Lower urinary tract symptoms (LUTS) are very prevalent in men and are widely dispersed across the globe. And its prevalence is often determined using the IPSS (International Prostate Symptom Score). In the evaluation of LUTS, there are difficulties associated with the quantification of something subjective as a symptom, increased by the difficulties already known in the use of IPSS in a low literacy setting. Validate a visual scale to assess LUTS, especially in developing countries, as an alternative to IPSS. VASUS consist of 5 questions, where Q1 and Q2 assess urinary stream quality, Q3 nocturia, Q4 incomplete emptying and Q5 QoL (figure 1).

Between 2014 and 2017, we carried out a study in the male population over thirty years from São Tomé and Príncipe, a Portuguese speaking African Country. A stratified sample (age and district) of subjects completed IPSS, VASUS and a free flowmetry.

Eight hundred and twelve men born in São Tomé and Príncipe over 30 years of age (average age: 50.72, range: 30-95), distributed geographically (by district) and by age, completed the study protocol. Table 1 shows the main socio-demographic characteristics.
Positive correlations between IPSS and VASUS were found for all variables (p-value <0.0001), analyzed (Table 2). The Spearman correlation to the total result of the IPSS and VASUS was r=0.547 (p<0.0001) The highest value was found in the nocturia question (Q3) (r=0.767, p<0.0001). 
VASUS and IPSS quality of life questions were positively correlated (r=0.656, p<0.0001). There was a strong association between this (VASUS Q5) and the total score in VASUS (r=0.656, p<0.0001).
In the evaluation of urodynamic variables, negative correlation for all variables was found, being stronger for VASUS than for IPSS (Table 1). 
Comparison of Qmax (maximum flow) averages, in Q1 and Q2 of the VASUS (F=55.31; p<0.0001; F=53.44; p<0.0001) and Q5 of the IPSS (F=29.55; p<0.0001), between patients with mild symptoms and those with moderate to severe symptoms, showed strong statistical significance in both questionnaires.

With VASUS we created a visual scale that could be quickly and easily applied in a low literacy setting and that could be useful as a screening and also a monitoring tool.
When verifying the association of VASUS with the IPSS, namely when comparing questions with similar objectives such as nocturia (VASUS - Q3 and IPSS - Q7), the stream quality (VASUS - Q1 and Q2 and IPSS - Q5) or the quality of life (VASUS - Q5 and IPSS - Q8), we verified strong positive correlations. These results are in agreement with those verified for other visual scales.

To our knowledge, this is the first work to validate a visual scale for LUTS in a large-scale sample of individuals from the general male population without prior known LUTS-inducing urological disease. VASUS is a visual alternative to IPSS allowing evaluation of LUTS and having correlation with IPSS and flowmetry. Its use in developing countries with low levels of literacy will be an asset. The authors believe that widespread use of a scale such as VASUS in urology consultations is warranted, in order to increase daily practice objectification of LUTS.

Continence 2S2 (2022) 100252
DOI: 10.1016/j.cont.2022.100252