45 consecutive men between the ages of 37 and 84 years (mean age 66 years) completed both an IPSS and ICIQ-MLUTS questionnaire when attending for pressure-flow studies from 1st September 2018 to 4th March 2019. 100% of men fully completed both questionnaires.
Mean IPSS score (35 total) was 20.4 + 6.6 (range 6-31), with a mean ICIQ-MLUTS score (84 total) of 33.7 + 10.2 (range 17-57). With both questionnaires, the more symptomatic the patient is the higher the score. The mean percentage of total score was 58.3% for IPSS and 40.1% for ICIQ. There was a strong positive correlation between the two with a Spearman co-efficient of 0.624 which was statistically significant (p value 0.000005). Table 1 shows the mean scores for each and the correlation observed between domains in both questionnaires (with associated p values). All exhibit either a moderate or strong positive correlation. Frequency shows the lowest correlation, and whilst this result is statistically significant (p=0.014), it is not as strong as for the other 6 symptoms, which are all significant at a p value of <0.01.
The IPSS questionnaire assesses voiding (intermittency, weak stream and straining) versus storage LUTS (frequency, urgency and nocturia). There is one post-micturition question for incomplete emptying. In addition to the voiding and storage symptoms assessed in IPSS, the ICIQ-MLUTS also assesses leakage (both stress and urge), enuresis, hesitancy, terminal dribbling, double voiding, and episodes of retention (amongst other symptoms). Table 1 also demonstrates the prevalence of these symptoms in our cohort. 36 patients had not previously had urinary retention (80%). Out of the remaining 20%, 3 had once (7%), 1 twice (2%), and 5 more than twice (11%).
Table 2 compares groups of voiding, storage and post micturition symptoms between the two questionnaires. The 3 storage questions in IPSS relate to frequency, urgency and nocturia, with 5 in ICIQ – frequency, nocturia, urgency, urge leakage and enuresis. There was a strong correlation between the two questionnaires (Spearman’s r= 0.522 p=0.0002). The 3 voiding symptoms assessed by IPSS are intermittency, weak stream and straining, compared to 6 in ICIQ; hesitancy, straining to start flow, straining to continue flow, 2 questions on strength of flow (1 pictorial) and intermittency. There was a strong correlation (r= 0.763 p= 1.1x10-9). ICIQ-MLUTS assesses post micturition symptoms with 3 questions regarding post micturition dribble, wetting after re-dressing, sensation of incomplete emptying and need to return to void within 15 minutes, whereas IPSS asks solely about sensation of incomplete emptying. Only a moderate correlation was observed (r=0.487 p=0.001).
Quality of life measures
Mean response to the quality of life score on the IPSS (0 = delighted to 6 = terrible) was 4.7 + 1.2 (range 2-6). Total bother score on the ICIQ-MLUTS is out of a total score of 200 (0 = not at all to 10 = a great deal for 20 domains). The mean score was 95.8 + 44.9 (range 0-191). Spearman’s r=0.564 (p = 0.00005), indicating a moderate to strong correlation between the two scores. Total symptom score for IPSS correlated strongly with its QOL score, Spearman’s r=0.679 (p =2.9x10-7). Total symptom score for ICIQ also had a strong correlation with its total bother score, Spearman’s r=0.829 (p = 2.0x10-12).