What are the components of the American Urological Association (AUA) score used to assess benign prostatic hyperplasia (BPH) symptoms?

Components of the American Urological Association (AUA) Symptom Score

The American Urological Association (AUA) Symptom Score consists of seven specific questions that assess both storage and voiding symptoms related to benign prostatic hyperplasia (BPH), with each question scored from 0-5 points for a total possible score of 35 points. 1

The Seven Core Questions of the AUA Symptom Score

The AUA Symptom Score evaluates the following seven symptoms:

Storage (Irritative) Symptoms:

1. Frequency: "Over the past month, how often have you had to urinate again less than two hours after you finished urinating?"
2. Urgency: "Over the past month, how often have you found it difficult to postpone urination?"
3. Nocturia: "Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?"

Voiding (Obstructive) Symptoms:

1. Incomplete emptying: "Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?"
2. Intermittency: "Over the past month, how often have you found you stopped and started again several times when you urinated?"
3. Weak stream: "Over the past month, how often have you had a weak urinary stream?"
4. Straining: "Over the past month, how often have you had to push or strain to begin urination?"

Scoring System

Each question is scored on a scale of 0-5:

• 0: Not at all
• 1: Less than 1 time in 5
• 2: Less than half the time
• 3: About half the time
• 4: More than half the time
• 5: Almost always

For nocturia (question 7), the scale represents the number of times the patient gets up at night:

• 0: None
• 1: 1 time
• 2: 2 times
• 3: 3 times
• 4: 4 times
• 5: 5 or more times

Symptom Severity Classification

The total score is used to classify symptom severity 2:

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

Additional Components Often Used with the AUA Score

Disease-Specific Quality of Life Question (Bother Score)

This single question is included in the International Prostate Symptom Score (IPSS), which is identical to the AUA score plus this additional question 1:

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

• Scored from 0 (delighted) to 6 (terrible)

BPH Impact Index

This four-question assessment evaluates how BPH symptoms affect daily life 1:

1. Physical discomfort from urinary problems
2. Worry about health due to urinary problems
3. Overall bothersomeness of urinary problems
4. Interference with usual activities due to urinary problems

Clinical Application

The AUA Symptom Score is crucial for:

• Initial assessment of symptom severity
• Monitoring treatment response
• Guiding treatment decisions based on symptom severity

Common Pitfalls

• Misinterpretation: Studies show that 49% of patients may misunderstand the questions 2
• Overreliance: The score should not replace clinical judgment
• Ignoring bother: Symptom severity alone doesn't fully capture impact on quality of life 2
• Gender bias: Despite being developed for BPH, similar symptoms can occur in women for different reasons 3

The AUA Symptom Score has excellent test-retest reliability (r = 0.92) and internal consistency (Cronbach's α = 0.86), making it a reliable tool for clinical assessment of lower urinary tract symptoms 4.