Grading severity and bother using the IPSS and ICIQ-MLUTS scores in men seeking lower urinary tract symptoms therapy

Purpose;To establish severity banding ranges, bother assessment and key item content in principal patient reported outcomes measures (PROMs) in men seeking therapy for lower urinary tract symptoms (LUTS).Materials and Methods;Data for International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire Male LUTS (ICIQ-MLUTS) were derived from a study evaluating 820 men at 26 UK hospitals. Receiver operating characteristic (ROC) curves were used to establish severity bandings. Results;Classification tree showed that thresholds between mild-moderate and moderate-severe severity bands were 15 and 27 respectively for IPSS, 16 and 26 for ICIQ-MLUTS/severity, and 22 and 81 for ICIQ-MLUTS/bother. Highest area under ROC and lowest Akaike’s information criteria of univariate logistic regression indicated that ICIQ-MLUTS/bother was more related to global quality of life (QoL) than were IPSS and ICIQ-MLUTS/severity. The symptoms affecting IPSS-QoL were only fully identified by ICIQ-MLUTS, because two key symptoms (urinary incontinence and post-micturition dribble) are not measured by IPSS. ICIQ-MLUTS demonstrated that bother of some LUTS is disproportionate to severity, and that persisting high bother levels following surgery are more likely due to storage (18-25%) and post-voiding (18-28%) LUTS than voiding LUTS (5-13%). Symptom improvement after surgery is uncertain if baseline IPSS-QoL score was <3.Conclusions;The severity threshold scores were measured for the two key LUTS PROMs, and the results indicate suitable categories of symptom severity for use in men referred for urological care. The ICIQ-MLUTS measures all the LUTS affecting QoL, and includes individual symptom bother scores.