Prospective Evaluation of a New Visual Prostate Symptom Score, the International Prostate Symptom Score, and Uroflowmetry in Men With Urethral Stricture Disease

Abstract

To evaluate the correlation between the visual prostate symptom score (VPSS) and the international prostate symptom score (IPSS) and uroflowmetry parameters in men with urethral stricture disease. The VPSS offers a nonverbal, pictographic assessment of lower urinary tract symptoms. A total of 100 men followed up with a diagnosis of urethral stricture were evaluated from March 2011 to November 2012 with IPSS, VPSS, uroflowmetry, urethral calibration, and urethrography. Follow-up every 3 months for 3-18 months was available in 78 men for a total of 289 visits. Procedures performed were urethral dilation in 105, internal urethrotomy in 54, and urethroplasty in 8 patients. Statistical analysis was performed with Spearman's rank correlation, Fisher's exact, and Student t tests. The time taken to complete the VPSS vs IPSS was significantly shorter (118 vs 215seconds at the first and 80 vs 156seconds at follow-up visits; P<.001). There were significant correlations between the VPSS and IPSS (r= 0.845; P<.001), maximum urinary flow rate (Qmax; r= 0.681; P<.001) and urethral diameter (r=-0.552; P<.001). A combination of VPSS >8 and Qmax<15mL/s had positive and negative predictive values of 87% and 89%, respectively, for the presence of urethral stricture. The VPSS correlates significantly with the IPSS, Qmax, and urethral diameter in men with urethral stricture disease and takes significantly less time to complete. A combination of VPSS >8 and Qmax<15mL/s can be used to avoid further invasive evaluation during follow-up in men with urethral strictures.