Annals of African Medicine

: 2013  |  Volume : 12  |  Issue : 3  |  Page : 174--175

International Prostate Symptoms Score usage in a developing country

Kasonde Bowa 
 Department of Urology, The Copperbelt University School of Medicine, Ndola, Zambia

Correspondence Address:
Kasonde Bowa
Associate Professor of Urology, The Copperbelt University School of Medicine, 6th Floor, Ndola Central Hospital, West Wing, Broadway and Nkana Street, Ndola

How to cite this article:
Bowa K. International Prostate Symptoms Score usage in a developing country.Ann Afr Med 2013;12:174-175

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Bowa K. International Prostate Symptoms Score usage in a developing country. Ann Afr Med [serial online] 2013 [cited 2021 Jun 25 ];12:174-175
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International Prostate Symptoms Score (IPSS) was introduced in 1992 by the American Urological Association. It was later adopted by the World Health Organization with an addition of a quality of life score. [1] It is used as an objective measure of bladder function secondary to bladder neck disease. It is most frequently used in the evaluation of prostate disease symptoms. It is a self-administered questionnaire that may be filled in by the patient in the waiting room of a Urology outpatient service. It comprises seven questions with a potential score of 5 for each question. Three of the questions relate to problems of bladder storage, while four relate to voiding.

 Usage of International Prostate Symptoms Score

There is a wide international usage of this scoring system with translation into other languages.It is primarily used in identifying the extent of early bladder disease from outflow obstruction. It has a high sensitivity and specificity. However, it is not disease specific; it gives an impression of the impact of the disease on bladder function. Better evaluation of bladder function can be obtained with a calculation of the storage and voiding subscores. [2] The Residual urine and flow rates give more objective measures of bladder function. Looking at the application of IPSS, two things need to be considered,that is the provider and the patient factors. In its use in African settings these would be the key considerations.

Provider factors

The applications of the IPSS in African setting would be faced with the following encumbrances due to issues related to the provision of urology services.There is a critical shortage of urologists to interpret the IPSS scores. There is also lack of knowledge of the score generally and its usage. Even if the above were addressed the volume of patients in an ordinary urology clinic in Africa are too large for the routine administration of the score. In many instances there are no stand alone urology clinics. The facility is shared by several specialists and has multiple usage. The urology services may run on say Monday from 09:00AM to 12:00 Noon. After this period the cardiology services run.So the time available for urology service provision is limited. Furthermore,there are no specific urology trained nurses to supervise the administration of the IPSS tool.

Patient factors

Additional factors that make it difficult for the IPSS score to achieve wide coverage in Africa would be the patient factors. The literacy and numeracy levels in Africa range between 30% and 60%. Average literacy rates are slightly under 50%. Among patients with prostate disease this will be in excess of 70%. Beyond this there is a high tolerance to disease and most people donot complain until the symptoms become unbearable. The value of the IPSS, is in detecting early symptomatology. Many of the patients will also have visual problems related to ageing.This means that the self-administration of the score would be difficult even if they were among the few that were able to read. Further, some loss of meaning occurs in understanding things like frequency, quality of life and so on. Therefore, the score would need to be translated into several local or regional languages.


The IPSS has been successfully used in many parts of the world since its introduction in 1992. Attempts at its usage in the African settings are commendable. However, several key factors mitigated against its wide usage for at least a number of years. Key among these are services and patient factors.


1Rodrigues P, Meller A, Campagnari JC, Alcântara D, D'Império M. International Prostate Symptom Score-IPSS-AUA as discriminat scale in 400 male patients with lower urinary tract symptoms (LUTS). Int Braz J Urol 2004;30:135-41.
2Liao CH, Chung SD, Kuo HC. Diagnostic value of International Prostate Symptom Score voiding-to-storage subscore ratio in male lower urinary tract symptoms. Int J Clin Pract 2011;65:552-8.