International Prostate Symptom Score

The International Prostate Symptom Score (IPSS) is an 8 question (7 symptom questions + 1 quality of life question) written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the disease Benign Prostatic Hyperplasia (BPH). Created in 1992 by the American Urological Association, it originally lacked the 8th QOL question, hence its original name: the American Urological Association symptom score (AUA-7).

The IPSS was designed to be self-administered by the patient, with speed and ease in mind. Hence, it can be used in both urology clinics as well as the clinics of primary care physicians (i.e. by general practitioners) for the diagnosis of BPH.Additionally, the IPSS can be performed multiple times to compare the progression of symptoms and their severity over months and years.

In addition to diagnosis and charting disease progression, the IPSS is effective in helping to determine treatment for patients. Patients with benign prostatic hyperplasia (BPH) either 1) may need no treatment, just observation, because many patients stay the same or even improve over the years, or 2) many need only medical treatment, a) either only with an alpha-1-adrenergic antagonist, e.g. tamsulosin, or b) with an alpha-1-adrenergic antagonist plus finasteride, depending on the severity of their symptoms, or 3) may need surgical intervention. [Patel AK, Chapple CR. Benign prostatic hyperplasia: treatment in primary care. BMJ. 2006 Sep 9;333(7567):535-9. Review.] [Wasserman NF. Benign prostatic hyperplasia: a review and ultrasound classification. Radiol Clin North Am. 2006 Sep;44(5):689-710, viii. Review.] [Burnett AL, Wein AJ. Benign prostatic hyperplasia in primary care: what you need to know. J Urol. 2006 Mar;175(3 Pt 2):S19-24. Review.] [Dull P, Reagan RW Jr, Bahnson RR. Managing benign prostatic hyperplasia. Am Fam Physician. 2002 Jul 1;66(1):77-84. Review.] [McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM Jr, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA; Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003 Dec 18;349(25):2387-98. [http://content.nejm.org/cgi/content/abstract/349/25/2387 Fulltext] ]

BPH patients are treated with surgery if a) BPH becomes a risk factor for upper urinary tract damage (i.e. damage to the ureters and kidneys, which may include severe damage such as pyelonephritis, hydronephrosis, and renal failure), or b) if the symptoms of BPH on the lower urinary tract become serious (i.e. 1) recurrent infections, or 2) bladder decompensation, i.e. urinary retention >25% immediately after voiding the bladder). In all non-emergency cases, not only the severity of BPH symptoms, but also the subjective quality-of-life of the patient and the wishes of the patient are taken into account before deciding on surgery.

The IPSS is available free-of-charge on the Internet. See: http://www.gp-training.net/protocol/docs/ipss.docOr see: http://www.usrf.org/questionnaires/AUA_SymptomScore.html

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