The visual prostate symptom score is a simple tool to identify and follow up in general practice patients with lower urinary tract symptoms associated with benign prostatic hyperplasia (a study with 1359 patients)

Pre-therapeutical assessment of lower urinary tract symptoms in adult men: Systematic review and clinical practice guidelines

INTRODUCTION

The aim was to propose initial and pre-therapeutical assessment of lower urinary tract symptoms in adult men through a systematic review and clinical practice guidelines.

METHODS

These guidelines were based on a systematic review performed between January 2011 and November 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The protocol was registered in the International Prospective Register of Systematic Reviews database (CRD42022336418). The recommendations and the methodology of elaboration were prospectively validated by the French Health Authority (Haute Autorité de santé [HAS]).

RESULTS

In total, 1662 publications were screened for eligibility and 311 met the inclusion criteria, 167 studies were retained among them 17 guidelines from French, European or International institutions. Perform on initial evaluation: identification of cardiovascular risk factors, metabolic syndrome, current medication, urinary and sexual symptoms (by structured interview or validated self-questionnaires), physical examination (lumbar fossa, pelvis, prostate, genitalia), urinalysis (dipstick or microscopy), abdominal ultrasound of the urinary tract (kidneys, bladder, prostate), post-void residual urine measurement (by ultrasound or automated measurement; under physiological conditions). Micturition flowmetry is recommended (except for general practitioners). Update and complete initial assessment before medication, interventional or surgical treatment if too old or incomplete. Perform a preoperative assessment (bleeding risk, infectious risk, geriatric risk). Urodynamic assessment, endorectal ultrasound and cystoscopy should not be systematically performed (only if additional information is needed). Perform urodynamics and urethrocystoscopy in case of failed interventional or surgical treatment. Following the initial workup, it is recommended to refer the patient to a urologist in case of: macroscopic hematuria, recurrent urinary tract infection or persistent perineal and/or suprapubic pain, persistent microscopic hematuria or leukocyturia in absence of urinary tract infection, predominant storage-phase symptoms, abnormal examination of the genitals or suspected prostate cancer, urinary retention, urinary tract stones, ureterohydronephrosis or morphological abnormalities of the prostate or the urinary tract.

CONCLUSION

These guidelines aimed to define the recommended investigation for LUTS in adult men at diagnosis, before medical treatment and before surgical and interventional treatments, in order to better personalize management and avoid unnecessary and/or invasive examinations.

How Do Patients Understand Questions about Lower Urinary Tract Symptoms? A Qualitative Study of Problems in Completing Urological Questionnaires

Lower urinary tract symptoms are common complaints in ageing people. For a urological evaluation of such complaints in men, the International Prostate Symptom Score (IPSS) is used worldwide. Previous quantitative studies have revealed serious problems in completing this questionnaire. In order to gain insight into the nature and causes of these problems, we conducted a qualitative study. Not only the purely verbal IPSS was studied but also two alternatives, including pictograms: the Visual Prostate Symptom Score (VPSS) and the Score Visuel Prostatique en Image (SVPI). Men aged 40 years and over with an inadequate level of health literacy (IHL; n = 18) or an adequate level of health literacy (AHL; n = 47) participated. Each participant filled out one of the three questionnaires while thinking aloud. The analysis of their utterances revealed problems in both health literacy groups with form-filling tasks and subtasks for all three questionnaires. Most noticeable were the problems with the IPSS; the terminology and layout of this form led to difficulties. In the VPSS and SVPI, the pictograms sometimes raised problems. As in previous research on form-filling behavior, an overestimation by form designers of form fillers' knowledge and skills seems to be an important explanation for the problems observed.

Visual Analogue Score for Urinary Symptoms-VASUS, validation of a visual scale for lower urinary tract symptoms (LUTS) in an African country

PURPOSE

Validate a visual scale to assess LUTS, especially in developing countries, as an alternative to IPSS. VASUS consist of five questions, where Q1 and Q2 assess urinary stream quality, Q3 nocturia, Q4 incomplete emptying and Q5 QoL.

METHODS

Between 2014 and 2017, we carried out a study in the male population over 30 years from São Tomé and Príncipe, a Portuguese speaking African Country. A stratified sample (age and district) of subjects completed IPSS, VASUS and a free flowmetry.

RESULTS

We obtained 812 valid responses (average age: 50.72, range: 30-95 years old). In the comparison between IPSS and VASUS, we found positive correlations, with p value < 0.0001, for all variables analyzed and negative correlation for all urodynamic variables. Upon verifying the association of VASUS with IPSS, namely when comparing questions with similar objectives such as nocturia (VASUS-Q3 and IPSS-Q7), the stream quality (VASUS-Q1 and Q2 and IPSS-Q5) or the quality of life (VASUS-Q5 and IPSS-Q8), strong positive correlations were found.

CONCLUSION

VASUS is a visual alternative to IPSS allowing evaluation of LUTS and having correlation with IPSS and flowmetry. Its use in developing countries with low levels of literacy will be an asset. The authors believe that widespread use of a scale such as VASUS in urology consultations is warranted, to increase daily practice objectification of LUTS.

Luts-V: A new simplified score for assessing lower urinary tract symptoms in men

Objectives:

Develop and validate a new and simplified score for evaluating the lower urinary tract symptoms in men.

Materials and methods:

We modified the existing visual prostate symptom score, including changes in the images, sequence, and new alternatives, resulting in a new visual score (LUTS visual score-LUTS-V). For the validation of the new tool, we used the International Prostatic Symptom Score as the gold-standard and the new LUTS-V to 306 men. The total IPSS score and the total LUTS-V score of each subject were evaluated to determine the agreement between the two instruments. ROC curve was used to evaluate the diagnostic accuracy and best cut-off of LUTS-V. Sensitivity, specificity, and diagnostic odds ratios were used to describe the diagnostic properties.

Results:

The mean age of the participants was 59 [52-87] years. There was a significant correlation between LUTS-V and IPSS. (r=0.72 (p <0.0001). The Bland-Altman analyzes demonstrate good agreement between the two questionnaires (bias=5.6%). LUTS-V demonstrated excellent diagnostic accuracy in detecting the most serious cases with an area under the ROC curve of 83% [78-87%] 95% CI. p <0.001). LUTS-V >4 was the best threshold, with a sensitivity of 74% and specificity of 78%.

Conclusions:

LUTS-V is a simple, self-administered tool with a significant discriminatory power to identify subjects with moderate to severe LUTS and may represent a useful instrument for the diagnosis and follow-up of men with urinary symptoms.