International Prostate Symptoms Score (IPSS)
Used to quantify benign prostatic hyperplasia (BPH) & to monitor treatment success.
Provided by
SMSNAInstructions
Ask: "Over the past month..."
The International Prostate Symptom Score (I-PSS) is based on the answers to seven questions concerning urinary symptoms and one question concerning quality of life. Each question concerning urinary symptoms allows the patient to choose one out of six answers indicating increasing severity of the particular symptom. The answers are assigned points from 0 to 5. The total score can therefore range from 0 to 35 (asymptomatic to very symptomatic).
The questions refer to the following urinary symptoms:
| Question | Symptom |
| 1 | Incomplete emptying |
| 2 | Frequency |
| 3 | Intermittency |
| 4 | Urgency |
| 5 | Weak Stream |
| 6 | Straining |
| 7 | Nocturia |
Question eight refers to the patient’s perceived quality of life. The first seven questions of the I-PSS are identical to the questions appearing on the American Urological Association (AUA) Symptom Index which currently categorizes symptoms as follows:
| Severity | Score |
| Mild | <8 |
| Moderate | 8-19 |
| Severe | 20-35 |
The International Scientific Committee (SCI), under the patronage of the World Health Organization (WHO) and the International Union Against Cancer (UICC), recommends the use of only a single question to assess the quality of life. The answers to this question range from “delighted” to “terrible” or 0 to 6. Although this single question may or may not capture the global impact of benign prostatic hyperplasia (BPH) Symptoms or quality of life, it may serve as a valuable starting point for a doctor-patient conversation. The SCI has agreed to use the symptom index for BPH, which has been developed by the AUA Measurement Committee, as the official worldwide symptoms assessment tool for patients suffering from prostatism. The SCI recommends that physicians consider the following components for a basic diagnostic workup: history; physical exam; appropriate labs, such as U/A, creatine, etc.; and DRE or other evaluation to rule out prostate cancer.
All questions & possible results
Instructions
Ask: "Over the past month..."
Residual Urine: How often have you had the sensation of not emptying your bladder completely?
Select one option:
- Not at all
- Less than 1 time in 5
- Less than half of the time
- About half of the time
- More than half of the time
- Almost Always
Frequency: How often have you had to urinate again less than two hours?
Select one option:
- Not at all
- Less than 1 in 5
- Less than half of the time
- About half of the time
- More than half of the time
- Almost always
Intermittency: How often have you found you stopped and started again several times when you urinated?
Select one option:
- Not at all
- Less than 1 in 5
- Less than half of the time
- About half of the time
- More than half of the time
- Almost always
Urgency: How difficult have you found postponing urination?
Select one option:
- Not at all
- Less than 1 in 5
- Less than half of the time
- About half of the time
- More than half of the time
- Almost always
Weak Stream: How often have you had a weak urinary stream?
Select one option:
- Not at all
- Less than 1 in 5
- Less than half of the time
- About half of the time
- More than half of the time
- Almost always
Straining: How often have you had to strain to start urination?
Select one option:
- Not at all
- Less than 1 in 5
- Less than half of the time
- About half of the time
- More than half of the time
- Almost always
Nocturia: How many times did you typically get up at night to urinate?
Select one option:
- None
- 1 Time
- 2 Times
- 3 Times
- 4 Times
- 5 Times
Quality of life: 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?
Select one option:
- Delighted
- Pleased
- Mostly Satisfied
- Mixed
- Mostly Dissatisfied
- Unhappy
- Terrible
Possible results
BPH Quality of Life Score 6 (out of 6 pts) - Terrible
On a scale of 0 (best) to 6 (worse).
BPH Quality of Life Score 3 (out of 6 pts) - Mixed
On a scale of 0 (best) to 6 (worse).
Prostate Symptom Score: Mild (<8 pts)
Evaluation of LUTS in Men
The IPSS tool has no diagnostic value since other diseases (e.g., infections, neurogenic lower urinary tract dysfunction or tumors) may also cause a high IPS score.
