HappyOrNot® Smileys and the Visual Analogue Scale (VAS) in the Assessment of Urinary Symptoms

Introduction

Several validated questionnaires have been developed to assess the severity and impact of urinary symptoms, using different sets of questions and scoring methods. Although these tests can provide an accurate assessment of patients' symptoms and the bother caused by them, their clinical usability is limited. Some patients have difficulty completing and understanding the questionnaires without assistance. In addition, analysing multi-item questionnaires based on numerical values is time-consuming, and their repeatability in clinical practice is questionable.

A simple, easy-to-use, and easily repeatable test would be valuable for assessing the severity and impact of urinary symptoms. One possibility is the Visual Analogue Scale (VAS), where the patient evaluates symptom severity or bother on a 10-cm line, with one end representing no symptoms/no bother and the other end representing the worst possible symptom/bother.

VAS scales have been used successfully for many years, particularly in pain assessment. For example, in urogynecological conditions, VAS has been shown to be a functional and reproducible tool compared with validated questionnaires. However, some negative findings have also been reported regarding its use in assessing urinary incontinence in women.

The use of VAS for evaluating lower urinary tract symptoms in men has been studied. The study compared VAS with the seven symptoms assessed by the IPSS questionnaire and found a good correlation. VAS compared with IPSS has also been studied in prostate cancer patients undergoing radiation therapy, where VAS performed even better than IPSS in measuring quality of life. The clinical validation of VAS for urinary symptoms has been reported in one study of 1,000 men, showing good correlation with both IPSS and uroflowmetry. In our own pilot study, VAS correlated well with the EPIC-26 questionnaire when assessing post-prostatectomy urinary symptoms.