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Year : 2012  |  Volume : 28  |  Issue : 2  |  Page : 234-235

UWIN symptom score: Can it be the new gold standard for prostate symptoms' evaluation?


Date of Web Publication13-Jul-2012

Correspondence Address:
Neeraj Kumar Goyal

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How to cite this article:
Goyal NK. UWIN symptom score: Can it be the new gold standard for prostate symptoms' evaluation?. Indian J Urol 2012;28:234-5

How to cite this URL:
Goyal NK. UWIN symptom score: Can it be the new gold standard for prostate symptoms' evaluation?. Indian J Urol [serial online] 2012 [cited 2023 Mar 27];28:234-5. Available from:

Barqawi AB, Sullivan KF, Crawford ED, Roehrborn CG, Hughes A, O′Leary M, et al., Methods of Developing UWIN, the Modified American Urological Association Symptom Score. J Urol 2011;186:940-4.

   Summary Top

Initial assessment of men with benign prostatic hyperplasia includes clinical history, physical examination, urinalysis, subjective symptoms' evaluation using scoring instruments and objective tests including uroflowmetry and post-void residual urine measurements. The American Urological Association symptom score (AUA-SS) instrument is widely used to assess severity of lower urinary tract symptoms in men. It is also used to measure the bothersome impact index, monitor the response to therapy and evaluate symptom progression. In the present study, authors have described a shorter form of AUA-SS that may provide symptom score assessment with minimal compromise in accuracy. They developed a four-domain new scoring tool 'UWIN' (urgency, weak stream, incomplete emptying and nocturia) and quality of life questionnaire. [1]

Complete data were collected on 8,731 men who attended Prostate Cancer Awareness Week (PCAW) in the years 2003 and 2004. As part of the standard screening procedure the established AUA-SS index for lower urinary health was provided to each participant. Correlation analysis and area under the receiver operating characteristic (ROCs) were used to determine the best reduced index and cutoff points in scores for the severity categories of mild, moderate and severe. The number of responses in the original seven AUA-SS was lowered from six to four for each item in the modified score. Similarly, the bothersome index was lowered from seven to three in this modified tool. Only four out of the original seven items were retained. The combination of items with the best joint correlation to AUA-SS and bothersome score was UWIN (urgency, weak stream, incomplete emptying and nocturia). So, the newly framed UWIN index was the sum of four items, each having a score from 0 to 3, resulting in a range of total score between 0 and 12. The best accuracy of UWIN symptom severity compared to AUA-SS was obtained for the UWIN cutoff points mild-0 to 3, moderate-4 to 8 and severe-9 to 12, yielding 88.0% agreement. The correlation of UWIN with AUA-SS was 0.938. The correlation of UWIN bother to AUA bothersome score was 0.638. The ROC for the mild, moderate and severe UWIN categories compared to the categorized AUA-SS score was 0.96, 0.97 and 0.99, respectively.

   Comments Top

Lower urinary tract symptoms due to BPH are assessed by objective and subjective criteria. Medical questionnaires are developed to aid in evaluation of health of a population, deciding treatment in an individual and for follow-ups. AUA-SS has been the accepted questionnaire to assess symptoms related to BPH. In daily clinical practice the use of patient questionnaires can be limited by questionnaire length and the burden it poses on the respondent to read, understand and answer all the questions. According to Johnson et al., AUA-SS can be difficult for respondents to interpret. [2] They found that as the patient education level decreased, the understanding of AUA-SS questions also decreased and the rate of misreporting the total score increased. Frequency and urgency questions were found to be the most difficult to understand in their study. The new UWIN questionnaire omits frequency, which should make the UWIN questionnaire easier for respondents. But, the urgency question was elected to be retained due to its high correlation to bother. However, future refinement of the symptom questionnaire should be made to reframe the urgency-related questions. In comparison to a lengthy questionnaire, a shorter instrument places less burden on the respondent, improves compliance and broadens the application of the instrument while making information collection more efficient. [3] Examples of successful modifications in the other medical questionnaires are the child asthma symptom questionnaire that was decreased from 17 to 8 items and a Medical Outcome Study

36-Item Short-Form Health Survey was decreased from 36 to 12 items. [4]

Accordingly, the authors introduced a simplified form of the AUA-SS questionnaire called UWIN. In another recently published study of 278 participants, the UWIN questionnaire has been validated that it can be used in place of the AUA- SS. They reported that it is equivalent to the gold standard AUA-SS but shorter, more efficient and less burdensome to respondents and clinicians. [5] Thus, this shortened form of the instrument may be more valuable than the traditional ones, especially in developing countries like India, where the literacy level can have a significant effect on the applicability of any such instrument. However, large population-based prospective studies need to be designed before bringing it into clinical practice.

   References Top

1.Barqawi AB, Sullivan KF, Crawford ED, Roehrborn CG, Hughes A, O'Leary M, et al. Methods of Developing UWIN, the Modified American Urological Association Symptom Score. J Urol 2011;186:940-4.  Back to cited text no. 1
2.Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Schoenberg ED, Owen-Smith A, et al. Patient misunderstanding of the individual questions of the American Urological Association symptom score. J Urol 2008;179:2291-4.  Back to cited text no. 2
3.Coste J, Guillemin F, Pouchot J, Fermanian J. Methodological approaches to shortening composite measurement scales. J Clin Epidemiol 1997;50:247-52.  Back to cited text no. 3
4.Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1 : 307-10.  Back to cited text no. 4
5.Crawford ED, O'Donnell CI, Barqawi AB, O'Leary M, Sullivan KF, Hughes A, et al. Validation of the modified american urological association symptom score. J Urol 2011;186:945-8.  Back to cited text no. 5


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