How are lower urinary tract symptoms and disease progression being measured?
LUTS are typically quantified by validated symptom scales such as the International Prostate Symptom Score (IPSS). Of note, the IPSS is a tool to quantify symptoms and not a tool to make the diagnosis of LUTS/BPH, a fact which is highlighted by the finding that women can also exhibit high IPSS values. Moreover, it should be noted that four of the seven IPSS items relate to voiding and postvoiding symptoms, whereas only three of the items relate to storage symptoms. This causes an inherent bias of the IPSS towards voiding symptoms and hence towards treatments reducing prostate size and/or bladder outlet obstruction. Additionally, the presence of a given symptom does not necessarily mean that it bothers the patient. A frequently applied objective indicator of symptom severity in LUTS/BPH patients is free-flow maximum flow rate (Qmax). However, in the absence of pressure-flow studies, Qmax is not a pure indicator of bladder outlet resistance but rather, at least in part, also reflects bla
