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Assessment Tools & Questionnaires

Validated patient-reported outcome measures (PROMs), severity grading scales, and objective assessment tools are the foundation of reconstructive-urology and urogynecology workup. They anchor the clinical conversation, document baseline severity, guide surgical decision-making, and provide the objective endpoints for quality reporting and research.

This page catalogs the major validated instruments used in GU reconstructive practice, organized by clinical domain. For each tool, the entries cover purpose, scoring, validation, and clinical role — not the psychometric minutiae available in the primary literature.

Erectile and Sexual Function​

SHIM / IIEF-5 (Sexual Health Inventory for Men)​

The short-form 5-item version of the International Index of Erectile Function (IIEF), focused on erectile function over the past 6 months.[1][2]

ParameterDetail
Questions5 — confidence, firmness for penetration, maintenance during intercourse, difficulty maintaining to completion, satisfaction
Scoring range1–25
ED severitySevere 1–7, Moderate 8–11, Mild-moderate 12–16, Mild 17–21, No ED 22–25
Time horizonPast 6 months
Validation>10 languages; the single most-cited male sexual function instrument (>4,500 citations)[2]
Clinical roleBaseline ED assessment; response to PDE5i / VED / ICI; pre- and post-implant comparison

Limitation: SHIM captures ED severity specifically, not broader sexual function. For the latter, use EPIC-SF (Expanded Prostate Cancer Index Sexual Function) or PCI-SF in prostate-cancer populations.[3]

Full IIEF (IIEF-15)​

Comprehensive 15-item instrument covering 5 domains: erectile function, orgasmic/ejaculatory function, sexual desire, intercourse satisfaction, and overall satisfaction.[2]

Used in:

  • Clinical trials requiring multi-domain outcome capture
  • Research studies where SHIM alone is insufficient
  • Peyronie's disease work-up in combination with the PDQ (Peyronie's Disease Questionnaire) for psychosocial and sexual-function tracking

Pelvic Organ Prolapse​

POP-Q (Pelvic Organ Prolapse Quantification)​

The only validated objective method for measuring prolapse. Recommended before treatment by ACOG, AUGS, SGS, and ICS.[4][5]

Six vaginal reference points, all measured relative to the hymen (0 cm) — positive values are beyond the hymen, negative values are above it:

PointLocation
AaAnterior vaginal wall, 3 cm proximal to urethral meatus
BaMost dependent point of the anterior vaginal wall
ApPosterior vaginal wall, 3 cm proximal to hymen
BpMost dependent point of the posterior vaginal wall
CMost distal edge of the cervix or vaginal cuff
DPosterior fornix (when cervix is present)

Plus three linear measurements:

  • GH — genital hiatus (external urethral meatus to posterior midline hymen)
  • PB — perineal body (posterior hymen to mid-anal opening)
  • TVL — total vaginal length

Staging (based on most severely prolapsed segment):

StageDefinition
0No prolapse; all points ≤ –3 cm (Aa, Ap) and C ≤ –(TVL − 2)
IMost distal portion > 1 cm above the hymen
IIMost distal portion within 1 cm of the hymen (above or below)
IIIMost distal portion > 1 cm below the hymen but < TVL − 2
IVComplete eversion

Simplified POP-Q (S-POP) — adequate reproducibility for busy clinical practice; uses fewer measurements.[6]

PFDI-20 and PFIQ-7 (Pelvic Floor Distress / Impact)​

  • PFDI-20 (Pelvic Floor Distress Inventory-20): 20 items, range 0–300, distress from pelvic floor symptoms across three subscales (UDI-6 urinary, POPDI-6 prolapse, CRAD-8 colorectal-anal)[7]
  • PFIQ-7 (Pelvic Floor Impact Questionnaire-7): 21 items total (7 per subscale), range 0–300, quality of life impact across the same three domains

Paired use captures both symptom distress and functional impact.

