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Donovan JL, Peters TJ, Abrams P, Brookes ST, de aa Rosette JJ, Schafer W. Scoring the short form ICSmaleSF questionnaire. International Continence Society. J Urol. 2000 Dec;164(6):1948-55

PURPOSE: The International Continence Society (ICS) ICSmale questionnaire was devised to provide a thorough evaluation of the occurrence and bothersomeness of lower urinary tract symptoms and their impact on the lives of men with benign prostatic disease. This report completes the developmental work on the questionnaire, producing the concise short form instrument, ICSmaleSF, with a valid, reliable and scientifically justified scoring system. MATERIALS AND METHODS: Two data sets were used. The short form version of the questionnaire was devised and initially evaluated using data on men with uncomplicated lower urinary tract symptoms who were involved in the CLasP randomized controlled trial comparing laser therapy with transurethral prostatic resection and conservative management or monitoring without active intervention. External validation of the scoring system was undertaken using data from phase II of the ICS benign prostatic hyperplasia (BPH) study, an observational study of outcome in men with lower urinary tract symptoms related to benign prostatic enlargement. All patients completed the developmental version of the ICSmale questionnaire. Parallel analysis on the CLasP data set identified items that were responsive to change or highly problematic, allowing other redundant and overlapping items to be eliminated. Factor analysis and Cronbach's alpha coefficients were used to examine the clustering of items. Regression models were used to investigate the validity of followup scores within and across treatment groups in the CLasP and ICS/BPH studies. RESULTS: The questionnaire, which originally comprised 22 items, was shortened to 11 items in the 2 distinct factors of voiding (ICSmaleVS) and incontinence (ICSmaleIS) symptoms. Cronbach's alpha coefficients were high at 0.76 for ICSmaleVS and 0.78 for ICSmaleIS. A simple additive score was calculated by adding the 5 items in ICSmaleVS and 6 in ICSmaleIS. ICSmaleVS and ICSmaleIS detected expected improvement in the laser therapy and transurethral prostatic resection groups, and stability in the conservative management group within CLasP. Similarly each subscore but particularly ICSmaleVS was sensitive to differences in the outcome of the range of treatments in the ICS/BPH study. While frequency and nocturia were highly problematic and sensitive to change individually, they did not load into the other main factors or correlate with each other. It is suggested that these symptoms should be evaluated separately with the additional inclusion of a single item measure of the impact of lower urinary tract symptoms on daily life. CONCLUSIONS: The ICSmaleSF represents a comprehensive, concise, valid and reliable instrument for evaluating men with lower urinary tract symptoms. Unlike other questionnaires in the field it contains subscores for the domains of voiding and incontinent symptoms as well as the separate consideration of frequency, nocturia and impact on daily life. We hope that it will become the tool of choice for the comprehensive evaluation of treatment of men with lower urinary tract symptoms associated with benign prostatic disease.


Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J, Chapple C, De La Rosette JJ, Kondo A. The ICS-'BPH' Study: the psychometric validity and reliability of the ICSmale questionnaire. Br J Urol. 1996 Apr;77(4):554-62

OBJECTIVE: To assess the validity and reliability of the ICSmale questionnaire developed for the International Continence Society-'Benign Prostatic Hyperplasia' (ICS-'BPH') study. PATIENTS AND METHODS: Urology departments in 12 countries recruited 1271 consecutive men > 45 years old, with lower urinary tract symptoms and possible benign prostatic obstruction, to the ICS-'BPH' study (the clinical group); 423 ambulent men were recruited from a general practice in the UK to provide a community group. Each individual was asked to complete the wide-ranging ICSmale questionnaire, comprising questions concerned with urinary symptoms, the bother they cause, and issues of quality of life and sexual function. Content, construct and criterion validity of the symptom and problem questions were assessed by interviews with patients and urologists, testing hypotheses within sub-studies, and in relation to frequency-volume diaries and uroflowmetry. Reliability was assessed by measures of internal consistency and a test-retest analysis. RESULTS: The ICSmale questionnaire was easy to complete. It was clearly able to differentiate between men in clinical and community populations, and detected the expected positive age gradient for most symptoms in the community group. There was reasonable agreement between relevant parts of the questionnaire and frequency-volume charts when a relatively flexible approach was taken, but there was a very poor relationship between questions assessing strength of stream and the results of uroflowmetry. Internal consistency was high, and overall the questionnaire demonstrated good test-retest reliability. CONCLUSION: The self-completed ICSmale questionnaire had high levels of psychometric validity and reliability.