Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score


Tetsuya Fukimura, Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. e-mail:


Study Type – Therapy (symptom prevalence)

Level of Evidence 2a

What's known on the subject? and What does the study add?

The International Prostate Symptom Score (IPSS) has been most commonly used for the symptom assessment of men with lower urinary tract symptoms (LUTS). However, LUTS in men are so variable that they may not be fully captured by the IPSS questionnaire alone. This study has demonstrated that the Core Lower Urinary Tract Symptom Score (CLSS) questionnaire, which addresses 10 important symptoms, is an appropriate initial assessment tool for LUTS in men with various diseases/conditions.


• International Prostate Symptom Score (IPSS) has been commonly used to assess lower urinary tract symptoms (LUTS). We have recently developed Core Lower Urinary Tract Symptom Score (CLSS). The aim of this study is to compare IPSS and CLSS for assessing LUTS in men.


• Consecutive 515 men fulfilled IPSS and CLSS questionnaires.

• IPSS QOL Index was used as the QOL surrogate.

• The clinical diagnoses were BPH (n = 116), BPH with OAB wet (n = 80), prostate cancer (n = 128), prostatitis (n = 68), underactive bladder (n = 8), others (n = 72), and controls (e.g., occult blood) (n = 42).

• Simple statistics and predictability of poor QOL (QOL Index 4 or greater) were examined.


• All symptom scores were significantly increased in symptomatic men compared with controls. Scores of corresponding symptoms of two questionnaires were significantly correlated (r = 0.58–0.85, all P < 0.0001).

• A multivariate regression model to predict poor QOL indicated nine symptoms (daytime frequency, nocturia, urgency, urgency incontinence, slow stream, straining, incomplete emptying, bladder pain and urethral pain) as independent factors.

• The hazard ratios for bladder pain (2.2) and urgency incontinence (2.0) were among the highest.

• All the nine symptoms are addressed in CLSS, while three symptoms (urgency incontinence, bladder, and urethral pain) are dismissed in IPSS.


• CLSS questionnaire is more comprehensive than IPSS questionnaire for symptom assessment of men with various diseases/conditions, although both questionnaires can capture LUTS with possible negative impact on QOL.