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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Evaluation of Traditional and Pictorial Symptom Scores among Indian Men with Lower Urinary Tract Symptoms: A Retrospective Observational Study
Correspondence Address :
Eeshansh Khare,
304, Subhash Colony, Bararipura Road, Behind Church Compound, Chhindwara-480001, Madhya Pradesh, India.
E-mail: eeshanshkhare29@gmail.com
Introduction: The traditional questionnaire for Lower Urinary Tract Symptoms (LUTS) in males is the International Prostate Symptom Score (IPSS). To minimise its limitations, a picture-based Visual Prostate Symptom Score (VPSS) was developed as an alternative.
Aim: To compare the ease of use, applicability, and clinical correlation of the Traditional Symptom Score (TSS) and Pictorial Symptom Score (PSS) among Indian men presenting with LUTS.
Materials and Methods: This was a retrospective, record-based observational study conducted on 100 male patients with LUTS in the Outpatient Department (OPD) of the Urology Department at Vivanta Critical Care and Multispeciality Hospital, Chhindwara, Madhya Pradesh, India, from January 2024 to December 2024. The first 50 patients were given the IPSS questionnaire to complete, followed by the VPSS, and were considered Group I; the next consecutive 50 patients who completed the VPSS first and the IPSS later were considered Group II. Evaluation parameters were age, education status, time taken for filling symptom scores, help needed for filling symptom scores, prostate-specific antigen, prostate size, and uroflowmetry parameters. Unpaired t-test, Chi-square test, and Pearson’s correlation test were used in statistical analysis.
Results: The majority of patients, 16 (32%) in Group I and 20 (40%) in Group II, were aged 61-70 years. 29 (58%) in group I and 16 (32%) in group II had an average educational status of primary education and below. Thirty-two patients in group I completed the PSS without help, but only 15 in group II completed the TSS without help. 12 patients had difficulty completing the PSS, compared with 38 for the TSS. Difficulty faced by patients was understanding the scoring systems of each question and the questions asked in questionnaires. Mean Prostate-specific antigen (PSA) in group I and II was 2.46±1.5 ng/mL and 2.17±1.35 ng/mL, respectively. Patients with increased prostate size had a higher total score in group I (r=0.91) and group II as well (r=0.90). PSA also showed a positive correlation with both scores (r=0.83 and r=0.76, respectively). Both TSS and PSS showed a negative correlation with maximum flow rate (r = -0.60 and r = -0.76, respectively).
Conclusion: The PSS was easier for patients to complete than the traditional symptom score. The severity of LUTS was strongly correlated with both symptom scores. Maximum urinary flow rate inversely correlated with both symptom scores.
Maximum urinary flow rate, Prostate, Prostate specific antigen, Obstructive, Post voiding
Many of the patients attending the urology OPD present with LUTS. LUTS can be obstructive, storage, and post-voiding (1). These symptoms have a strong positive association with age (2). The common cause for LUTS in males is benign enlargement of the prostate (BPE); however, other non prostatic causes are also present (2). The bother of lower urinary tract symptoms varies with each patient (3). Some patients have slow and prolonged progressive symptoms, whereas in some it may resolve with time (3). Validated questionnaires like TSS (Table/Fig 1) known as IPSS (4), and PSS (Table/Fig 2) known as VPSS (5), are key tools in diagnostic evaluation of LUTS in males.
Other diagnostic tests for further evaluation of LUTS include voiding diary, uroflowmetry, routine urine examination, urine culture and sensitivity test, local genitourinary examination with or without Digital Rectal Examination (DRE), Ultrasonography (USG) and serum PSA in suspected cases of prostatic enlargement (6).
Despite the differences in both scores, a correlation exists between the TSS and PSS. Though PSS is easy to use by patients with limited education, its wide application worldwide is limited, however some studies (7),(8) in distinct parts of the world is available. Studies by Oranusi CK et al., showed negative correlation of maximum flow rate with IPSS score (9). Similarly van der Walt CLE et al., showed correlation between IPSS and VPSS and uroflowmetry parameters (10).
