International prostate symptoms score among patients with symptomatic prostate enlargement at MTRH-Eldoret

Abstract

Background: The International Prostate Symptoms Score (IPSS) is a validated, welldesigned and extensively studied scale for quantifying Lower Urinary Tract Symptoms (LUTS) to diagnose prostate disease, and may predict the severity of the disease, patient‟s quality of life, size of the prostate and suggest the modality of management for the condition. Despite the high morbidity attributed to prostate related disorders, there has been no local study which relates IPSS with sociodemographic factors, diagnosis and care at Moi Teaching and Referral Hospital (MTRH) Study setting -This study was carried out at MTRH, Eldoret Kenya, in the urology clinic, laboratories and surgical wards. Study design: This is a hospital based cross-sectional descriptive study. Objective: To describe the IPSS score and its correlation with socio-demographics, clinical diagnosis, size of prostate, mode of treatment and histological diagnosis of patients seen at MTRH urology clinic with LUTS due to prostate enlargement. Sample size: One hundred and four (104) patients were recruited in this study. Sampling Technique: Patients presenting with Lower Urinary Tract Symptoms due to prostate enlargement who consented were consecutively enrolled until the desired sample size was achieved. Data Collection & Handling: The patients‟ biodata, IPSS score, most bothersome symptom, prostate size, mode of treatment and histological diagnosis were collected using interviewer administered structured questionnaires, clinical examination surgical operations and laboratory investigation results. The data was entered in Microsoft Excel and later exported to SPSS® version 24 of Windows® for analysis. Results: One hundred and four patients were recruited in this study. The age of the patients ranged between 46 and 88yrs with a mean age of 69±9 years. On digital rectal examination, the size of the prostate was either mild (19%), moderate (55%) or grossly enlarged (26%). Using the transabdominal ultrasound examination prostate size ranged from 30 to 173 cm3, with a mean prostate volume of 76.4±28 cm3. The mean duration of the symptoms before seeking medical help was 10±6 months. In terms of most bothersome symptoms, 36% of the patients had a weak stream while 33% had straining at micturition. While none of the patients presented with mild IPSS cores, majority (70%) presented with a severe IPSS score with the rest presenting with a moderate IPSS scores. Most (80%) of the patients had poor quality of life. Histologically, most of the prostate masses were benign (70%). In the results, we focused on the key issue of IPSS and its impact; the duration of the symptoms, most bothersome symptoms and effect on QOL. Conclusion: Patients with LUTS due to prostate enlargement tend to present late. Patients with high IPSS score are likely to have larger prostate size, benign histological structure of the gland and poor quality of life. Recommendation: IPSS should be used both as a screening tool, diagnostic tool and for follow up of patients with LUTS due to prostate enlargement.