Development and Initial Testing of the FLOW Instrument: Novel Assessment of Lower Urinary Tract Symptoms in Men

Bellucci

Miranda

et al. 2020

Preprint

Objectives: To evaluated the accuracy of a single question on nocturia to identify men with moderate and severe LUTS. Methods: We evaluated men aged ≥40 years who presented for medical evaluation at two different urological clinics. They completed the IPSS and the Nocturia Single Question Scale (NSQS). NSQS consists of a single question assessing nocturia frequency ranging from 0 to 4. The severity of LUTS using NSQS (index test) versus IPSS (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative. Results: The accuracy of the NSQS to discriminate patients with severe LUTS based on the ROC curve was 75% (CI 95% 73 − 82%; p < 0.001). Conclusion: Patients without nocturia or a single void/night (NSQS < 2) have low probability, while NSQS ≥ 3 has a high probability of having moderate or severe LUTS. NSQS is an acceptable alternative to the IPSS, being a fast and simple tool to identify men according to LUTS's severity.

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of a Nocturia Single Question Scale as a Predictor of Severity of Lower Urinary Tract Symptoms in Men

Bellucci

Miranda

et al. 2020

Preprint

“…This introduces the risk of unwarranted interference in patient responses (14,15). The use of simplified, more accessible instruments has been proposed to ease questionnaire completion and minimize interference (16,17).…”

Section: Patients With a Low Education Level Have Been Demonstrated Tmentioning

confidence: 99%

“…Bland-Altman analysis showed good agreement between the two questionnaires ( Figure 3) (bias = 0.056; p < 0.001). Maximum urinary flow rates were found to be significantly lower in moderate and severe cases when compared to those with mild symptoms, i.e., 12 ml/s [8][9][10][11][12][13][14][15][16][17][18] and 17 ml/s [13][14][15][16][17][18][19][20][21][22][23][24][25], respectively (p < 0.001), with a median difference of 5 ml/s. Furthermore, maximum urinary flow rates decreased in correlation with the pictograms depicting the force of the urinary stream, with the following median Qmax values: A = 17.5 [13][14][15][16], B = 15 [11][12][13][14][15][16][17][18][19][20][21][22][23], C = 12 [8][9][10]…”

Section: Patients With a Low Education Level Have Been Demonstrated Tmentioning

confidence: 99%

LUTS-V: A New Simplified Score for Assessing Lower Urinary Tract Symptoms in Men

Araujo

Alvaia

et al. 2020

Preprint

OBJECTIVETo validate a new simplified score for the assessment of men with LUTS (LUTS-V).METHODSWe made adjustments to the VPSS, resulting in a new simplified instrument (LUTS visual score – LUTS-V). In a pilot study, LUTS-V was administered to 50 men to identify interpretation issues. We used the International Prostate Symptom Score (IPSS) as the gold standard to validate the new tool in 306 men. The total IPSS and LUTS-V scores for each subject were evaluated and we used Bland-Altman analysis and Pearson’s correlation plot to assess the agreement between the scores. A ROC curve was utilized to determine the diagnostic accuracy of LUTS-V and its diagnostic properties were described in terms of sensitivity, specificity, positive and negative predictive values.RESULTSMedian age was 59 [52-67] years and, according to the IPSS, 26 (8.7%) patients had severe symptoms, while 99 (33%) had moderate symptoms, and 175 (58.3%) had mild symptoms. We found a positive correlation between the IPSS and LUTS-V (r = 0.72; p < 0.0001). Bland-Altman analysis showed good agreement between the two questionnaires. We found LUTS-V to have a diagnostic accuracy to detect more severe cases of 83% (95% CI: [78-87%]; p < 0.001), as estimated by the area under the ROC curve. The cut-off value of ≥ 4 points was the best threshold, with a sensitivity of 74% and a specificity of 78%, which resulted in a negative predictive value of 81% and a positive predictive value of 71% in this scenario. Median completion time was 0.51 [0.41-1.07] min for LUTS-V and 2.5 [2.2-3.4] min for the IPSS (p < 0.0001). In addition, 91.5% of patients completed the questionnaires with no help, while the other 8.5% were interviewed.CONCLUSIONLUTS-V is a simple, self-administered tool with a significant discriminating power to identify patients with moderate to severe symptoms.

“…Simplified questionnaires have been developed and validated and may be more appropriate for the evaluation of subjects with lower education level (Van Der Walt et al, 2011;Eid et al, 2014;Stothers et al, 2017;Mallya et al, 2017;Moses et al, 2017). Among these instruments is the UWIN (Urgency, Weak Stream, Incomplete Emptying and Nocturia), which was developed to facilitate the completion of the IPSS questionnaire, thus making the administration of the questionnaire more efficient.…”

Section: Introductionmentioning

confidence: 99%

Transcultural adaptation and validation of the questionnaire “Urgency, Weak stream, Incomplete emptying and Nocturia (UWIN)” for the Brazilian Portuguese

Freitas

Ribeiro

et al. 2020

PeerJ

Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a negative affect in the quality of life and represent an economic burden for the healthcare system worldwide. The International Prostatism Symptom Score (IPSS) is a validated tool for assessing these symptoms, but patients with low literacy may have difficulties comprehending and completing it accurately. The Urgency, Weak Stream, Incomplete Emptying, and Nocturia (UWIN) questionnaire was developed as a shorter tool in the assessment of LUTS to improve accuracy and minimize error. This study aimed at performing cross-cultural adaptation to Brazilian Portuguese and validation of UWIN questionnaire for patients with LUTS. The cross-cultural adaptation followed the steps of conceptual, item, semantic, operational, and pre-test equivalence to obtain the UWIN-Br version. The IPSS (gold standard) and UWIN-Br were coadministered, and information regarding the uroflowmetry examination was also recorded. We evaluated 306 men, median age 59 [52-66] years. There was a positive correlation r = 0.804 (p < 0.001) between the total IPSS score and the total UWIN-Br score, as well as the quality of life question (r = 0.761) (p < 0.001). The Bland-Altman plot showed good agreement between. Also, we observed that the maximum flow values decreased with the severity of the LUTS. UWIN-Br demonstrated excellent diagnostic accuracy in detecting the most severe cases. The area under the ROC curve was 89% [81–97%] 95% CI. 280 (91.5%) subjects completed the questionnaires without help, while 26 (8.5%) did so through an interview. The response time was 1.2 [1.0–1.5] min for UWIN-Br and 2.8 [2.2–3.4] min for IPSS (p < 0.001). UWIN-Br presents satisfactory and similar psychometric properties to the IPSS in the evaluation of LUTS and quality of life and is suitable for use in both clinical practice and research in our country.