This study evaluates traditional and pictorial symptom scores along with uroflowmetry parameters in district-level urological practice at a single center.
Objectives of this study:
1. To study the demographic profile of male patients with male LUTS.
2. To study the ease and difficulties faced at the time of filling TSS and PSS symptom scores.
3. To study relation between peak urinary flow rate (Qmax) and TSS and PSS score.
A retrospective, record-based observational study conducted on 100 male patients with LUTS in the Outpatient Department (OPD) of the Urology Department at Vivanta Critical Care and a private district-level Multispeciality Hospital, Chhindwara, Madhya Pradesh, India, from January 2024 to December 2024. Previously documented TSS and PSS questionnaires, uroflowmetry findings, PSA values, and other clinical parameters were analysed. Institutional Ethical approval (VCCH/ICH/2026/001) was obtained for this study.
Inclusion criteria: Records of male patients with LUTS, aged more than 35 years, and patients who had filled out symptom score questionnaires were included.
Exclusion criteria: Records of female patients, incompletely filled questionnaires, patients who had suprapubic catheter or per urethral catheter, patients who had history of urological intervention (for urethra and urinary bladder) before OPD visit, patients with carcinoma prostate, patients on chemotherapy and/or radiotherapy for any other oncologic cause, Inpatient Department (IPD) patients and patients who had not given consent for participation in study were excluded.
Study Procedure
Both traditional and pictorial scores categorise patients into three groups based on severity of symptoms: mild, moderate, and severe. Questions related to storage symptoms in TSS (4) enquire about three things (frequency, urgency, and nocturia) while PSS enquires only about two (daytime and nighttime frequency of voiding) (5). TSS enquires about four voiding-related questions (poor urinary flow, straining during voiding, intermittency, and sense of inadequate voiding), while PSS has only one question related to voiding symptom (pictorial urine flow). Both scores also vary in terms of Quality-of-life (QoL) questions; in TSS, this question is asked separately but not calculated in the final score, while in PSS, it is included in the total score.
Traditional Symptom Score (TSS) (Table/Fig 1) and Pictorial Symptom Score (PSS) (Table/Fig 2) used in the present study were originally IPSS and VPSS questionnaires. Patients were categorised into two groups based on the sequence of questionnaire administration documented in the records as follows-
• Group I included patients who completed TSS before PSS, while
• Group II included patients who completed PSS before TSS.
Responses from the second questionnaire, completed at the first follow-up visit (7–10 days after the initial assessment), were extracted from patient records. Thus, 50 patients were enrolled in each group. Hindi version of each questionnaire was used in all patients. Back translation of the English version of the questionnaires was not used in the study.
Data collected in the study included age, medication for LUTS (at the time of OPD visit), education status, time taken for filling questionnaires, difficulty faced at the time of filling these score forms, (that is, inability in understanding the questions and scoring system of questionnaires, understanding the QoL part in questionnaires), nursing staff assisted patients by reading questions aloud; however, this might have influenced patient responses and questionnaire interpretation. Prostate-specific Antigen (PSA), prostate size on sonography, and uroflowmetry findings, including maximum urinary flow rate (Qmax), were recorded.
STATISTICAL ANALYSIs
The data were analysed using Statistical Package for Social Sciences (SPSS) software version 20.0. Numerical variables were summarised as mean and standard deviation and compared between two groups with an unpaired t-test. Categorical variables were summarised as counts and compared between the two groups by Pearson’s Chi-square test. Correlation was assessed using the Pearson correlation coefficient. For these comparisons, p<0.05 was considered statistically significant.
The mean age of patients in groups I and II was 60.34±10.36 years and 62.64±10.44 years, respectively (Table/Fig 3). Age-wise education status of patients in both groups was insignificant (p-value=0.10) (Table/Fig 4). Average total scores in each group were in the severe category (Table/Fig 5).
The comparison between the time taken to fill PSS by group I patients and by group II patients to complete TSS was highly significant, indicating that PSS was filled with much greater ease after completing TSS, whereas TSS was difficult to fill even after completing PSS (Table/Fig 6).
