THE JOURNAL OF FEMALE
URINARY INCONTINENCE

Commented Abstracts

• The significance of the American Urological Association symptom index score in the evaluation of women with bladder outlet obstruction.
  Groutz, A.; Blaivas, J.G.; Fait, G.; Sassone, A.M.; Chaikin, D.C.; Gordon, D.
  Weill Medical College, Cornell University, New York, New York, USA.
  Urology, v.163, p. 207-11,2000

ABSTRACT

PURPOSE: The American Urological Association (AUA) symptom index was originally designed to assess the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia. Data concerning the clinical application of the AUA symptom index to women are sparse. We evaluated the significance of the AUA symptom index in women with urodynamically defined bladder outlet obstruction.

MATERIALS AND METHODS: From a urodynamic database of 587 consecutive women 38 (6.5%) were identified with bladder outlet obstruction, defined as a maximum flow rate of less than 12 ml. per second on repeat noninvasive uroflowmetry studies with a detrusor pressure at a maximum flow of greater than 20 cm. water on pressure flow study. All patients underwent a complete clinical and urodynamic evaluation, and completed the AUA symptom index questionnaire. Results in women with urodynamic obstruction were compared with those in 2 control groups, including women without obstruction but with sphincteric incontinence and asymptomatic healthy women.

RESULTS: Mean symptom score was significantly higher in women with obstruction than in those with sphincteric incontinence or no symptoms (15.8+/-8.4 versus 10.3+/-6.4 and 2.1+/-2.7, respectively). Likewise, scores were classified as severe in 34% of women with obstruction compared with only 7% of those with sphincteric incontinence. However, no correlation was noted between symptom index scores and objective urodynamic parameters, which is similar to data already reported in male populations.

CONCLUSIONS: The AUA symptom index score may be useful as a bothersomeness index in women with bladder outlet obstruction. However, subjective symptoms associated with bladder outlet obstruction are nonspecific and a complete urodynamic evaluation is essential for making the diagnosis.

EDITORIAL COMMENT

Symptom indexes are created with the intention of making ‘objective’ something essentially subjective, the patients complaints. Questions are created and values and weights assigned for the symptoms that, when added, must allow the inclusion of the patient in one category: mild, moderate or intense. The findings would initially allow the evaluation of the seriousness of the problem and compare, from the initial moment, the results obtained with the initial treatment. The first problem of these indexes is the lack of specificity since several disturbances may lead to lower Urinary tract symptoms. Besides this, paradoxically, even though the primordial objective of these indexes is to make objective and less intuitive the evaluation of the symptoms, no correlation has been proven between the symptoms score and urodynamic parameters of obstruction. Groutz’s et al work shows that the index of AUA may be applied also in women. We must still define for what this index is really for.

Aparecido Donizeti Agostinho