Tam CA1, Elliott SP2, Voelzke BB3, Myers JB4, Vanni AJ5, Breyer BN6, Smith TG 3rd7, McClung CD8, Erickson BA9; Trauma and Urologic Reconstruction Network of Surgeons (TURNS).

Urology. 2016 Sep;95:197-201. doi: 10.1016/j.urology.2016.04.006. Epub 2016 Apr 21.

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Abstract

OBJECTIVE:

To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty.

MATERIALS AND METHODS:

This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence.

RESULTS:

Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56).

CONCLUSION:

The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.