Comparison of lower urinary tract symptoms between incontinent males and females: An analysis of AUASS and its subdomains.

Abstract

Introduction and objectives: The American Urological Association Symptom Score (AUASS) assesses lower urinary tract symptoms (LUTS), primarily in males with benign prostatic hyperplasia. Though validated in females, differences remain understudied. This study compares AUASS in incontinent males and females, evaluating LUTS severity across total score, voiding and storage subdomains, and quality of life (QoL). Comparing sex-specific differences in LUTS prevalence, risk factors, and severity may help providers deliver patient-centered incontinence care.

Methods: A single-institution retrospective review (2019-2025) included incontinent patients (Michigan Incontinence Symptom Index: M-ISI > 7) who completed AUASS and M-ISI within 7 days. Independent t-tests and chi-squared tests were used where appropriate. Multivariable linear regression assessed the effects of sex on AUASS, adjusting for demographics and comorbidities.

Results: 5304 incontinent patients were included for further analysis including 3374 males and 1930 females. On univariable analysis, total AUASS did not significantly differ between males and females (p = 0.37). Urge incontinence was associated with increased AUASS severity across all subdomains (p < 0.024). On multivariable analysis, female sex was an independent predictor of lower total AUASS severity (p < 0.001) and voiding scores (p < 0.001), but worse QoL (p < 0.001). Absolute differences between sexes were small (<1.1 points across all metrics). Younger age and multiple comorbidities predicted worse total AUASS (p < 0.001).

Conclusion: This AUASS assessment reveals significant demographic variations in LUTS severity. Overall, urge incontinence was the strongest predictor of worse AUASS scores. Although female sex was independently associated with slightly lower AUASS scores, the magnitude of these differences was small and may not be clinically significant. Females reported worse QoL despite lower adjusted symptom scores, suggesting that factors beyond measured symptom severity may contribute to patient-perceived burden.