Lower urinary tract symptoms (LUTS) refers to a cluster of symptoms experienced by patients with complaints of the lower urinary tract, including overactive bladder, urinary incontinence, interstitial cystitis, and benign prostatic hyperplasia (BPH) [1]. The International Prostate Symptom Score (IPSS), which is a widely used questionnaire to assess LUTS in male patients, evaluates incomplete emptying, frequency, intermittency, urgency, weak stream, hesitancy, and nocturia [2,3]. Additionally, it aids in determining other associated symptoms in the quality of life (QoL) section. However, there has been increasing debate on the precision and accuracy of the IPSS [3-5]. It does not comprehensively assess all LUTS, particularly storage symptoms (e.g., incontinence) as described by patients [5]. The Danish Prostatic Symptom Score (DAN-PSS) is another known questionnaire that evaluates storage symptoms, including incontinence, in a more detailed manner than IPSS. The DAN-PSS is recommended as level B by the International Consultation on Male LUTS [6,7]; however, it remained popular only in Scandinavian countries.

The International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS) has been created from the International Continence Society (ICS) Male Questionnaire, which is a product of the ICS-BPH Study [8]. Currently, the ICIQ-MLUTS is a highly recommended, patient-completed questionnaire used for evaluating male LUTS. Six storage symptoms, as well as voiding symptoms, can be assessed using ICIQ-MLTUS. It also provides individual bother scores associated with the present symptoms [7]. The aim of this study was to analyze the validity and reliability of the Turkish version of ICIQ-MLUTS.

In total, 117 male patients were included in the study. The mean age of the patients was 58.9±10.5 years. Regarding the level of education, 30 participants (25.6%) held a university degree, 52 (44.4%) graduated from high school, and 35 others (29.9%) completed primary education. All participants agreed that the questionnaire was clear, appropriate, and easy to understand when interviewed at the end of their first visit.

Domain scores of ICIQ-MLUTS questionnaire of the patients are shown in Table 1.

For reliability, Cronbach alpha value, which is indicative of internal consistency, was found as 0.798, which indicated that the questionnaire was internally consistent. The internal consistency of each question was examined separately; all questions had values over 0.7 (Table 2).

For evaluating test-retest reliability, the test was administered to 116 patients for the second time, with an interval of 2–4 weeks. The mean domain scores of ICIQ-MLUTS for the first and second visits are given in Table 3. The total agreement percentage was 62.4%, and the mean correlation value, 0.741 (Fig. 1).

When the bother scales for each symptom were evaluated, we found that nocturia and incomplete emptying were the most bothering symptoms. Unpredictable incontinence and nocturnal incontinence were the least bothering symptoms.

The management strategy for men with LUTS has recently gained a different dimension. During the 90’s, enlarged prostate, urinary symptoms, and bladder outlet obstruction were the main subjects of discussion in the management of men with LUTS. Nowadays, bladder dysfunction, polyuria, and outflow tract pathology are mainly involved in the evaluation of male LUTS [7].

In the EpiLUTS study, it has been emphasized that a more expansive view of LUTS looks beyond an organ-specific focus and the interaction of the whole urinary system in both men and women, and it was suggested that all these symptoms should be evaluated completely [10]. This indicates the need for comprehensive questionnaires.

LUTS in men can be classified as storage symptoms, voiding symptoms, and postvoiding symptoms. Storage symptoms are more prominent in both men and women presenting with LUTS [10]. In our country, LUTS in men is commonly evaluated using the IPSS questionnaire. Although this form is recommended as grade A, it is not as efficient in evaluating every information relating to LUTS, especially for storage symptoms like incontinence and overactive bladder symptoms. Despite using the word “prostate” in its title, the IPSS should not be taken as a condition-specific form, particularly for prostate [7].

A recent community study reported that the most distressing LUTS in men were urgency and nocturia. Postmicturition dribbling and urge urinary incontinence were other bothersome problems. The efficiency of IPSS has been a subject of debate since it has low to moderate correlation with frequency-volume charts and has only one QoL question with a likert scale [5]. This is another possible reason for exploring the need of a more comprehensive questionnaire.

In 1996, the ICS-male questionnaire was produced according to the ICS-BPH study. The long form has been reduced to a simpler type. ICS male short form contains questions on symptoms that cause the highest levels of problem or bothersomeness, which is incontinence like the DAN-PSS. However, unlike the IPSS it is scored simply by adding all the individual scores. This form was then developed into the ICIQ-MLUTS form. Although highly recommended, the ICIQ-MLUTS is not as popular as the IPSS. The module of ICIQ-MLUTS consists of 13 questions, evaluating 6 storage symptoms, 5 emptying symptoms, and additional frequency and nocturia questions. Each question has a 4-point severity scale (0–4). Each question is also supplemented with a 10-point QoL visual analog scale (0–10) question, which adds an extra intensity effect to the questionnaire [7,8,11,12].

We aimed to provide validation for the Turkish language version of the ICIQ-MLUTS and to use this form in the management of male LUTS in Urology clinics in Turkey. During the validation steps of the ICIQ-MLUTS, in the translation-back translation part, the questions were observed to be clear and simple in Turkish. A few changes were applied to the questionnaire after the intelligibility interview step. When we looked at the age and education groups, it was observed that the patients could adapt easily to the questionnaire. We observed significant results of internal consistency for the validity step. The Cronbach alpha value of the complete questionnaire was 0.798. In the separate analysis of each question, Cronbach alpha values were over 0.7. During the test-retest period, significant correlation and agreement values were found. These results demonstrate the strong internal consistency of the ICIQ-MLUTS in Turkish.

The validated Turkish version of ICIQ-MLUTS will help in evaluating male LUTS in Turkey. We believe that the Turkish version of ICIQ-MLUTS is a new breakthrough in our country in the new era of the management of male LUTS.