The International Prostate Symptoms Score (IPSS)

Oct 22, 2018

The International Prostate Symptom Score (IPSS) is a scoring system used to screen for and diagnose benign prostatic hyperplasia (BPH) as well as to monitor symptoms and guide decisions about how to manage the disease.

The IPSS is based on the answers to eight questions, seven regarding disease symptoms and one question related to the patient’s quality of life.

For the symptom questions, the patient is asked to choose the rating that best represents their condition. The scale ranges from 1 to 5, with 5 representing the most symptomatic disease and giving an overall maximum possible score of 35. The answers to the quality of life question are scored on a scale of 1 to 6.

The symptom questions ask the patient to report on their experience of the following during the past month:

how often the bladder has felt like it s not completely emptied
how often there is an urge to urinate less than two hours after the last time
how often the flow has stopped and started again
how often it is difficult to withhold from urinating
how often the stream of urine is weak
how often urinating is a strain
how often one needs to get up at night to urinate

These symptom questions are the same as those used in the American Urological Association Symptom Index. According to these scoring systems, the scores can be categorized as follows

Symptoms are mild if the score is 7 or less
Symptoms are moderate if the score is 8 to19
Symptoms are severe if the score is 20 to 35

Quality of life, as perceived by the patient, is assessed using the eighth question as per recommendations from The International Scientific Committee (SCI), under the patronage of the World Health Organization (WHO) and the International Union Against Cancer (UICC). For responses to this question, a score of 6 means the patient perceives their quality of life as “terrible,” while a score of 0 indicates that a patient is delighted” with their quality of life.

International prostate symptom score (IPSS)

	Not at all	Less than 1 time in 5	Less than half the time	About half the time	More than half the time	Almost always	Your score
Incomplete emptying Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?	0	1	2	3	4	5
Frequency Over the past month, how often have you had to urinate again less than two hours after you finished urinating?	0	1	2	3	4	5
Intermittency Over the past month, how often have you found you stopped and started again several times when you urinated?	0	1	2	3	4	5
Urgency Over the last month, how difficult have you found it to postpone urination?	0	1	2	3	4	5
Weak stream Over the past month, how often have you had a weak urinary stream?	0	1	2	3	4	5
Straining Over the past month, how often have you had to push or strain to begin urination?	0	1	2	3	4	5

	None	1 time	2 times	3 times	4 times	5 times or more	Your score
Nocturia Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?	0	1	2	3	4	5

Total IPSS score

Quality of life due to urinary symptoms	Delighted	Pleased	Mostly satisfied	Mixed – about equally satisfied and dissatisfied	Mostly dissatisfied	Unhappy	Your score
If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?	0	1	2	3	4	5

Sources