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Differences in the Internal Consistency of the AUA Symptom Index in an Unselected Population of Males and Females
Jason Frankel, MD1, Gail Mancuso, RN2, Edward Myer, MD2.
1University of Connecticut, Farmington, CT, USA, 2Middlesex Hospital, Middletown, CT, USA.

Background: Since the AUA symptom index (AUASI) was developed in 1992, it has served as the gold standard for measurement of symptoms of BPH and as the model for subsequent symptom indices. Its features include content validity and internal consistency. The purpose of this study is to evaluate how the internal consistency of the AUASI is maintained in an unselected population of males and females.
Methods: This is a cross-sectional study of 254 consecutive patients who underwent joint replacement between 1/1/13 and 5/30/14. The AUASI was administered as part of a standardized pre-operative evaluation by a single nurse practitioner.
Results: A total of 103 males and 151 females completed the AUASI. The mean ages of males and females were 65.7 and 68.3 years. Median AUASI was 5 (range 0-34) with no significant difference in scores between males and females (p=0.93). The internal consistency of the index was confirmed to be similar to historical results (Cronbach’s alpha=0.79) for all respondents (Table). When separated by gender, reliability estimates were similar for both males and females (Cronbach’s alpha=0.82 for males and =0.77 for females). The strength of the internal correlations differed depending on gender. Factor analysis showed mathematical support for a 2 factor solution along the lines of the traditional distinction between obstructive (voiding) and irritative (storage) categories (Cronbach alpha = 0.74) for all cases. When analyzed by gender, symptoms separated into 2 factors which correlated differently for males and females: among females, the obstructive and irritative categories were maintained, while among males, the symptom of incomplete emptying correlated to both obstructive and irritative categories.
Conclusions: The symptoms of the AUA symptom index are not specific for pathological conditions of the prostate. The test is internally consistent in both males and females. Statistical analysis confirms distinct internal correlations among subjectively irritative and obstructive symptoms. Symptoms correlate differently in men and in women both by 1-factor and 2-factor analysis.
Correlation Matrix, All Respondents
Inc. EmptyFrequencyIntermittencyUrgencyWeak StreamStrainingNocturia
Inc. Empty1.000
Frequency0.4311.000
Intermittency0.5260.4031.000
Urgency0.4250.5220.4161.000
Weak Stream0.4370.4310.4090.3651.000
Straining0.3780.2760.4740.2020.443
Nocturia0.2410.4050.2100.3060.1910.1591.000


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