Modified IPSS Score – Is it Necessary?

Dear All,

I am providing a modified amendment of the Existing IPSS score.

In this version of modified IPSS, more weightage is provided for Nocturia, Intermittency and Hesitancy/ delay. Along with fluid intake and medications are not given much importance in Present IPSS. Should these factors be given more importance and added as non inclusion will result in poorer outcomes of Treatments.

I am hopeful that this proposal will have varied opinion among the members of this Group.

With warm Regards,

Venu

Proposed Amendments to IPSS Scores

Section A

Symptoms

Score

 

1

2

3

Nocturia (waking up to pass urine at night)

0–1/night - 2/night

3/night

≥4/night

Frequency (of passing urine)

≥4 hours - 3 hours

2 hours

≤1 hour

Urgency (intense urination urge)

None - Sometimes

Most of the time

Always

Delay/hesitancy (in starting urination)

None - Sometimes

Most of the time

Always

Straining (pushing to urinate)

None - Sometimes

Most of the time

Always

Urine flow

Full force - Moderate force

Weak force

Drops

Intermittency (stop/start urination)

None - Sometimes

None - Sometimes

Always

Incomplete emptying

None - Sometimes

None - Sometimes

Always

Symptoms score

0: Normal

1-8: Mild

9-16: Moderate

17-28: Severe

Quality of life score

0Delighted

1 - Mixed

2 - Bad

3 - Terrible

Section B

Drinks (mugs/glasses): water/coffee/tea/fizzy drinks/alcohol/other

Total fluid intake (litres): 0.5–1 L/1.1–2 L/2.1–3 L/>3 L

Medication: diuretics/alpha blockers/anticholinergics/antidepressants/antipsychotics/Ca channel blockers/ACE inhibitors/other

 

Comments(7)

  • Altaf Khan
    Altaf Khan
    02 Dec 2020 08:55:56 PM

    Dear Sir,

    I think if we can quantify each symptoms by number of times rather than sometimes or most of the times, it will be easier to calculate the score.
    Total maximal score of eight symptoms comes to 24, but you have put severe symptoms score 17-28, does it include quality of life score too?
    How will you be scoring section B to know the outcome of treatment?

    Warm Regards
    Altaf Khan

  • Ravindra Sabnis
    Ravindra Sabnis
    03 Dec 2020 07:54:00 PM

    It is everyone's experience that current IPSS form is not easy for many Indians to understand. Often requires assistance which removes its authenticity. I agree with you sir that some times too many options are confusing. However sometimes, too less options also does not represent what a person wants to say. It is nice that you have made attempts to simplify IPSS score by giving not too many options & also simplifying questions. 

    However I have following suggestions 
    1) Intermittency & incomplete voiding - score 1 & 2 are same so patient will get confused where to put score. 
    2) Urgency & hesitancy are two tricky symptoms. here more options is useful. If we restrict to only 3 options - then pts who have more that some times but not most often - will be forced to put it somewhere. Also none & sometimes have same weightage. 
    3) First two questions are correct & removes lot of confusion from previous chart. 
    Dr Altaf's comments are also valid. 
    Actually nomenclature itself is always challanged but nothing is done. It is not prostate score - but it is outlet obstruction score, Can be used in females also. names are gives as micturation symptom score but nothing is materialised 
    I feel this simplified score may be easy & relevant in our context

  • Venugopal P
    Venugopal P
    05 Dec 2020 09:29:43 AM

    Dear All,

    Let me clearly mention that these modified IPSS score is not my creation as thought of by Sabnis. I did not post the article from which I took it because I wanted to know the opinion of our experts as regards this.

    https://journals.sagepub.com/doi/pdf/10.1177/2051415820972569

    I am also of the opinion that the IPSS score as suggested by AUA and others are not really useful for a country like India. Many of my generation who has LUTS cannot appreciate the questions asked and most of the time needs the help of others to fill them up and even then the ‘other’ has to interpret it properly.

