Worldwide, the most commonly used LUTS questionnaire for men is the International Prostate Symptom Score (IPSS). The questionnaire is used for assessing symptom severity before, during and after treatment. However, quantitative research showed self-administration of the IPSS led to incomplete questionnaires in 53-73% of cases en misreporting at least 4 IPSS points in 28-58% of cases. Qualitative research showed that difficulties with understanding and completing the questionnaire threaten the validity of the results [1].
For this reason, a clearer and more figurative LUTS questionnaire was developed, always prioritizing the patient’s perspective (patients with varying levels of health literacy including): the DRIPSS [2] (see Figure). The aim of this study is to validate the DRIPSS for use in urological practice.

In a multicenter, quantitative, cross-sectional study design, all adult men with LUTS received one of two study booklets (to prevent order effects) prior to their first outpatient appointment; these study booklets contained the IPSS, DRIPSS, two voiding diaries, and questions regarding preference and comprehensibility. Flowmetry was performed during the first visit. Statistical analysis was conducted using SPSS 30. Individual questionnaire items were correlated with objective measurements and with each other. Z-scores were calculated.

1,636 men received a booklet, of whom 1,535 participated (response rate 93.8%, mean age 70.0 years (SD 13.2 years)).
DRIPSS question 1 (Q1) correlated significantly with daytime frequency (DF) and daytime voiding volume. These correlation coefficients (CC) and those of IPSS questions 2 and 4 did not differ significantly. See Table. 
For DRIPSS Q2, this applied to nighttime frequency (NF) and nighttime voiding volume. The CC with NF was stronger than that of IPSS question 7. 
For DRIPSS Q3, this applied to bladder voiding efficiency (BVE) and daytime voiding volume. This CC and those of IPSS questions 2 and 4 did not differ significantly. 
For DRIPSS Q4, this applied to residual volume and flow time and was negative for Qmax, Qave, flowmetryvolume, and BVE. Z-scores with IPSS questions regarding outflow showed an equal or stronger correlation with the DRIPSS. 
For DRIPSS Q5, this applied to Qmax, Qave, DF, and NF. The CC for DRIPSS was equal to or stronger than that of the IPSS QoL question. 

Regarding questionnaire preference, n=872 (74.1%) chose DRIPSS, n=258 (21.9%) chose IPSS, and n=46 (3.9%) chose both. For convenience, n=785 (64.7%) chose DRIPSS, n=371 (30.7%) chose IPSS, and n=57 men (4.7%) chose both.

The DRIPSS is a new questionnaire for LUTS developed and based on qualitative research conducted in collaboration with patients with varying levels of health literacy. In the current quantitative, prospective, multicenter validation study, the DRIPSS was evaluated in a large study group with a high response rate. 
The results showed that, in direct comparison with the IPSS and (more importantly) in comparison with objective measures, the DRIPSS is non-inferior to the IPSS and even scores better on several items than the IPSS. In addition, the vast majority of patients perceive the DRIPSS as simpler and prefer it over the current gold standard, the IPSS.
While DRIPSS shows great promise, its true value still needs to be demonstrated in practice, particularly since some IPSS items are not included in DRIPSS.

The DRIPSS shows a strong correlation with objective findings and is therefore a reliable instrument. Compared to the IPSS, it is non-inferior and even superior on certain items. The vast majority of users find the DRIPSS more precise and easier to use than the IPSS. Longitudinal research is currently underway.

Schlatmann, F.W.M.; van Balken, M.R.; de Winter, A.F.; de Jong, I.-J.; Jansen, C.J.M. How Do Patients Understand Questions about Lower Urinary Tract Symptoms? A Qualitative Study of Problems in Completing Urological Questionnaires. Int. J. Environ. Res. Public Health 2022, 19 (15), 9650
Schlatmann, F. W. M., van Balken, M. R., de Winter, A. F., de Jong, I. J. & Jansen, C. J. M. Developing a new urology questionnaire from the patient’s perspective. Information Design Journal 2025, 29(2), 92-107