Does evaluation with the International Prostate Symptom Score predict the outcome of transurethral resection of the prostate?
OBJECTIVE
We determined the reliability of the International Prostate Symptom Score (I-PSS) in predicting the outcome of transurethral prostatectomy and, therefore, how useful it can be in patient selection for surgery.


METHODS
A prospective trial was done of 105 consecutive patients undergoing transurethral prostatectomy at our institution. Patients were assessed with the I-PSS before and 3 months after surgery. Flow rates and preoperative residual volumes also were measured.


RESULTS
There was significant postoperative improvement in all parameters of the symptom score and a change in symptom profile. Symptoms remaining with the greatest scores at 3 months postoperatively were frequency, urgency and nocturia. A significant correlation was found between I-PSS and quality of life before and after transurethral prostatectomy, and between postoperative improvement in flow rates and change in I-PSS. Patients with a greater preoperative I-PSS gained the most symptomatic benefit. The positive predictive value of a significant postoperative improvement of at least 7 I-PSS points depended on the preoperative I-PSS criteria applied. With a preoperative I-PSS of more than 17 the positive predictive value was 87% with a corresponding negative predictive value of 71%.


CONCLUSIONS
The preoperative I-PSS predicted a symptomatic improvement of more than 7 points with high sensitivity. The predictive value depends on the definition of significant improvement (magnitude of I-PSS change) and the level of I-PSS symptoms defined as sufficient to warrant transurethral prostatectomy.
Hakenberg
O W
OW
Division of Surgery (Urology), Repatriation General Hospital, Daw Park, Australia.
Pinnock
C B
CB
Marshall
V R
VR
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000601:surgery*; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome