The significance of the American Urological Association symptom index score in the evaluation of women with bladder outlet obstruction

Purpose: The American Urological Association (AUA) symptom index was origin ally designed to assess the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia. Data concerning the clinical applicatio n of the AUA symptom index to women are sparse. We evaluated the significan ce of the AUA symptom index in women with urodynamically defined bladder ou tlet obstruction. Materials and Methods: From a urodynamic database of 587 consecutive women 38 (6.5%) were identified with bladder outlet obstruction, defined as a max imum flow rate of less than 12 mi. per second on repeat noninvasive uroflow metry studies with a detrusor pressure at a maximum flow of greater than 20 cm. water on pressure flow study. All patients underwent a complete clinic al and urodynamic evaluation, and completed the AUA symptom index questionn aire. Results in women with urodynamic obstruction were compared with those in 2 control groups, including women without obstruction but with sphincteric in continence and asymptomatic healthy women. Results: Mean symptom score was significantly higher in women with obstruction than in those with sphincter ic incontinence or no symptoms (15.8 +/- 8.4 versus 10.3 +/- 6.4 and 2.1 +/ - 2.7, respectively). Likewise, scores were classified as severe in 34% of women with obstruction compared with only 7% of those with sphincteric inco ntinence. However, no correlation was noted between symptom index scores an d objective urodynamic parameters, which is similar to data already reporte d in male populations. Conclusions: The AUA symptom index score may be useful as a bothersomeness index in women with bladder outlet obstruction. However, subjective symptom s associated with bladder outlet obstruction are nonspecific and a complete urodynamic evaluation is essential for making the diagnosis.