Development and validation of an Arabic version of the International Prostate Symptom Score

Objective To develop and validate an Arabic version of the International Prostate Symptom Score (IPSS). Patients, Subjects and Methods An Arabic version of the IPSS (IPSS-Arb) was developed through a series of translations and modifications which involved the authors, urology and non-urology medical and nursing staff. The validity and reliability were assessed in 76 patients with urinary symptoms due to benign prostatic hyperplasia (BPH) and in 63 control subjects without BPH; 25 patients had transurethral resection of prostate (TURP) whereas the remaining 51 patients were treated with terazosin. The reliability of the IPSS-Arb was assessed by determining the internal consistency (Cronbach's α coefficient) and by assessing the test-retest reliability (intraclass correlation coefficient, ICC). Construct validity was assessed by determining the correlation between the IPSS-Arb scores and the quality-of-life question (QoL-Arb), and by determining the ability of the IPSS-Arb to discriminate between the patients and controls by calculating the area under the receiver operating characteristic (ROC) curve. Results The Cronbach's α coefficient (internal consistency) for the IPSS-Arb was 0.85, and 0.78-0.88 for the individual items. The test-retest reliability (ICC) was 0.88 (P < 0.001). In addition, the IPSS-Arb had a high correlation with the QoL-Arb (Spearman rank correlation coefficient 0.82, P = 0.01). The mean (sem, 95% confidence interval) area under the ROC curve for the IPSS-Arb was 0.93 (0.09, 0.89-0.97), whereas the area for its individual questions was 0.79-0.90. The IPSS-Arb also showed a high sensitivity to change. The mean (sd) IPSS-Arb scores before and after TURP were 23.1 (6.4) and 6.9 (1.8), respectively (P < 0.001); in the terazosin group, the scores were 12.6 (7.4) and 8.2 (4.0), respectively (P < 0.001). CONCLUSIONS The IPSS-Arb was shown to be a reliable and valid instrument for patients with BPH. We recommend using it for patient assessment and follow-up, and as a research tool in Arabic-speaking patients both in the Middle East and worldwide. In addition, this study provided another proof of the wide suitability of the IPSS among various nations worldwide.