    Sanman along with I and Others have brought out the Usefulness VPSS (Visual Prostate Symptom Score), modified from the work of Chris LE van der Walt, Chris F Heyns, Adam E Groeneveld et al (2011, Urology). Sanman has modified it to be made useful for us Indians. The simplicity of Modified VPSS is such that it can be used by most elderly with LUTS with no help from others.

    https://www.indianjurol.com/article.asp?issn=0970-1591;year=2020;volume=36;issue=2;spage=123;epage=129;aulast=Sanman (PDF available)

    https://www.indianjurol.com/temp/IndianJUrol362123-9627515_024027.pdf

    To this probably addition of Nocturia, Hesitancy/ delay could be added to give more validity for the symptom score.

    I hope others in our group will let us have their opinion as regards IPSS and its utility for a country like India.

    With warm regards,

    Venu

     

  • Sanman K N
    Sanman K N
    05 Dec 2020 05:38:50 PM

    Dear sir and all, 

    Existing IPSS has its own limitations , begining with complexity of scoring system ,it's interpretation,not only for patients, even for non Urology doctors. Also Major draw back of recall memory and the "poor stream" component is totally subjective . 

    For all these reasons , simplified version for assessment , VPSS - Visual prostrate symptom score by Dr Wander Walt and Professor Chris Hynes came in . Even that had subjective parameter which was unattended and also original VPSS had no grading of severity. To overcome these limitations , we have come up with " New , Improvised VPSS" , which has validation of symptom score and also had suggested severity grading on par with IPSS but simpler than IPSS, for Indian prospect to begin with.

    Present article modified IPSS ,had made IPSS still more complex by adding part B.
    As Sabnis sir rightly said, sometimes efforts to simplify complex things ,might not address all parameters of what one had to measure. However all efforts " Re - search" are  need to be welcomed with open mind for critical analysis  and external validation rather than only criticizing.
    More over science is not stagnant water but ,which needs to be continuous flow of knowledge with new dimensions.
    Thank you,
    Dr Sanman K N


  • Ravindra Sabnis
    Ravindra Sabnis
    06 Dec 2020 07:31:39 PM

    From all the comments we had, & our experience for many decades now, it is very clear that IPSS does not give us what we want, & hence some modification is required. presently we are continuing with IPSS because we have no option. I feel VPSS or as suggested in article posted by Venu sir, things can be adopted. Unless we adopt & start using, we will not know the benefits. May be few years down the line new score may totally replace present IPSS. 

  • Dr. Roy Chally
    Dr. Roy Chally
    08 Dec 2020 02:44:21 PM

    Agree that the second part is unnecessary. The modified scoring symptoms has more items. As Subnis mentioned we struggle with our patients to get the form filled. Hence I am not happy to see more items in the scoring sheet. 

         The more troublesome  symptoms in BOO due to BEP are urgency, urge wetting and nocturnal frequency. I dot see any special weightage in the scoring for these symptoms. 
        The scoring system is for some objectivity. This scoring and the conventional IPSs should be compared with the quality of life score. Ideally the Prostate symptom score should have good correlation with quality of life score. 
        In the natural history of BOO due to BEP the symptoms waxes and wanes. Hence the scoring system can be misleading in follow up studies. 
      In clinical practice I see little benefit for recording IPPS. Recording the quality of life score should be more helpful. 

  • Dr. Roy Chally
    Dr. Roy Chally
    08 Dec 2020 09:03:59 PM

    Agree that the second part is unnecessary. The modified scoring symptoms has more items. As Subnis mentioned we struggle with our patients to get the form filled. Hence I am not happy to see more items in the scoring sheet. 

         The more troublesome  symptoms in BOO due to BEP are urgency, urge wetting and nocturnal frequency. I dot see any special weightage in the scoring for these symptoms. 
        The scoring system is for some objectivity. This scoring and the conventional IPSs should be compared with the quality of life score. Ideally the Prostate symptom score should have good correlation with quality of life score. 
        In the natural history of BOO due to BEP the symptoms waxes and wanes. Hence the scoring system can be misleading in follow up studies. 
      In clinical practice I see little benefit for recording IPPS. Recording the quality of life score should be more helpful. 

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