Prospective comparison of the IPSS, MIPSS and VPSS questionnaires with uroflowmetry and cognitive functions control in men with benign prostatic hyperplasia

Introduction. Accurate assessment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) is one of the key tasks of a urologist for selecting adequate therapy, monitoring treatment, and determining indications for surgical treatment. The International Prostate Symptom Score (IPSS) questionnaire, developed in 1992, has become a simple and widely used method to grade the presence, type, and severity of LUTS in men with BPH. However, the IPSS has certain limitations: the poorer a patient’s cognitive abilities, the greater the likelihood of incorrect responses due to the complexity and abstract nature of the questions and the difficulty in translating subjective sensations into a written numerical score.

In 2011, a new tool, namely the Visual Prostate Symptom Score (VPSS), was proposed as a visual analogue of the IPSS, in which the questions are presented in pictorial form, thereby reducing the dependence on literacy and cognitive function. Despite these advances, the search for the most rational and cognitively accessible questionnaire for assessing LUTS remains relevant.

Aim. To compare the IPSS, modified IPSS (mIPSS), and VPSS questionnaires in men with BPH, with reference to uroflowmetry and cognitive function, and to improve the diagnostic accuracy of IPSS through its modification.

Materials and Methods. A total of 72 men with symptomatic BPH presenting for initial outpatient evaluation were included in the prospective study. The median age was 68 [64–72] years. All patients underwent standard assessments according to the Russian Society of Urology clinical guidelines: urinalysis, complete blood count, prostate-specific antigen (PSA) testing, transrectal ultrasound (TRUS) with measurement of prostate volume and post-void residual urine, renal ultrasonography, and uroflowmetry. Inclusion criteria were: prostate volume 40–180 cc, residual urine ≤150 mL, and PSA < 4 ng/mL. Exclusion criteria were suspicion of prostate cancer or other causes of voiding dysfunction unrelated to BPH.

All patients provided written informed consent, and the study was approved by the local ethics committee. Each participant completed four questionnaires, including the newly developed modified IPSS (mIPSS). In this version, the IPSS items were divided into two groups: voiding (obstructive) symptoms: questions 1, 3, 5, 6; storage (irritative) symptoms: questions 2, 4, 7.

Results. For most questions, the proportion of identical responses between questionnaires exceeded 50%, and all correlation coefficients were r > 0.6, indicating a strong association between the results and suggesting that the tools measure similar constructs and are largely interchangeable. Uroflowmetry parameters correlated significantly only with the total mIPSS score. Both Qmax and Qave showed a significant inverse correlation with mIPSS total score, while voided volume showed no correlation with any questionnaire scores. The urinary stream strength item correlated significantly with Qmax and Qave, and nocturia correlated with all three parameters (Qmax, Qave, and voided volume). This indicates that the mIPSS questionnaire can be used as a rational and sufficiently quick tool for assessing lower urinary tract symptoms (LUTS).

The mIPSS and IPSS questionnaires are interchangeable in terms of the evaluated characteristics of urination; however, mIPSS shows a stronger correlation with objective uroflowmetry parameters and is therefore considered a more reliable assessment method.

Conclusion. The results demonstrate the advantages of the modified IPSS (mIPSS) compared with the standard IPSS, owing to its stronger correlation with objective urodynamic findings and greater ease of use. The mIPSS and VPSS questionnaires may be effectively applied to identify voiding disorders, particularly in patients with cognitive impairment. At the same time, the interchangeability of the questionnaire items and the rationale for dividing the questions into obstructive and irritative categories by splitting them into two columns have been demonstrated.