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 moderatesevere severity bands were 15 and 27 respectively for IPSS, 16 and 26 for ICIQMLUTS/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