International Prostate Symptom Score (IPSS) vs. International Consultation on Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (ICIQ-MLUTS)

A recently published article from Turkey¹ discusses perceived limitations of the International Prostate Symptom Score (IPSS) in evaluating male lower urinary tract symptoms (LUTS) and whether the International Consultation on Incontinence (ICI) Questionnaire-Male LUTS (ICIQ-MLUTS) might better capture the full symptom burden experienced by men seeking care because of LUTS. The latter is a validated patient related outcome measure given an A grade by the ICI. It consists of 13 questions, each scored 0-4 in terms of severity, which are summed to give the overall score. In addition to questions addressed by the IPSS, the ICIQ-MLUTS questions specifically address the additional symptoms of urgency urinary incontinence, stress urinary incontinence, insensate urinary loss, nocturnal enuresis, and post micturition symptoms like post void dribbling. The “bother” of each symptom is identified separately and given a score of 1-10.

Based on a cross-sectional analysis of 313 men, with appropriate exclusions, presenting for the first time for evaluation of LUTS, the authors reported that 32.6% reported symptoms that were missed when only the IPSS was utilized. Additionally, they reported that a score of greater than 3 on IPSS question 4(urgency)was significantly associated with the likelihood of having symptoms that were missed when only the IPSS was used. They conclude that while the IPSS remains a practical first line tool for LUTS evaluation, it is insufficient on its own for capturing the full symptom burden of men with LUTS. They suggest a two-step approach, using the IPSS for broad initial screening as a “triage test”, followed by the ICIQ-MLUTS to detect overlooked but clinically relevant symptoms, especially in those who are highly symptomatic or who score 3 or above on IPSS question 4.

The conclusions regarding ICIQ-MLUTS echo those expressed in an earlier article,² that is, that this questionnaire is more comprehensive than IPSS as it includes symptoms omitted by IPSS that are potentially important to men. This article proposes banding ranges for ICI-MLUTS for both severity and bother. Thresholds between mild-moderate and moderate-severe were 16 and 26 for severity and 22 and 81 for severity. The authors also questioned the 1992 banding of symptom severity for IPSS as yielding too many “false positives” and argued that the ICIQ-MLUTS provides a more comprehensive insight than IPSS in the diagnostic assessment pathway.

The whole range of ICIQ assessments can easily be accessed on the internet

Written by: Alan Wein, MD, PhD, FACS, Professor of Clinical Urology, Department of Urology, Desai Sethi Urology Institute (DSUI), University of Miami Miller School of Medicine, University of Miami Health Systems, Miami, FL

References:

Guzeloy M, Erkin A, IPSS may not tell the whole story: integrating ICIQ-MLUTS for comprehensive LUTS assessment. Neurourology Urodynamics, 2025, https://doi.org/10.1002/nau.70156
Ito, H, Young, A, Lewis A et al. Grading severity and bother using the international prostate symptom score and international consultation on incontinence questionnaire male lower urinary tract symptoms score in men seeking lower urinary tract symptoms therapy, J. Urology, 2020; 204: 1003-1011

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