSS 0-7 category.     

The efficacy of an abbreviated model of the International Prostate Symptom Score in evaluating benign prostatic hyperplasia

OBJECTIVES: To investigate the acceptability to patients in Turkey of the International Prostate Symptom Score (IPSS) for evaluating benign prostatic hyperplasia (BPH), and to devise a possible abbreviated model, saving time when administered by a physician. PATIENTS AND METHODS: The IPSS questionnaire was initially self-administered in 200 consecutive patients aged> 50 years and with lower urinary tract symptoms. Patients were instructed only to mark questions which they clearly understood. The IPSS was then administered to 500 consecutive patients by the same physician. Subsequently, each of the seven questions was separately correlated with the IPSS and quality-of-life (QoL) score. The first five questions with the highest correlation coefficient for both the total IPSS and QoL score were identified, and every possible combination of these questions produced and correlated. RESULTS: In the first group, 29% of the patients did not complete the form and 44% could not mark at least one item; the effect of educational level was significant (P < 0.05). In the second group a combination of the first three items had a Pearson's correlation of 0.90 with the total IPSS; similarly, four questions combined (2, 3, 6 and 7) also correlated well (r = 0.92). Both combinations took significantly less time to administer (P < 0.05). CONCLUSION: The abbreviated form of the IPSS consisting of three or four items may be used to assess symptoms in patients with BPH, especially in underdeveloped countries.     

Correlation of non-invasive urodynamics with International Prostate Symptom Score (IPSS) and prostate volume

AIM: To study the correlation between non-invasive urodynamic data, the International Prostate Symptom Score (IPSS) and the prostate volume. MATERIALS AND METHODS: Data of 667 healthy volunteers participating in a longitudinal study of changes in urinary bladder contractility secondary to BPE were analyzed. The prostate volume was assessed by transabdominal ultrasonography. Uroflowmetry followed to verify if a minimum free flow rate of 4.5 ml/sec could be achieved. While (re)filling the bladder by drinking, the subjects completed the Dutch version of the IPSS. Next, the bladder pressure was non-invasively measured using the condom catheter method. The urethral resistance (URR) was calculated from the maximum condom pressure and the maximum free flow rate. RESULTS: The IPSS ranged from 0 to 29, (6.1 +/- 4.8) (mean +/- SD), whereas the prostate volumes ranged from 8 to 140 cm3, (34 +/- 18). Twenty eight percent (185/667) of the subjects had a non-invasively quantified high URR and a significantly higher IPSS (7.3 +/- 5.2) than those with a low URR (IPSS (5.7 +/- 4.6)), Mann-Whitney U-test: P < 0.001. The IPSS and the URR were significantly correlated, Spearman's rho (rho) = 0.20, P < 0.001. A significant difference between the prostate volumes, 36 +/- 21 cm3 in the high URR versus 33 +/- 17 cm3 in the low URR group, was not found, P = 0.18. CONCLUSIONS: A weak though statistically significant correlation was found between the non-invasively quantified URR and the IPSS. This suggests that an elevated resistance is a necessary, but not a sufficient condition for lower urinary tract symptoms (LUTS). No correlation was found between the URR and the prostate volume.     

Reliability and validity of the Malay version of the International Prostate Symptom Score in the Malaysian population

PURPOSE: We validated the Malay version of the International Prostate Symptom Score in patients with and without urinary symptoms in the Malaysian population. MATERIALS AND METHODS: Validity and reliability were studied in patients with and without lower urinary tract symptoms. Reliability was evaluated using the test-retest method and internal consistency was assessed by Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with lower urinary tract symptoms who underwent transurethral prostate resection. RESULTS: Internal consistency was excellent. A high degree of internal consistency was observed for each of the 7 items and for the total score (Cronbach's alpha 0.53 and greater, and 0.68, respectively). The test-retest correlation coefficients of the 7 items were highly significant. The intraclass correlation coefficient was high at 0.51 and greater. There was a high degree of sensitivity and specificity to the effects of treatment. Significant change from baseline to posttreatment scores was observed in all 8 items in the treated but not in the control group. CONCLUSIONS: The Malay International Prostate Symptom Score is a suitable, reliable, valid instrument that is sensitive to clinical change in the Malaysian population.     

Epidemiologic Survey of Lower Urinary Tract Symptoms in Asia and Australia Using the International Prostate Symptom Score

Background The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia.
Methods The symptom index (0 to 35) and quality-of-life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia.
Results The percentages of Asian men considered to be symptomatic (symptom index ≧ 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively.
Conclusions Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.     

Change in International Prostate Symptom Score, prostrate-specific antigen and prostate volume in patients with benign prostatic hyperplasia followed longitudinally

OBJECTIVE: The natural history of benign prostatic hyperplasia (BPH) in Japan resembles Western studies in that symptoms worsen, improve or stabilize in equal proportions of patients. We sought to determine if this pattern persisted in men seeking care at a urology referral center and if worsening of symptoms was due to increase in prostate volume (PV). METHODS: We reviewed the records of all BPH patients who attended the Urology Clinic of Sapporo Medical University Hospital, during December 2003 and June 2004 with the inclusion criterion that they have at least two PV and lower urinary tract symptoms measurements using the International Prostate Symptom Score (IPSS). Patients who had prostate cancer or who underwent hormone therapy or prostate surgery between the two visits were excluded. Correlation (Spearman's rank) was used to assess interrelationships among variables at baseline and follow up; the strength of association between change in IPSS and change in PV were modeled by multiple linear regression. RESULTS: Sixty-seven patients were eligible. Baseline PV correlated with residual urine volume (r = 0.37, P < 0.05) and prostate-specific antigen (PSA; r = 0.65, P < 0.001) but not IPSS (r =-0.16). PV increased in 46 (70%) men, remained the same in 10 and decreased in 11; in the former group, the mean prostate enlargement generally increased as baseline PV increased. In multiple linear regression models that included baseline IPSS, correlation between change in IPSS and change in PV was 0.47 (P = 0.05) based on 25 patients with measures at concurrent visits. Change in PV was also correlated with change in quality of life score (0.46, P = 0.02) but not with change in PSA (r = 0.38, P = 0.07, maximum flow rate (-0.24) or residual urine volume (-0.06). CONCLUSIONS: IPSS were not correlated with any laboratory measure of urinary function at baseline; however, change in IPSS was associated with change in PV. PV was also moderately correlated to PSA levels and residual urine volume at baseline.