PISQ-IR (Pelvic Organ Prolapse / Incontinence Sexual Questionnaire — IUGA-Revised)​

Validated sexual function assessment specifically for women with prolapse and/or incontinence. Captures the sexual-function domain that PFDI-20 / PFIQ-7 do not.[20]

Urinary Incontinence — Objective Severity​

Pad Weight Tests​

Standardized objective measurement of urinary leakage. Differ by duration.[8][9][10]

TestDurationBest useAccuracy
1-hour pad testICS-standardized protocol with fixed provocative maneuversInitial diagnosisSensitivity 60–93%, specificity 60–84%; less reproducible than longer tests[8]
24-hour pad test24 hours of normal daily activityTreatment-outcome gold standardMore clinically useful than 1-hour[8][11]
7-day pad testOne week of normal activityCaptures maximum leakage; strong correlation with 24-hour and moderate correlation with ICIQ-SFBest capture of peak leakage[10]

Interpretation: Abnormal increase defined as >15 g pad weight gain.[12]

Clinical role: Underutilized despite being inexpensive, easy to perform, and valuable for diagnosis, treatment selection, and outcome assessment.[9]

MSIGS (Male Stress Incontinence Grading Scale)​

Grading system using the Standing Cough Test for male stress urinary incontinence.[13]

GradeObserved leakage
0No leakage
1Drops / trickle
2Stream — ends before coughing ends
3Stream — persists through cough
4Leakage with minimal provocation / Valsalva

Clinical utility: Adds prognostic value to pads-per-day in predicting transobturator sling success; incorporated into the Shakir refined nomogram for sling candidate selection. Increasing MSIGS grade associated with treatment failure.[13]

Voiding / Bladder Diaries​

3–7 day diary of fluid intake, voiding events, and incontinence episodes. Captures storage LUTS, identifies modifiable factors (fluid volume, caffeine, diuretic timing), and monitors response to treatment.[14][15]

ICIQ Bladder Diary (validated)​

The 3-day ICIQ bladder diary is the validated standard.[16] Records:

  • Time and volume of each void
  • Fluid intake (type and volume)
  • Incontinence episodes with circumstances (urge, stress, leakage with activity)
  • Pad use

AUA/SUFU OAB guideline recommendation: bladder diary is part of the standard OAB workup — for diagnosis, excluding alternative conditions, assessing bother, and evaluating treatment response.[15]

Role alongside urodynamics: complementary — more accessible, affordable, and can be completed at home. Particularly valuable in resource-limited settings or when urodynamic equipment is unavailable.[14]

Lower Urinary Tract Symptoms​

InstrumentPopulationKey features
IPSS (International Prostate Symptom Score)Men (and by extension mixed LUTS)7 symptom items + 1 QoL item; gold-standard BPH/LUTS assessment[17][18]
ICIQ-UI-SF (Short Form)All adults4 items; frequency, volume, bother, circumstance; heavily validated and cited[2]
ICIQ-LUTS-QOLAll adultsQuality-of-life impact of LUTS[17]
ICSmaleSFMenMale-specific LUTS short form[18]
LURN-SI-29 / LURN-SI-10All gendersVoiding, storage, and incontinence symptoms; validated across genders[15]
Bristol Female LUTSWomenComprehensive female-specific LUTS[15]

Incontinence-Specific​

InstrumentPurpose
ISI (Incontinence Symptom Index)Severity + bother across incontinence types[19]
IIQ-7 (Incontinence Impact Questionnaire-7)Emotional and functional impact of incontinence[19]
UDI-6 (Urogenital Distress Inventory-6)Short form urogenital distress (overlaps PFDI-20)[2][17]

Urethral Stricture Disease​

USS-PROM (Urethral Stricture Surgery PROM)​

The disease-specific PROM for anterior urethral reconstruction. Validated by the BAUS section; combines LUTS, health-status (EQ-5D), and treatment satisfaction items.[21][22]

Clinical role: baseline documentation and longitudinal tracking before and after urethroplasty. The USS-PROM has largely replaced ad-hoc symptom scoring in urethral-reconstruction research and high-volume clinics.