Group I showed a positive correlation with prostate size and PSA, whereas there was a negative correlation with Qmax (Table/Fig 7). A similar correlation was found in group II (Table/Fig 7).
Filling out TSS requires a good level of education and a longer duration, and often healthcare assistance is required to complete TSS (11).
A study of 92 men with Benign Prostatic Hyperplasia (BPH) evaluated the effect of educational status on IPSS responses. Among literate patients, no significant difference was found between self-administered and physician-assisted questionnaires (p=0.55). In contrast, illiterate patients showed significant differences between the two methods (p<0.001), indicating difficulty with self-completion (11).
In a study of 342 patients, the VPSS was completed without assistance significantly more often than the IPSS (p<0.001). Educational level did not independently affect VPSS completion, whereas a university-level education was an independent predictor of successful IPSS completion (OR=9.735, p<0.001). VPSS also required significantly less time to complete than IPSS across all groups (p<0.001). Strong positive correlations were observed between VPSS and IPSS scores, and VPSS total and weak-stream scores showed significant negative correlations with maximum and average urinary flow rates (Qmax and Qave) (p<0.001), supporting the validity and ease of use of VPSS across different educational backgrounds (12).
In the current study, the majority of patients in group I had primary education or below, whereas in group II, the majority were postgraduate. Although education levels across regions and countries cannot be directly compared, TSS seems exceedingly difficult to use in the study region, where education levels are limited.
According to Taneja Y et al., there was a statistically significant difference in the number of patients requiring assistance in completing the questionnaires by education level. There was a positive correlation between IPSS total score and VPSS total score (r=0.7235; p<0.0001), VPSS total score and VPSS quality of life (Qol; r=0.70753; p<0.0001), IPSS total versus IPSS Qol (r=0.65583; p<0.0001), and IPSS Qol versus VPSS Qol (r=0.84093; p<0.0001). A negative correlation was observed between total VPSS and Qmax, total IPSS and Qmax, IPSS total versus Qavg (r=-0.479; p<0.0001), and VPSS total versus Qavg (r=-0.5; p<0.0001). All VPSS questions showed statistically significant correlation with the corresponding IPSS questions (8).
In a study by Afriansyah A et al., a total of 103 men completed the VPSS and IPSS. Associations between literacy and educational level and questionnaire completion, and correlations between VPSS and IPSS scores, were analysed. The VPSS was completed independently more often than the IPSS (79.6% vs. 53.4%). While no illiterate participant could complete the IPSS unaided, 44.1% could complete the VPSS (p<0.001). Lower educational level was associated with a greater need for assistance (p<0.001). VPSS scores showed significant correlations with corresponding IPSS scores (r=0.503–0.823; all p<0.001) (13).
In the Nigerian study, IPSS showed a negative correlation with maximum flow rate (r=0.368; p<0.0075); likewise, the current study also showed a negative correlation between Qmax and TSS (r=-0.60 for group I) (9).
Limitation(s)
As the present study was a retrospective observational study and Hindi versions of symptom scores were used, the results cannot be standardised across other populations. This is a single-centre study, so there may be selection bias as well. Also, the sample size was small, and the study was conducted in a multispecialty private hospital in a district. The study’s duration was also short. Both TSS and PSS were assessed only once, at the first OPD visit. Uroflowmetry was also done only at the time of the first OPD visit. Impact of ongoing LUTS medications on symptom scores and uroflowmetry was also not evaluated. Correlation and group comparisons were performed without controlling for age, education, medication status, prostate size, and baseline symptom score. Assistance may also lead to final interpretation bias.
The present single-centre study showed a significant correlation between traditional and pictorial LUTS questionnaires and maximum flow rate among patients consulting the urology OPD at a private hospital in a district of India. Patients completed the PSS without assistance in the majority of cases and in less time. The current study’s findings suggest that PSS can be used to categorise patients with LUTS by severity in the Hindi-speaking population.
DOI: 10.7860/JCDR/2026/87303.24397
Date of Submission: Jan 08, 2026
Date of Peer Review: May 02, 2026
Date of Acceptance: Jul 06, 2026
Date of Publishing: Sep 01, 2026
Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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