Pediatric Urology Is There Any Difference Between Questionnaires on Pediatric Lower Urinary Tract Dysfunction? Mesut Altan, Burak Çitamak, Ali Cansu Bozaci, Emin Mammadov, Hasan Serkan Dog ˘an, and Serdar Tekgül OBJECTIVE To investigate the diagnostic properties of 3 different scoring systems (Dysfunctional Voiding Symptom Score [DVSS], Dysfunctional Voiding and Incontinence Symptoms Score [DVISS], In- continence Symptom Index-Pediatric [ISI-P, for children older than 11 years]) that are used to evaluate lower urinary tract symptoms in pediatric population. MATERIALS AND METHODS Eighty-four participants were evaluated by detailed history, physical examination, 3 different scoring systems (DVSS, DVISS, ISI-P), ultrasonography, and uroflowmetry. Depending on the tests, cases were stratified as healthy or lower urinary tract symptoms (LUTS) by 2 urologists who were blinded to the questionnaires. Patients were reevaluated by the same tests and questionnaires 3 months after treatment. Diagnostic properties of questionnaires were calculated. Additionally, parents were asked to scale the improvement of symptoms subjectively from 0% to 100% to correlate to each of the three scoring systems. RESULTS The mean ages of the normal and the LUTS groups were 9.1 ± 2.6 years and 10.1 ± 2.8 years, respectively (P = .301). Gender (male:female) distribution was 21:21 in the LUTS group and 25:17 in the control group (P = .381). In terms of diagnosis, DVISS has the highest accuracy (sensi- tivity: 81%, specificity: 97.6%, accuracy: 89%) followed by ISI-P (sensitivity: 55.6%, specificity: 100%, accuracy: 82%) and DVSS (sensitivity: 54.8%, specificity: 97.6%, accuracy: 76%). The similar order was valid for the 23 patients older than 11 years (accuracy for DVISS: 87%, for ISI- P: 82%, and for DVSS: 78%). In terms of response to treatment, all 3 tests showed good corre- lation with parents’ ratings (DVSS: P < .001, DVISS: P = .005, ISI-P: P = .042). CONCLUSION Although DVISS had the highest accuracy in distinguishing the patients from healthy controls, all 3 questionnaires seem to be equivalent for the evaluation of response to treatment. UROLOGY ■■: ■■–■■, 2017. © 2017 Elsevier Inc. P ediatric voiding dysfunction and urinary inconti- nence are as common as 10% with varying degrees of severity. 1,2 Children with voiding dysfunction may have complaints such as daytime urinary incontinence, urgency, urinary retention, difficulty in urination, and constipation. 3-5 Although they are generally disturbing symp- toms without any major complication, some may suffer from additional morbidity such as recurrent urinary tract infec- tion, reflux and even upper tract damage. This condition may also cause some major mental health and psychoso- cial problems such as general anxiety state, low self- esteem, and fear of humiliation. 6,7 It is of utmost important to define the severity of the problem with objective pa- rameters and to assess the response to treatment in the follow-up using the same objective evaluation. This can be done by voiding diaries and structured evalu- ation tools like symptom questionnaires. Voiding diaries are good but their use is not practical, and they carry re- liability problems. There are some questionnaire forms for voiding problems in children with the aim of facilitating the diagnosis and evaluating the response to the treat- ment. These questionnaires can be listed as Dysfunc- tional Voiding Symptom Score (DVSS), Incontinence Symptom Index-Pediatric (ISI-P), Dysfunctional Voiding and Incontinence Scoring System (DVISS), and Pediat- ric Urinary Incontinence quality of life (PIN-Q). 8-13 In the pediatric urology literature, there is no study comparing these questionnaires with each other in terms of diagno- sis and follow-up. The aim of this study was to compare Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Hacettepe University School of Medicine, Hacettepe Üniversitesi Hastaneleri, Eris ¸kin Hastanesi, B Katı Üroloji Anabilim Dalı, Sıhhıye, Ankara 06100, Turkey Address correspondence to: Ali Cansu Bozaci, M.D., Department of Urology, Hacettepe University School of Medicine, Hacettepe Üniversitesi Hastaneleri, Eris ¸kin Hastanesi, B Katı Üroloji Anabilim Dalı, Sıhhıye, Ankara 06100, Turkey. E-mail: alicansu@ doctor.com Submitted: October 20, 2016, accepted (with revisions): December 28, 2016 1 http://dx.doi.org/10.1016/j.urology.2016.12.055 0090-4295 © 2017 Elsevier Inc. All rights reserved. ARTICLE IN PRESS