Urethral Stricture Score​

Validated scoring system predictive of operative complexity, recurrence, and complications.[23][24] Incorporates:

  • Stricture Length
  • Segment (anatomic location)
  • Etiology

An extension — the LSE system — provides further stratification. Both are predictive of operative decision-making (graft vs. excision-primary anastomosis), complication risk, and recurrence.

Other Validated Tools​

InstrumentDomain
EPIC (Expanded Prostate Cancer Index Composite)Post-prostate-cancer urinary, sexual, and bowel function — widely used in prostate-cancer reconstruction research[18]
NIH-CPSI (NIH Chronic Prostatitis Symptom Index)Pain, urination, and overall impact in chronic prostatitis / CPPS[25]
ICIQ-S (ICIQ-Satisfaction)Validated satisfaction measure after urological surgery — useful for postoperative outcome reporting across reconstructive procedures[26]
EQ-5DGeneric health-related quality of life; component of USS-PROM and many other disease-specific bundles[21][22][27]
PDQ (Peyronie's Disease Questionnaire)Peyronie's-specific psychosocial, sexual function, and pain domains

How to Use These in Practice​

At initial visit​

  • Men with ED → SHIM / IIEF-5 (baseline) + PDQ if curvature / plaque
  • Men with LUTS → IPSS + ICIQ-UI-SF (if incontinence) + bladder diary
  • Men with SUI (post-prostatectomy) → pads-per-day + MSIGS / standing cough test + 24-hour pad test
  • Women with prolapse → POP-Q exam + PFDI-20 + PFIQ-7 + PISQ-IR if sexually active
  • Women with incontinence → ICIQ-UI-SF + UDI-6 + IIQ-7 + bladder diary + pad test
  • Men / women with urethral stricture → USS-PROM + stricture scoring (LSE / USS)

At follow-up​

  • Re-administer the same instruments used at baseline — comparability is the value
  • Pad tests preferred for objective verification of incontinence-surgery outcomes (24-hour or 7-day)
  • ICIQ-S for generic post-surgical satisfaction benchmarking

Counseling role​

Validated instruments provide the reference anchor for the subjective-vs-objective disconnect that patients consistently report after reconstructive surgery — men who report "much worse shortening" than objective measurement shows, women who report persistent "leakage" that doesn't register on pad testing. Use the numbers to ground the conversation.

See Also​

References​

1. Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17(4):307–19. doi:10.1038/sj.ijir.3901327

2. Bordeianou LG, Anger JT, Boutros M, et al. Measuring pelvic floor disorder symptoms using patient-reported instruments: proceedings of the consensus meeting of the Pelvic Floor Consortium of ASCRS, ICS, AUGS, and SUFU. Female Pelvic Med Reconstr Surg. 2020;26(1):1–15. doi:10.1097/SPV.0000000000000817

3. Levinson AW, Ward NT, Sanda MG, et al. Comparison of validated instruments measuring sexual function in men. Urology. 2010;76(2):380–386. doi:10.1016/j.urology.2010.04.033

4. American College of Obstetricians and Gynecologists. Pelvic organ prolapse: ACOG practice bulletin, number 214. Obstet Gynecol. 2019;134(5):e126–e142. doi:10.1097/AOG.0000000000003519

5. AUGS / SGS. Pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2019;25(6):397–408. doi:10.1097/SPV.0000000000000794

6. Madhu C, Swift S, Moloney-Geany S, Drake MJ. How to use the Pelvic Organ Prolapse Quantification (POP-Q) system? Neurourol Urodyn. 2018;37(S6):S39–S43. doi:10.1002/nau.23740

7. Haya N, Feiner B, Baessler K, Christmann-Schmid C, Maher C. Perioperative interventions in pelvic organ prolapse surgery. Cochrane Database Syst Rev. 2018;8:CD013105. doi:10.1002/14651858.CD013105

