LUTS (lower urinary tract symptoms) are one of the most common urological problems among adult men. Traditionally, the clinical evaluation of these patients has been based on the International Prostate Symptom Score (IPSS), a validated questionnaire that assesses both voiding and filling-phase LUTS. In clinical practice, however, frequent discrepancies are observed between the severity of filling-phase LUTS reported by patients and the scores obtained on the IPSS, raising the question of whether this questionnaire may underestimate the actual impact of the filling component—typically indicative of an overactive bladder—on the patient’s quality of life. To address this clinical question, our researchers conducted a cross-sectional study of 233 consecutive men who were seeking specialist evaluation for LUTS for the first time.
All participants completed both the IPSS questionnaire and the Overactive Bladder Questionnaire (OABq), a tool specifically designed to assess filling-phase LUTS and overactive bladder symptoms. To specifically investigate patients with symptoms predominantly related to the voiding phase, men who reported filling-phase LUTS on the IPSS were excluded from the analysis. An OABq score ≥40 was considered indicative of moderate-to-severe filling-phase LUTS. The primary objective of the study was to determine whether the OABq could identify additional filling-phase LUTS in patients who, based solely on the IPSS, appeared to have only emptying-phase LUTS, while also assessing the actual impact of these symptoms on quality of life.
I risultati ottenuti sono stati estremamente significativi. Oltre la metà dei pazienti con LUTS prevalentemente della fase di svuotamento secondo l’IPSS presentava un punteggio OABq patologico, a dimostrazione di come una quota rilevante di sintomi da vescica iperattiva sfugga alla valutazione basata sul solo IPSS. I punteggi OABq risultavano significativamente più elevati negli uomini con LUTS della fase di svuotamento severi rispetto a quelli con LUTS della fase di svuotamento lievi (p < 0,001). In particolare, una percentuale di OABq patologico è stata riscontrata nel 67,4% dei pazienti con LUTS della fase di svuotamento moderato-severi e nel 49,6% di quelli con LUTS della fase di svuotamento lievi (p < 0,001).
Multivariate analysis identified younger age, the IPSS score for the voiding phase, and an OABq score ≥40 as independent predictors of poorer quality of life on the IPSS-QoL, regardless of prostate volume and maximum flow rate. The clinical implications of this study are significant: in the evaluation of male patients with LUTS, the IPSS alone is insufficient to fully capture the symptomatic component of the filling phase attributable to overactive bladder. The integration of the OABq into clinical practice allows for the identification of a population of patients with unrecognized overactive bladder symptoms that negatively impact quality of life, thereby enabling a more targeted and personalized therapeutic approach.
Pozzi E, Boeri L, Capogrosso P, Cazzaniga W, Candela L, Fallara G, Schifano N, Costa A, Cignoli D, Tutolo M, Matloob R, Abbate C, Montorsi F, Salonia A. Can We Rely Solely on the International Prostate Symptoms Score to Investigate Storage Symptoms in Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement? Findings from a Cross-sectional Study. Eur Urol Focus. 2022 Mar;8(2):555-562. doi: 10.1016/j.euf.2021.03.004. Epub 2021 Mar 20. PMID: 33757736.
