What are the International Prostate Symptom Score (IPSS) questions?

International Prostate Symptom Score (IPSS) Questions

The International Prostate Symptom Score (IPSS) consists of seven symptom questions plus one quality of life question that are used to quantify and classify lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). 1

The Seven Symptom Questions

The IPSS includes the following seven questions, each scored from 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):

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. Frequency: Over the past month, how often have you had to urinate again less than two hours after you finished urinating?

3. Intermittency: Over the past month, how often have you found you stopped and started again several times when you urinated?

4. Urgency: Over the past month, how often have you found it difficult to postpone urination?

5. Weak stream: Over the past month, how often have you had a weak urinary stream?

6. Straining: Over the past month, how often have you had to push or strain to begin urination?

7. Nocturia: Over the past month, how many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning? (0 = none, 1 = once, 2 = twice, 3 = three times, 4 = four times, 5 = five or more times)

Quality of Life Question (Bother Question)

The eighth question assesses the impact of urinary symptoms on quality of life:

1. Quality of life due to urinary symptoms: If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? (0 = delighted, 1 = pleased, 2 = mostly satisfied, 3 = mixed, 4 = mostly dissatisfied, 5 = unhappy, 6 = terrible)

Scoring and Interpretation

• Total IPSS score: Sum of questions 1-7 (range: 0-35)
• Symptom severity classification:
  • Mild symptoms: 0-7 points
  • Moderate symptoms: 8-19 points
  • Severe symptoms: 20-35 points 1

Clinical Significance

• A change of 2-3 points in the IPSS is considered clinically meaningful 1
• The IPSS bother question (question 8) has been shown to correlate strongly with the BPH Impact Index (r = 0.68) and may be a better predictor of health-related quality of life than the total IPSS score 2, 3
• The IPSS is used to guide treatment decisions:
  • Mild symptoms (0-7): Watchful waiting with annual follow-up
  • Moderate symptoms (8-19) with bother: Alpha-blockers as first-line therapy
  • Severe symptoms (≥20) or large prostates: 5-alpha reductase inhibitors, with combination therapy considered 1

Important Considerations

• While the IPSS was designed to be self-administered, studies show that approximately 45-60% of patients, particularly those with limited education, may need assistance completing the questionnaire 4, 5
• Visual alternatives like the Visual Prostate Symptom Score (VPSS) may be more accessible for patients with limited literacy 5
• The IPSS should be used as part of a comprehensive evaluation that includes medical history, physical examination with digital rectal examination, urinalysis, and selective PSA testing 1

The IPSS remains the most widely used validated tool for assessing LUTS in men with BPH and is essential for diagnosis, treatment planning, and monitoring response to therapy.