IPSS May Not Tell the Whole Story: Integrating ICIQ-MLUTS for Comprehensive LUTS Assessment.

Purpose: This study aimed to assess the limitations of the International Prostate Symptom Score (IPSS) in evaluating male lower urinary tract symptoms (LUTS) and to determine whether the International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS) can uncover clinically relevant symptoms overlooked by IPSS.

Methods: A total of 239 Turkish men aged 50-80 with LUTS were prospectively evaluated using the linguistically validated Turkish versions of the IPSS and the short form of the ICIQ-MLUTS questionnaires. Symptoms not assessed by IPSS (urgency incontinence, stress incontinence, unaware leakage, nocturnal enuresis, postvoid dribbling) were identified. Multivariate logistic regression and ROC analyses were conducted to explore predictors of having at least one of these symptoms with a severity score ≥ 2.

Results: While the IPSS categorized patients into mild (18.0%), moderate (47.7%), and severe (34.3%) LUTS groups, 32.6% of all participants reported at least one significant symptom not captured by IPSS. In multivariate analysis, an IPSS question 4 (urgency) score ≥ 3 was independently associated with a 1.5-fold increased risk (p = 0.002), while being classified as severely symptomatic conferred a 7.7-fold increased risk (p = < 0.001) of having overlooked symptoms. ROC analysis showed acceptable predictive performance (AUC = 0.710 for urgency score ≥ 3; AUC = 0.671 for severe IPSS classification).

Conclusion: A considerable proportion of clinically relevant LUTS, especially incontinence and post-micturition symptoms, go undetected when using IPSS alone. Patients with high urgency scores or severe symptom burden may benefit from further evaluation beyond the IPSS, which highlights the potential role of IPSS as a triage test in LUTS assessment.

Clinical trial registration: This study does not require clinical trial registration because it is not a prospective interventional trial involving human participants.