The International Consultation on Incontinence Questionnaire (ICIQ) and American Urological Association Symptom Index (AUASI) are widely used questionnaires to evaluate male and female lower urinary tract symptoms. The purpose of this study was to investigate the correlation and to cross validate gender matching items in the AUASI and the ICIQ MLUTS / FLUTS questionnaires in a patient population seeking care for lower urinary tract symptoms (LUTS).

Subjects were prospectively enrolled into an observational LUTS cohort from a functional urology clinic and answered questionnaires. Each patient answered the 2 questionnaires and data were analyzed in SAS to correlate and cross validate gender matching items from the ICIQ MLUTS / FLUTS against same domain AUASI items using Spearman’s correlation.

A total of 304 patients (126 males, 178 females) were enrolled. Mean age was 58±17 years. 540 clinic visits occurred between May 2019 and November 2020. Response rates were 93% (500/540) for AUASI, and 91% (490/540) for ICIQ. A correlation model stratified by gender (Table 1) found significant correlation between gender for all matching items of each instrument (p values < 0.0001). Correlation plots were stratified by gender accounting for number of observations within each item strata (Figure 2). In Males, nocturia also had the best correlation (r=0.95), followed by intermittency (r=0.76), incomplete emptying (r=0.75), weak stream (r=0.73), straining (r=0.61), daytime frequency (r=0.61) and urgency (r=0.6) respectively. In Females, the best correlation was seen in nocturia (r=0.92), followed by straining (r=0.82), Intermittency (r=0.76), urgency (r=0.65) and daytime frequency (r=0.56) respectively. Nocturia had the best correlation in both genders while daytime frequency had the least correlation in the female group (r=0.56) and urgency in the male group (r=0.60).

Items of the AUASI and the ICIQ questionnaires demonstrated significant gender correlations; however, there were specific differences in the strength of association for common questions (e.g., urgency, frequency). There are several factors that might play a role in these differences and such factors can include difference in the wording of each question stem for each of the items in the questionnaires, and psychological factors such as mental fatigue from answering the larger sum of questions in the ICIQ. Additionally, differences in correlation varied between the female and male gender, suggesting that LUTS questions are interpreted differently among genders.

Further research is needed to identify reasons for gender specific biases in the quantification of bother attributed to each item of the AUASI and ICIQ questionnaires. Also, further analysis is needed to determine the cause of differences in the reporting of bother between male and female LUTS. Future studies will investigate the importance of the single gender items of the ICIQ MLUTS or FLUTS questionnaires on the opposite gender, such as the presence of bladder pain in men, which is only assessed in women and currently only a part of the FLUTS.