Scoring the short form ICSmaleSF questionnaire

Purpose: The International Continence Society (ICS) ICSmale questionnaire w as devised to provide a thorough evaluation of the occurrence and bothersom eness of lower urinary tract symptoms and their impact on the lives of men with benign prostatic disease. This report completes the developmental work on the questionnaire, producing the concise short form instrument, ICSmale SF, with a valid, reliable and scientifically justified scoring system. Materials and Methods: Two data sets were used. The short form version of t he questionnaire was devised and initially evaluated using data on men with uncomplicated lower urinary tract symptoms who were involved in the CLasP randomized controlled trial comparing laser therapy with transurethral pros tatic resection and conservative management or monitoring without active in tervention. External validation of the scoring system was undertaken using data from phase II of the ICS benign prostatic hyperplasia (BPH) study, an observational study of outcome in men with lower urinary tract symptoms rel ated to benign prostatic enlargement. All patients completed the developmen tal version of the ICSmale questionnaire. Parallel analysis on the CLasP da ta set identified items that were responsive to change or highly problemati c, allowing other redundant and overlapping items to be eliminated. Factor analysis and Cronbach's alpha coefficients were used to examine the cluster ing of items. Regression models were used to investigate the validity of fo llowup scores within and across treatment groups in the CLasP and ICS/BPH s tudies. Results: The questionnaire, which originally comprised 22 items, was shorte ned to 11 items in the 2 distinct factors of voiding (ICSmaleVS) and incont inence (ICSmaleIS) symptoms. Cronbach's cr coefficients were high at 0.76 f or ICSmaleVS and 0.78 for ICSmaleIS. A simple additive score was calculated by adding the 5 items in ICSmaleVS and 6 in ICSmaleIS. ICSmaleVS and ICSma leIS detected expected improvement in the laser therapy and transurethral p rostatic resection groups, and stability in the conservative management gro up within CLasP. Similarly each subscore but particularly ICSmaleVS was sen sitive to differences in the outcome of the range of treatments in the ICS/ BPH study. While frequency and nocturia were highly problematic and sensiti ve to change individually, they did not load into the other main factors or correlate with each other. It is suggested that these symptoms should be e valuated separately with the additional inclusion of a single item measure of the impact of lower urinary tract symptoms on daily life. Conclusions: The ICSmaleSF represents a comprehensive, concise, valid and r eliable instrument for evaluating men with lower urinary tract symptoms. Un like other questionnaires in the field it contains subscores for the domain s of voiding and incontinent symptoms as well as the separate consideration of frequency, nocturia and impact on daily life. We hope that it will beco me the tool of choice for the comprehensive evaluation of treatment of men with lower urinary tract symptoms associated with benign prostatic disease.