8. Medeiros Araujo C, de Morais NR, Sacomori C, de Sousa Dantas D. Pad test for urinary incontinence diagnosis in adults: systematic review of diagnostic test accuracy. Neurourol Urodyn. 2022;41(3):696–709. doi:10.1002/nau.24878

9. Krhut J, Zachoval R, Smith PP, et al. Pad weight testing in the evaluation of urinary incontinence. Neurourol Urodyn. 2014;33(5):507–10. doi:10.1002/nau.22436

10. Martínez-Cuenca E, Sánchez JV, Bonillo MÁ, et al. Longer is better than shorter: the added value of the seven-day pad test in the post-radical prostatectomy urinary incontinence. Neurourol Urodyn. 2021;40(4):994–1000. doi:10.1002/nau.24655

11. Matharu GS, Assassa RP, Williams KS, et al. Objective assessment of urinary incontinence in women: comparison of the one-hour and 24-hour pad tests. Eur Urol. 2004;45(2):208–12. doi:10.1016/j.eururo.2003.09.006

12. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446–56. doi:10.1001/jama.299.12.1446

13. Shakir NA, Fuchs JS, McKibben MJ, et al. Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. Neurourol Urodyn. 2018;37(8):2632–2637. doi:10.1002/nau.23703

14. Liapis I, Gammie A, Mohamed-Ahmed R, et al. Can we increase the value of data from bladder diaries? International Consultation on Incontinence-Research Society 2023. Neurourol Urodyn. 2024;43(6):1311–1320. doi:10.1002/nau.25374

15. Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. 2024;212(1):11–20. doi:10.1097/JU.0000000000003985

16. Bright E, Cotterill N, Drake M, Abrams P. Developing and validating the International Consultation on Incontinence Questionnaire Bladder Diary. Eur Urol. 2014;66(2):294–300. doi:10.1016/j.eururo.2014.02.057

17. D'hulst P, Muilwijk T, Vander Eeckt K, Van der Aa F, Joniau S. Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures. BJU Int. 2020;126(6):684–693. doi:10.1111/bju.15131

18. Donovan JL, Hamdy FC, Lane JA, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425–1437. doi:10.1056/NEJMoa1606221

19. Wingate JT, Erickson BA, Murphy G, et al. Multicenter analysis of patient reported outcomes following artificial urinary sphincter placement for male stress urinary incontinence. J Urol. 2018;199(3):785–790. doi:10.1016/j.juro.2017.09.089

20. Gray TG, Vickers H, Krishnaswamy P, Jha S. A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine. Int Urogynecol J. 2021;32(8):2033–2092. doi:10.1007/s00192-021-04810-1

21. Jackson MJ, Chaudhury I, Mangera A, et al. A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol. 2013;64(5):777–82. doi:10.1016/j.eururo.2013.04.037

22. Horiguchi A, Shinchi M, Ojima K, et al. Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease-specific patient-reported outcome measure. World J Urol. 2019;37(4):601–606. doi:10.1007/s00345-018-2540-z

23. Kurtzman JT, Kosber R, Kerr P, Brandes SB. Evaluating tools for characterizing anterior urethral stricture disease: a comparison of the LSE system and the Urethral Stricture Score. J Urol. 2022;208(5):1083–1089. doi:10.1097/JU.0000000000002880

24. John A, Kahokehr AA. Classification systems for anterior urethral stricture disease in men: a systematic review. World J Urol. 2021;39(3):761–769. doi:10.1007/s00345-020-03250-8

25. Schaeffer AJ. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006;355(16):1690–8. doi:10.1056/NEJMcp060423

26. Uren AD, Cotterill N, Hashim H, et al. International Consultation on Incontinence Questionnaire-Satisfaction: psychometric testing of a new patient-reported outcome measure for the evaluation of satisfaction after urological surgery. BJU Int. 2020;126(2):286–291. doi:10.1111/bju.15091

27. Chung PH, Vanni AJ, Breyer BN, et al. Evaluation of generic versus condition-specific quality of life indicators for successful urethral stricture surgery. Urology. 2019;126:222–226. doi:10.1016/j.urology.2018.12.009