The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty.
OBJECTIVE
To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty.


METHODS
This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence.


RESULTS
Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56).


CONCLUSIONS
The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.
Department of Urology, University of Iowa, Iowa City, IA.
Christopher A
CA
Tam
Department of Urology, University of Minnesota, Minneapolis, MN.
Sean P
SP
Elliott
Department of Urology, University of Washington, Seattle, WA.
Bryan B
BB
Voelzke
Division of Urology, University of Utah, Salt Lake City, UT.
Jeremy B
JB
Myers
Lahey Hospital and Medical Center, Institute of Urology, Burlington, MA.
Alex J
AJ
Vanni
Department of Urology, University of California, San Francisco, CA.
Benjamin N
BN
Breyer
Department of Urology, Baylor University, Waco, TX.
Thomas G
TG
Smith
Department of Urology, Ohio State University, Columbus, OH.
Christopher D
CD
McClung
Department of Urology, University of Iowa, Iowa City, IA. Electronic address: brad-erickson@uiowa.edu.
Bradley A
BA
Erickson
D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D063189:Symptom Assessment; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000175:diagnosis* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods