title: Comparison between visual prostate symptom score and international prostate symptom score in males older than 40 years in rural Indonesia.
abstract: OBJECTIVE
  To evaluate the effect of education and literacy status on completion of the Visual Prostate Symptom Score (VPSS) and the International Prostate Symptom Score (IPSS) in males aged over 40 years in a rural Indonesian area.
  
  
  METHODS
  We enrolled 103 men who had visited Tc-Hillers Maumere Hospital. Four questions related to frequency, nocturia, weak stream, and quality of life (QoL) were presented by pictogram in the VPSS. Data on age, educational level, and literacy status were analyzed to determine associations with the capability to complete the IPSS and the VPSS questionnaires. Correlation test was used to identify correlation between the VPSS and the IPSS.
  
  
  RESULTS
  The median age of the 103 respondents was 60 years. A total of 69 patients (67.0%) were able to read, 99 patients (96.1%) understood the Indonesian language, and 52 patients (50.5%) had an education grade>9. The IPSS was completed without assistance by 55 patients (53.4%) and the VPSS by 82 patients (79.6%). None of the patients who could not read could complete the IPSS without assistance, whereas 15 patients (44.1%) who could not read could complete the VPSS without assistance (P<0.001). In the analysis of education level, 40 of 51 patients (78.4%) with an education grade≤9 required assistance to complete the IPSS compared with 8 of 52 patients (15.4%) with an education grade>9 (P>0.001). In the same groups, 19 of 51 patients (37.3%) compared with 2 of 52 patients (3.8%) required assistance to complete the VPSS (P<0.001). Total VPSS, VPSS obstructive symptoms, VPSS irritative symptoms, and VPSS QoL scores significantly correlated with the total IPSS, IPSS obstructive symptoms, IPSS irritative symptoms, and IPSS QoL, respectively (correlation coefficient, P-value: 0.675, <0.001; 0.503, <0.001; 0.731, <0.001; and 0.823, <0.001, respectively).
  
  
  CONCLUSIONS
  The VPSS correlated significantly with the IPSS and could be completed without assistance by a greater proportion of men with low levels of education. The VPSS might be useful in evaluating men with lower urinary tract symptoms in rural Indonesian areas with a high level of illiteracy and low level of education.
authors.affiliation: Department of Surgery, Tc-Hillers Maumere Hospital, Sikka Regency, Nusa Tenggara Timur, Indonesia.
authors.forename: Andika
authors.initials: A
authors.lastname: Afriansyah
authors.affiliation: Department of Surgery, Tc-Hillers Maumere Hospital, Sikka Regency, Nusa Tenggara Timur, Indonesia.
authors.forename: Yogi Ismail
authors.initials: YI
authors.lastname: Gani
authors.affiliation: Department of Surgery, Tc-Hillers Maumere Hospital, Sikka Regency, Nusa Tenggara Timur, Indonesia.
authors.forename: Hari
authors.initials: H
authors.lastname: Nusali
keywords: Aged; Lower urinary tract symptoms; Male; Nocturia; Prostate