International Prostate Symptom Score (IPSS) Calculator

How does this International Prostate Symptom Score (IPSS) calculator work?

This health tool aims to collect and analyse the perceived symptoms of patients suffering from urinary tract dysfunctions and benign prostatic hyperplasia (BPH).

The seven multiple choice questions in the International Prostate Symptom Score (IPSS) calculator focus on the main symptoms that are of concern for the urinary tract function and might indicate prostate enlargement, as reflected in the American Urological Association symptom index:

1. Incomplete emptying - How often have you had the sensation of not emptying your bladder?

2. Frequency - How often have you had to urinate less than every two hours?

3. Intermittency - How often have you found you stopped and started again several times when you urinated?

4. Urgency - How often have you found it difficult to postpone urination?

5. Weak Stream - How often have you had a weak urinary stream?

6. Straining - How often have you had to strain to start urination?

7. Nocturia - How many times did you typically get up at night to urinate?

The patient can choose from a scale of 6 answers that are put in the order of severity increase and are assigned points from 0 to 5, 0 being usually the lack of presence of symptoms and 5 being the severe presence of concerning symptoms.

IPSS score interpretation

The overall score in the I-PSS ranges between 0 and 35, from asymptomatic to very symptomatic status. There is also an extra question, recommended by the WHO in collaboration with the International Union Against Cancer (UICC), that is focused on the quality of life due to urinary symptoms and can be used in addition to the main score to provide to the clinician more information about the patient:

Q: If you were to spend the rest of your life with your urinary condition just the way as it is now, how would you feel about that?

- Delighted (0 points);

- Pleased (1 point);

- Mostly satisfied (2 points);

- Mixed (3 points);

- Mostly dissatisfied (4 points);

- Unhappy (5 points);

- Terrible (6 points).

The AUA Symptom Index also classifies the score’s result range in the following 3 categories based on the patient perceived symptom intensity:

■ Mild – scores between 0 and 7;

■ Moderate – scores between 8 and 19;

■ Severe – scores between 20 and 35.

The next steps in diagnosing the patient will include history, physical exam, laboratory determinations (creatine, U/A, urine culture and blood urea) and common evaluations for prostate cancer to exclude or confirm the diagnosis of cancer amongst the other conditions possible to cause prostatic hyperplasia.

Benign prostatic hyperplasia represents the prostatic enlargement that is caused by something other than cancer and is characterized by the hyperplasia of stromal and epithelial cells and the formation of nodules in the transition zone. These nodules in turn impinge on the urethra and increase resistance to the urine flow.

The obstruction degree varies to the extent of which the surrounding tissue compresses the urethra. BPH is the main cause of lower urinary tract symptoms, the LUTS group classified in storage, voiding and after urination symptomatology. If left untreated, BPH is a progressive condition that leads to urinary tract infections.

References

1) de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM. (2014) Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis. PLoS One; 9(7):e101320.

2) Jiang YH, Lin VC, Liao CH, Kuo HC. (2013) International Prostatic Symptom Score-voiding/storage subscore ratio in association with total prostatic volume and maximum flow rate is diagnostic of bladder outlet-related lower urinary tract dysfunction in men with lower urinary tract symptoms. PLoS One; 8(3):e59176.