BPH Symptom Severity Assessment
The International Prostate Symptom Score (IPSS), also known as the AUA Symptom Index, is the recommended primary scoring system for assessing symptom severity in men over 50 with BPH. 1, 2
Primary Assessment Tool: IPSS
The IPSS should be administered to every patient presenting with suspected BPH at the initial visit, as it is superior to unstructured clinical interviews for quantifying symptom frequency and severity 1, 2
The IPSS consists of seven questions assessing both irritative symptoms (frequency, urgency, nocturia) and obstructive symptoms (incomplete emptying, intermittency, weak stream, straining), with a total score ranging from 0-35 points 1, 2
Symptom severity is classified as: mild (0-7 points), moderate (8-19 points), and severe (20-35 points) 1
The IPSS includes a critical single-item Disease Specific Quality of Life (QoL) question that measures how bothered the patient is by urinary symptoms, which is essential for treatment decisions 1, 2
Why IPSS Over Other Tools
The IPSS has been validated for clarity, test/retest reliability, internal consistency, and criteria strength 2
Treatment decisions must be based on both symptom severity score AND patient bother level - a moderately symptomatic patient who is highly bothered may warrant more aggressive intervention than a severely symptomatic patient who is not bothered 2
Complementary Assessment Tools
The BPH Impact Index (BPH-II) can be used alongside IPSS to provide more detailed assessment of how symptoms affect daily life, with four questions addressing physical discomfort, worry about health, bothersomeness, and impact on usual activities 1
The IPSS bother question correlates strongly with the BPH-II (r = 0.68), making it a convenient tool when the full BPH-II is not practical 3
Frequency-Volume Charts (voiding diaries) should be added when nocturia is the dominant symptom, with patients recording time and voided volume for each void over 3 consecutive 24-hour periods 1
Follow-Up Monitoring Protocol
Readminister the IPSS at each follow-up visit to objectively track symptom changes 1, 2
Schedule first follow-up at 4-12 weeks after initiating alpha-blockers, PDE5 inhibitors, anticholinergics, or beta-3 agonists 1, 2
Schedule first follow-up at 3-6 months for 5-alpha reductase inhibitors due to their slower onset of action 1, 2
Common Pitfalls to Avoid
Do not rely solely on IPSS score without assessing the patient's bother level - the QoL question is not optional 2
Do not use IPSS as a replacement for personal discussion of symptoms with the patient 2
Ensure patients understand the intent of each question, as misunderstanding can lead to inaccurate scoring 2
For illiterate or poorly educated patients, consider the Visual Prostate Symptom Score (VPSS) as an alternative, which has been validated to correlate significantly with IPSS (r = 0.453) 4