International Prostate Symptom Score

International Prostate Symptom Score (IPSS) is a standardized tool used to measure the severity of urinary symptoms in men, in order to evaluate the impact of an enlarged prostate or benign prostatic hyperplasia (BPH). The IPSS is derived from the American Urological Association (AUA) Symptom Index and consists of seven questions related to lower urinary tract symptoms (LUTS). Each question is scored from 0 to 5, leading to a total score ranging from 0 to 35, where higher scores indicate more severe symptoms.

Development and Usage

The IPSS was developed in the early 1990s as a means to provide a standardized method for evaluating the severity of BPH symptoms and their impact on a patient's quality of life. It is widely used in both clinical practice and research to assess the need for treatment and to monitor the effectiveness of interventions.

Questionnaire

The IPSS questionnaire includes seven questions that cover three major symptom categories: storage, voiding, and post-voiding symptoms. The questions address the frequency of:

1. Incomplete emptying
2. Frequency
3. Intermittency
4. Urgency
5. Weak stream
6. Straining
7. Nocturia

Each symptom is rated on a scale from 0 (not at all) to 5 (almost always). Additionally, the questionnaire includes an eighth question that assesses the patient's quality of life due to urinary symptoms, though this question is not included in the total IPSS score.

Scoring and Interpretation

The total score of the first seven questions can range from 0 to 35 and is interpreted as follows:

• 0-7: Mild symptoms
• 8-19: Moderate symptoms
• 20-35: Severe symptoms

The eighth question on quality of life is scored separately and helps to guide treatment decisions based on the patient's perceived bother from their symptoms.

Clinical Significance

The IPSS is a valuable tool in the diagnosis and management of BPH. It helps clinicians to objectively assess the severity of a patient's symptoms and to monitor changes over time or in response to treatment. The score can also facilitate discussions between the patient and healthcare provider regarding the potential benefits and risks of various treatment options.

Limitations

While the IPSS is widely used and accepted, it does have limitations. The questionnaire is subjective and relies on patient self-reporting, which can be influenced by individual perception and memory. Additionally, the IPSS does not differentiate between symptoms caused by BPH and those resulting from other urinary tract conditions.