Hesitancy or Straining, That Is the Question: Which Does Question 6 of the International Prostate Symptom Score Represent?

OBJECTIVES: To evaluate the agreement between initial straining, a proxy for Question 6 of the International Prostate Symptom Score (IPSS Q6), and three voiding symptoms (hesitancy, straining during voiding, and terminal straining). PARTICIPANTS AND METHODS: Data from a nationwide survey of lower urinary tract symptoms in adults conducted by the Japanese Continence Society were analyzed. The agreement was evaluated by the weighted kappa coefficient. In addition, the correlation between these four voiding symptoms and other voiding symptoms (slow stream, intermittency, and terminal dribbling) was evaluated by Spearman's rank correlation. RESULTS: Overall, 3122 male and 3088 female participants were included in the analysis. In both male and female groups, substantial agreement on initial straining was observed for hesitancy (kappa, 0.625 and 0.639, respectively) as well as straining during voiding (kappa, 0.790 and 0.801, respectively). Initial straining correlated moderately with other voiding symptoms (rs, 0.442 to 0.597), while hesitancy was moderately correlated with other voiding symptoms (rs, 0.461 to 0.638). Straining during voiding was moderately correlated with intermittency (rs, 0.591 to 0.617). CONCLUSION: The IPSS Q6 should not be used lightly as either a hesitancy or straining score because it substantially represents both hesitancy and straining during voiding.