Weiss et al reported an outcome score for men with lower urinary tract symptoms (LOTS). This can be used to evaluate the patient initially and to monitor the patient’s response to therapy. The authors are from New York Presbyterian Hospital-Weill Medical College of Cornell University, University of New York, and Lenox Hill Hospital in New York City.
The LOS uses 6 of the 7 questions from the International Prostate Symptom Score (IPSS). The IPSS scores responses from 0 (good) to 5 (poor)
Parameters:
(1) subjective response to therapy
(2) number of times that urine voidings per day
(3) maximum volume of voided urine in mL (MVV)
(4) measured peak flow rate in mL per second
(5) residual volume post-void
(6) urgency (question 4 of the IPSS)
(7) nocturia (question 7 of the IPSS)
(8) average of the responses for 4 questions from the IPSS
(8a) not emptying the bladder (question 1 on IPSS)
(8b) stopping and starting of urine stream (question 3 on IPSS)
(8c) weak stream (question 5 on IPSS)
(8d) need to push or strain to start urination (question 6 on IPSS)
(9) need for catheterization
|
Parameter |
Finding |
Points |
|---|---|---|
|
subjective response |
cured |
0 |
|
|
improved |
1 |
|
|
same (unchanged) |
2 |
|
|
worse |
2 |
|
number of voids per day |
<= 8 |
0 |
|
|
9 to 11 |
1 |
|
|
12 or more |
2 |
|
maximum volume of void |
>= 250 mL |
0 |
|
|
150 to 249 mL |
1 |
|
|
< 150 mL |
2 |
|
peak flow rate |
>= 15 mL per second |
0 |
|
|
10 to 14.9 mL per second |
1 |
|
|
< 10 mL per second |
2 |
|
post-void residual volume |
<= 50 mL |
0 |
|
|
50.1 to 200 mL |
1 |
|
|
> 200 mL |
2 |
|
urgency |
0 or 1 on IPSS |
0 |
|
|
2 or 3 on IPSS |
1 |
|
|
4 or 5 on IPSS |
2 |
|
nocturia |
0 or 1 on IPSS |
0 |
|
|
2 or 3 on IPSS |
1 |
|
|
4 or 5 on IPSS |
2 |
subscore for first 7 items
= SUM(points for the first 7 items)
|
Parameter |
Finding |
Points |
|---|---|---|
|
not emptying |
0 or 1 on IPSS |
0 |
|
|
2 or 3 on IPSS |
1 |
|
|
4 or 5 on IPSS |
2 |
|
stopping and starting |
0 or 1 on IPSS |
0 |
|
|
2 or 3 on IPSS |
1 |
|
|
4 or 5 on IPSS |
2 |
|
weak stream |
0 or 1 on IPSS |
0 |
|
|
2 or 3 on IPSS |
1 |
|
|
4 or 5 on IPSS |
2 |
|
pushing and straining |
0 or 1 on IPSS |
0 |
|
|
2 or 3 on IPSS |
1 |
|
|
4 or 5 on IPSS |
2 |
subscore for item 8 =
= SUM(points for the 4 questions) / 4
|
Parameter |
Finding |
Points |
|---|---|---|
|
need for catheterizaton |
no |
0 |
|
|
yes |
16 |
total score =
= MAX((points for catheterization), (subscore for first 7 items) + (subscore for item 8))
Interpretation:
• minimum LOS: 0
• maximum LOS: 16
• The higher the LOS the worse the outcome.
Performance:
• The Cronbach alpha was 0.81.
• The objective questions help to reduce the likelihood of under- or over-estimating outcomes.
Specialty: Nephrology, Clinical Laboratory
