The international prostate symptom score in both sexes: A urodynamics-based comparison

The aim of our study was to determine the urodynamic basis for the observat ion that aging women report comparable benign prostatic hyperplasia (BPH) s ymptom scores as age-matched men. Sixty-seven women (mean age, 60.4 +/- 1.5 years; mean +/- standard error of the mean) and 70 age-matched men (mean a ge, 63.7 +/- 0.9 years; P > 0.05) entered this prospective study. Men were referred for the diagnostic workup of lower urinary tract symptoms (LUTS) d ue to BPH and women predominantly for urinary incontinence. All patients co mpleted the International Prostate Symptom score (IPSS) with quality-of-lif e assessment and underwent a detailed clinical and urodynamic evaluation in cluding a multichannel pressure-flow study. Results of the IPSS, quality-of -life assessment, and irritative and obstructive component of the IPSS were correlated with urodynamic findings and the respective data were compared in both sexes. The mean IPSS was 15.7 for men and 13.0 for women (P = 0.02) , quality-of-life score was higher in women (4.2 vs. 3.4; P = 0.0008). The irritative score was significantly higher in women (8.7 vs. 6.8; P = 0.003) . Incidence of detrusor instability (DI), however, was higher in men (women , 38.1%; men, 48.6%; P = 0.015) and bladder capacity was higher in women (4 25 vs. 333 mi; P = 0.0001). There was no correlation between incidence and degree of DI with the irritative score in both sexes. The obstructive score was significantly higher in men (8.8 vs. 4.4; P = 0.0001). Ninety-one perc ent (64/70) of men had urodynamically documented bladder outlet obstruction (BOO), whereas this was the case in only 9% (6/67) of women. In parallel t o the irritative score, we could not identify a correlation between the deg ree of urodynamically proven BOO and the obstructive score in both sexes. T his urodynamics-based comparison fails to give an explanation for the obser vation that aging women report similar BPH scores as men. These data sugges t that other mechanisms, such as changes in diurnal urine production, struc tural alterations of the aging detrusor, endocrine disturbances affecting l ower urinary tract function, land subtle urodynamic changes are responsible . (C) 1999 Wiley-Liss, Inc.