Urinary tract infections are one of the main reasons for consultation in women. Adequate evaluation of symptoms is necessary since treatment is indicated without microbiological results. Age, estrogens status, and sexual activity are risk factors for UTIs. Therefore, we aimed to evaluate the differences in symptoms in pre-and postmenopausal females with acute cystitis.

We analysed urinary symptoms in patients with acute cystitis and subsequent microbiological confirmation. Symptoms were evaluated with the Acute Cystitis Symptom Score (ACSS), a patient self-reporting questionnaire for the clinical diagnostics and patient-reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute uncomplicated cystitis (UC). In addition, a multicentre study was conducted in Spain, Colombia and Peru, in which we evaluated the differences in symptoms between premenopausal and postmenopausal women. 
   The ACCS questionnaire was translated from original Russian and American English as a new master file to Spanish by three translators. Four Urologists from Spain and Latin America reviewed the translation and adapted the questionnaire. They reach consensus to use the same version for all countries whose primary language is Spanish. 20 females with different educational levels and 20 healthcare professionals evaluated the ACSS questionnaire cognitively. Considering their comments, the linguistically validated Spanish ACSS version was established.

The study included 126 patients, 80 premenopausal (mean age 33.79.6) and 46 (mean age 65.4-8.8) menopausal. A higher level of education was observed in women of childbearing age. Constipation was present in 48% of menopausal women and 16% of women of childbearing age (p=0.007). Sexual activity was reported by 95% of women of childbearing age and 49% of menopausal women (p<0.001).
   Although no significant differences were observed concerning symptoms associated with acute cystitis, menopausal women had a slightly higher score for typical symptoms (11.21 vs 10.83; p=0.686) concerning greater urgency and polyuria. However, higher scores are obtained for back pain (1.0 vs. 0.55), vaginal (0.59 vs. 0.11) and urethral discharge (0.22 vs. 0.04) and fever (0.26 vs. 0.09) in women of childbearing age. Finally, the impact on quality of life is higher in premenopausal women than in postmenopausal women, 5.60 vs 4.95 (p=0.318).
Isolation of microorganisms other than Escherichia coli was more frequent in menopausal women.

The Spanish validated Acute Cystitis Symptom Score (ACSS) questionnaire allows a correct assessment of symptoms associated with acute cystitis in pre-and postmenopausal women. Women of childbearing age may report lower urinary symptoms associated with cystitis and a higher degree of non-typical symptoms.

The Acute Cystitis Symptom Score (ACSS) questionnaire is useful for evaluating patients' symptoms with acute cystitis. In addition, it can be used as a patient's self-diagnosis tool in pre- and postmenopausal women.

Alidjanov JF, Abdufattaev UA, Makhsudov SA, Pilatz A, Akilov FA, Naber KG, et al. New self-reporting questionnaire to assess urinary tract infections and differential diagnosis: acute cystitis symptom score. Urol Int. 2014;92(2):230-6.
Alidjanov JF, Naber KG, Pilatz A, Radzhabov A, Zamuddinov M, Magyar A, et al. Additional assessment of Acute Cystitis Symptom Score questionnaire for patient-reported outcome measure in female patients with acute uncomplicated cystitis: part II. World J Urol. 2020;38(8):1977-88.
Alidjanov JF, Naber KG, Abdufattaev UA, Pilatz A, Wagenlehner FM. Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis. Urol Int. 2019;102(1):83-95.