International Prostate Symptom Score (IPSS) Flow

International Prostate Symptom Score flow


The International Prostate Symptom Score (IPSS) can be utilized to measure the severity of lower urinary tract symptoms. It is a validated, reproducible scoring system to assess disease severity and response to therapy.

The IPSS is made up of 7 questions related to voiding symptoms. A score of 0 to 7 indicates mild symptoms, 8 to 19 indicates moderate symptoms and 20 to 35 indicates severe symptoms.

It is not a reliable diagnostic tool for lower urinary tract symptoms (LUTS) suggestive of BPH, but can be used to quantitatively measure LUTS after a diagnosis is made.

The IPSS isn't adequate for ruling in or ruling out the diagnosis of bladder outlet obstruction. In the JAMA Rational Clinical Exam paper by D'Silva et al, a cut-off of ≥20 increased the likelihood of bladder outlet obstruction (positive LR, 1.5; 95% CI, 1.1-2.0), whereas scores of less than 20 had an LR that included 1.0 in the 95% CI (negative LR, 0.82; 95% CI, 0.67-1.00)[1].

The International Prostate Symptom Score flow contains the International Prostate Symptom Score (IPSS) questionnaire and associated calculation. After form submission, the International Prostate Symptom Score calculation is executed automatically. It's easy to extend this flow with conditional logic based on the interpretation of the International Prostate Symptom Score calculation.

International Prostate Symptom Score (IPSS) questionnaire


Click here to open the Dutch version of the IPSS


Each question is scored from 0 to 5 for a maximum score of 35 points.

The first six questions are scored based on the following[2]:

  • Not at all (0)
  • Less than 1 time in 5 (1)
  • Less than half the time (2)
  • About half the time (3)
  • More than half the time (4)
  • Almost always (5)

The seventh question, relating to nocturia, is scored from 0 to 5 based on how many times the patient gets up at night to urinate (viz. 1 is scored for one time per night and 5 for five times per night).[1]

The eighth, and final question (not included in the main IPSS score), relating to the patient's perceived quality of life, is assigned a score of 0 (delighted) to 6 (terrible).


[1] D'Silva KA, Dahm P, Wong CL. Does this man with lower urinary tract symptoms have bladder outlet obstruction?: The Rational Clinical Examination: a systematic review. JAMA. 2014 Aug;312(5):535-42.\
[2] International Prostate Symptom Score (IPSS) at Urological Sciences Research Foundation. Retrieved November 2011

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