Comparison of the Visual and International Prostate Symptom Score in the Evaluation of Patients With Benign Prostatic Enlargement at the Kenyatta National Hospital

Abstract

Study background Lower urinary tract dysfunction is a common urological complaint. It is of heterogeneous origin and becomes more prevalent with age. The clinical approach to LUTS features the usage of the IPSS which allows quantification of treatment severity with various discriminant, predictive and evaluation of treatment response roles. The International Prostate Symptom Score (IPSS) is a high-precision instrument that has been validated in multiple languages as a cost-effective tool for the evaluation of lower urinary tract dysfunction. Despite this, its accuracy and consistency are constrained among elderly patients in the developing world where comparatively lower education levels and multilingual societies predominate. The visual prostate symptom score (VPSS) consists of pictogram-based responses and has been found to provide reliable data in patients who are unable to self-administer the IPSS due to prerequisite literacy/numeracy. However, its usage remains unvalidated in Kenya. This study, therefore, scrutinizes the applicability of the visual prostate symptom in the evaluation of patients with benign prostatic enlargement by comparing its findings against those of the established gold standard – the IPSS. Broad objective The main objective of this study was to determine how accurate and reliable the VPSS is in evaluating lower urinary tract dysfunction by comparing it to the IPSS. 10 Study design and site This was a cross-sectional study of patients visiting the urology outpatient clinic at the Kenyatta National Hospital. Participants and methods Consenting patients who presented with symptoms of lower urinary tract dysfunction and benign prostatic enlargement were requested to complete written versions of the novel VPSS and the validated IPSS. Data management The principal outcome measure was the degree of concordance between scores obtained by VPSS and those obtained by IPSS. This was obtained through data analysis using the 26th version of the SPSS software. Pearson’s r value >0.4 was accepted as significant. Data on patient characteristics was also be collected to homogenize patient pools and reduce the influence of known confounders. Results This study detected a high degree of correlation between scores obtained using the novel VPSS and corresponding scores obtained by the IPSS. Pearson’s r-value was 0.6 for the total scores. The VPSS parameters with the highest fidelity were the nocturia and weakness of stream images respectively. The highest degree of correlation was found among patients who filled the VPSS without assistance. Demographic characteristics of the respondents did not significantly impact the degree of correlation...