The International Scientific Committee (SCI) recommends that physicians consider the following components for a basic diagnostic workup:
- History & physical exam
- Appropriate labs (e.g., U/A, creatine, etc.)
- DRE or other evaluation to rule out prostate cancer.
Consider urology referral if symptoms are severe, progressive, or if there is suspicion of another pathology, like prostate cancer.
Management
- Mild (score 0-7): Often managed with behavioral and lifestyle modifications.
- Moderate to severe (score 8-35):
- Consider alpha-blockers, 5-alpha-reductase inhibitors, antimuscarinics, beta-3 agonists, or combination therapy.
- For severe cases unresponsive to medical therapy, surgical options may be explored.
Prostate Symptom Score: Moderate (8-19 pts)
Evaluation of LUTS in Men
The IPSS tool has no diagnostic value since other diseases (e.g., infections, neurogenic lower urinary tract dysfunction or tumors) may also cause a high IPS score.
The International Scientific Committee (SCI) recommends that physicians consider the following components for a basic diagnostic workup:
- History & physical exam
- Appropriate labs (e.g., U/A, creatine, etc.)
- DRE or other evaluation to rule out prostate cancer.
Consider urology referral if symptoms are severe, progressive, or if there is suspicion of another pathology, like prostate cancer.
Management
- Mild (score 0-7): Often managed with behavioral and lifestyle modifications.
- Moderate to severe (score 8-35):
- Consider alpha-blockers, 5-alpha-reductase inhibitors, antimuscarinics, beta-3 agonists, or combination therapy.
- For severe cases unresponsive to medical therapy, surgical options may be explored.
BPH Quality of Life Score 5 (out of 6 pts) - Unhappy
On a scale of 0 (best) to 6 (worse).
BPH Quality of Life Score 0 (out of 6 pts) - Delighted
On a scale of 0 (best) to 6 (worse).
BPH Quality of Life Score 1 (out of 6 pts) - Pleased
On a scale of 0 (best) to 6 (worse).
Prostate Symptom Score: Severe (>19 pts)
Evaluation of LUTS in Men
The IPSS tool has no diagnostic value since other diseases (e.g., infections, neurogenic lower urinary tract dysfunction or tumors) may also cause a high IPS score.
The International Scientific Committee (SCI) recommends that physicians consider the following components for a basic diagnostic workup:
- History & physical exam
- Appropriate labs (e.g., U/A, creatine, etc.)
- DRE or other evaluation to rule out prostate cancer.
Consider urology referral if symptoms are severe, progressive, or if there is suspicion of another pathology, like prostate cancer.
Management
- Mild (score 0-7): Often managed with behavioral and lifestyle modifications.
- Moderate to severe (score 8-35):
- Consider alpha-blockers, 5-alpha-reductase inhibitors, antimuscarinics, beta-3 agonists, or combination therapy.
- For severe cases unresponsive to medical therapy, surgical options may be explored.
BPH Quality of Life Score 4 (out of 6 pts) - Mostly Dissatisfied
On a scale of 0 (best) to 6 (worse).
BPH Quality of Life Score 2 (out of 6 pts) - Mostly Satisfied
On a scale of 0 (best) to 6 (worse).
Citation
Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992 Nov;148(5):1549-57; discussion 1564. doi: 10.1016/s0022-5347(17)36966-5. PMID: 1279218.
Literature
- The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992 Nov;148(5):1549-57; discussion 1564. — Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT.
- Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management. J Urol. 2021 Oct;206(4):806-817. doi: 10.1097/JU.0000000000002183. Epub 2021 Aug 13. Erratum in: J Urol. 2021 Nov;206(5):1339. — Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, Gandhi MC, Kaplan SA, Kohler TS, Martin L, Parsons JK, Roehrborn CG, Stoffel JT, Welliver C, Wilt TJ.
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