DEVELOPMENT OF A MULTIREGIONAL UNITED STATES SPANISH VERSION OF THE INTERNATIONAL PROSTATE SYMPTOM SCORE AND THE BENIGN PROSTATIC HYPERPLASIA IMPACT INDEX

How international is the International Prostate Symptom Score? A literature review of validated translations of the IPSS, the most widely used self-administered patient questionnaire for male lower urinary tract symptoms

OBJECTIVES

The International Prostate Symptom Score (IPSS) approaches its 30th anniversary. This ubiquitous clinical assessment tool is a standard in the assessment and research of lower urinary tract symptoms in men. The authors explore its history, development, and subsequent dissemination through validated translations across the world. An estimated global coverage is calculated and mapped according to language population.

METHODS

Embase and Medline literature searches were performed, with further hand searches of grey literature and online resources. Twenty-two abstracts and journal articles validating language translations of the IPSS were reviewed in full and tabulated. Language population data were gathered from an official database and mapped.

RESULTS

The IPSS is available in 53 languages. Twenty-seven languages have statistically or clinically validated translations for use in male patients. This corresponds to a conservative estimate of global population coverage of approximately 2.3 billion men, or 60% of the worldwide male population. Translation methodology involves forward and back translation. Statistical validation is performed with control patients. Cronbach's alpha is used for internal consistency, and Spearman's coefficient (p) or Pearson's coefficient (r) for test-retest reliability. Issues such as the emergence of altered versions deviating from original validated translations and translation difficulties due to cultural differences are observed. Further translational work is needed to validate versions of the IPSS in languages of the developing world.

CONCLUSIONS

The IPSS is the most prevalent patient-administered questionnaire used in urology across the world. There is no other clinical tool seen to have similar coverage. This paper aims to provide a roadmap for future clinical tools to acquire a similar level of translation and dissemination.

Prospective comparison of a new visual prostate symptom score versus the international prostate symptom score in men with lower urinary tract symptoms

OBJECTIVE

To evaluate the correlation between the International Prostate Symptom Score (IPSS) and a new Visual Prostate Symptom Score (VPSS) using pictures rather than words to assess lower urinary tract symptoms (LUTS).

METHODS

Four IPSS questions related to frequency, nocturia, weak stream, and quality of life (QoL) were represented by pictograms in the VPSS. Men with LUTS were given the IPSS and VPSS to complete. Peak (Qmax.) and average (Qave.) urinary flow rates were measured. Statistical analysis was performed using Student's t, Fisher's exact, and Spearman's correlation tests.

RESULTS

The educational level of the 96 men (mean age 64, range 33-85 years) evaluated August 2009 to August 2010 was school grade 8-12 (62%), grade 1-7 (28%), university education (6%), and no schooling (4%). The IPSS was completed without assistance by 51 of 96 men (53%) and the VPSS by 79 of 96 men (82%) (P<.001). Comparing education grade<7 vs grade>10 groups, the IPSS required assistance in 27 of 31 men (87%) vs 9 of 38 men (24%) (P<.001), and the VPSS required assistance in 10 of 31 men (32%) vs 3 of 38 men (8%) (P=.014). There were statistically significant correlations between total VPSS, Qmax. and Qave., total VPSS and IPSS, and individual VPSS parameters (frequency, nocturia, weak stream and QoL) vs their IPSS counterparts.

CONCLUSIONS

The VPSS correlates significantly with the IPSS, Qmax. and Qave., and can be completed without assistance by a greater proportion of men with limited education, indicating that it may be more useful than the IPSS in patients who are illiterate or have limited education.

How to engage the Latino or African American patient with benign prostatic hyperplasia: crossing socioeconomic and cultural barriers

Disparities based on race and ethnicity still exist in the US healthcare system. Such disparities are reflected in the diagnosis and treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among African Americans and Latinos. The prevalence of risk factors for BPH and LUTS and symptom progression are higher in these populations, but treatment is less common. African American men and Latinos frequently have other serious comorbidities, such as cardiovascular disease, diabetes mellitus, and metabolic syndrome. Health plan constraints and variabilities, race/ethnicity, socioeconomic status, language, healthcare-seeking behaviors, and cultural beliefs and practices influence the treatment of BPH and LUTS, oftentimes resulting in unequal access to care or inferior quality of care. The provision of nondiscriminatory treatment poses a challenge to clinicians that can partially be addressed by improving the cultural competence of practitioners in minority communities. An awareness of the customs and healing traditions of African Americans and Latinos may also facilitate culturally appropriate care and improve outcomes, and the participation of clinicians in continuing education/professional development programs to increase knowledge about minority health issues is recommended. Conversely, improving the health literacy of African American and Latino patients with BPH and LUTS can help avoid ineffective nontraditional methods of treatment.