Questionnaires for patients with benign prostate hyperplasia
The International Prostate Symptom Score (IPSS) is determined by using a standardized questionnaire, commonly employed for screening and monitoring patients with benign prostatic hyperplasia. It is the most frequently used symptom score in studies related to Prostate Artery Embolization (PAE). The IPSS questionnaire comprises seven questions related to symptoms and one question regarding the patient’s quality of life.
The quality-of-life question in the IPSS asks patients to rate how they would feel if they had to live with their current symptoms on a scale of 0 (delighted) to 6 (terrible). Additionally, another questionnaire, the International Index of Erectile Function (IIEF-5), is commonly used to evaluate the impact of treatment on erectile function.
International Prostate Symptom Score (IPSS)
| Over the last 30 days | Not at all | Less (1 every 5 times) | < 1/2 of the times | 1/2 of the times | > 1/2 of the times | Almost always |
|---|---|---|---|---|---|---|
| Incomplete emptying | 0 | 1 | 2 | 3 | 4 | 5 |
| Frequency (Need to urinate in less than 2 hours) | 0 | 1 | 2 | 3 | 4 | 5 |
| Intermittency (Stopped and started again while urinating) | 0 | 1 | 2 | 3 | 4 | 5 |
| Urgency | 0 | 1 | 2 | 3 | 4 | 5 |
| Weak stream | 0 | 1 | 2 | 3 | 4 | 5 |
| Straining | 0 | 1 | 2 | 3 | 4 | 5 |
| None | 1 time | 2 times | 3 times | 4 times | 5 times | |
| Nocturia | 0 | 1 | 2 | 3 | 4 | 5 |
Quality of Life Score:
| Quality of Life due to urinary symptoms | Delighted | Pleased | Mostly satisfied | Mixed | Mostly dissatisfied | Unhappy | Terrible |
|---|---|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 | 6 |
International Index of Erectile Function:
| Last 30 days | 0 | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|---|
| Erectile Function - max score 30 Low IEEF scores (<14 out of 30), patient may be considered for a trial course of therapy with Sildenafil unless contraindicated |
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| How often were you able to get an erection during sexual activity? | No sexual activity | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always |
| When you had erections with sexual stimulation, how often were your erections hard enough for penetration? | No sexual activity | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always |
| When you attempted intercourse, how often were you able to penetrate (enter) your partner? | Did not attempt intercourse | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always |
| During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? | Did not attempt intercourse | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always |
| During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? | Did not attempt intercourse | Extremely difficult | Very difficult | Difficult | Slightly difficult | Not difficult |
| How do you rate your confidence that you could get and keep an erection? | Very low | Low | Moderate | High | Very high | |
| Intercourse Satisfaction - max score 15 Psychosexual counselling should be considered if low scores are recorded |
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| How many times have you attempted sexual intercourse? | No attempts | One to two attempts | Three to four attempts | Five to six attempts | Seven to ten attempts | Eleven or more attempts |
| When you attempted sexual intercourse, how often was it satisfactory for you? | Did not attempt intercourse | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always |
| How much have you enjoyed sexual intercourse? | No intercourse | No enjoyment at all | Not very enjoyable | Fairly enjoyable | Highly enjoyable | Very highly enjoyable |
| Orgasmic Function - max score 10 Patients demonstrating primary orgasmic or ejaculatory dysfunction should be referred for specialist investigation. |
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| When you had sexual stimulation or intercourse, how often did you ejaculate? | No sexual stimulation or intercourse | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always |
| When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax? | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always | |
| Sexual Desire - max score 10 Patients with reduced sexual desire require testing of blood levels of androgen and prolactin. |
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| How often have you felt sexual desire? | Almost never or never | A few times (less than half the time) | Sometimes (about half the time) | Most times (more than half the time) | Almost always or always | |
| How would you rate your level of sexual desire? | Very low or none at all | Low | Moderate | High | Very high | |
| Overall Satisfaction - max score 10 Psychosexual counselling should be considered if low scores are recorded |
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| How satisfied have you been with your overall sex life? | Very dissatisfied | Moderately dissatisfied | Equally satisfied & dissatisfied | Moderately satisfied | Very satisfied | |
| How satisfied have you been with your sexual relationship with your partner? | Very dissatisfied | Moderately dissatisfied | Equally satisfied & dissatisfied | Moderately satisfied | Very satisfied | |
- The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 1992;148(5):1549–1557; discussion 1564.
- Rosen R, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology, 1997, 49: 822-830.
- Sabnis, Ravindra Bhalchandra et al. “The Urological Society of India guidelines on management of benign prostatic hyperplasia/benign prostatic obstruction (Executive summary).” Indian journal of urology : IJU : journal of the Urological Society of India vol. 37,3 (2021): 210-213. doi:10.4103/iju.iju_121_21