Comparison of Diagnostic Accuracy of International Prostate Symptom Score vs Visual Prostate Symptoms Score in Patients with Benign Prostate Hyperplasia

Objective: To compare the diagnostic accuracy of the International Prostate Symptom Score (IPSS) with that of the Visual Prostate Symptom Score (VPSS). The results were compared with an ultrasonographic gold standard for diagnosing Benign Prostatic Hyperplasia (BPH) to identify the most reliable tool for clinical use. Methods: This was a cross-sectional, validation study. We enrolled 370 male patients aged 40–75 years who presented with lower urinary tract symptoms (LUTS). The exclusion criteria were prior urological surgery, malignancy, or neurology-related diseases that affected bladder function. Participants completed the IPSS (a seven-symptom questionnaire) and the VPSS (a pictorial four-symptom tool). The gold standard for BPH diagnosis is transabdominal ultrasound. The diagnostic accuracy was calculated, and a chi-square test was used to compare the overall diagnostic accuracy of the two scoring systems. Results: The International Prostate Symptom Score (IPSS) demonstrated a sensitivity of 91.0% and specificity of 72.2%, with positive and negative predictive values of 96.8% and 46.4%, respectively. The overall diagnostic accuracy was 89.2%. In comparison, the Visual Prostate Symptom Score (VPSS) showed higher sensitivity at 95.2% and specificity of 75.0%, with a positive predictive value of 97.2% and a negative predictive value of 62.8%. The overall diagnostic accuracy of the VPSS was 93.2%. The likelihood ratios favoured VPSS, with a positive likelihood ratio of 3.81 and a negative likelihood ratio of 0.06, compared to 3.27 and 0.12 for IPSS, indicating a comparatively improved diagnostic performance. Conclusion: The VPSS demonstrated high sensitivity for diagnosing BPH against the ultrasonographic gold standard in this Pakistani cohort.