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Lower urinary tract symptoms are common complaints in ageing people. For a urological evaluation of such complaints in men, the International Prostate Symptom Score (IPSS) is used worldwide. Previous quantitative studies have revealed serious problems in completing this questionnaire. In order to gain insight into the nature and causes of these problems, we conducted a qualitative study. Not only the purely verbal IPSS was studied but also two alternatives, including pictograms: the Visual Prostate Symptom Score (VPSS) and the Score Visuel Prostatique en Image (SVPI). Men aged 40 years and over with an inadequate level of health literacy (IHL; n = 18) or an adequate level of health literacy (AHL; n = 47) participated. Each participant filled out one of the three questionnaires while thinking aloud. The analysis of their utterances revealed problems in both health literacy groups with form-filling tasks and subtasks for all three questionnaires. Most noticeable were the problems with the IPSS; the terminology and layout of this form led to difficulties. In the VPSS and SVPI, the pictograms sometimes raised problems. As in previous research on form-filling behavior, an overestimation by form designers of form fillers’ knowledge and skills seems to be an important explanation for the problems observed.

In this chapter, we present our view on the diagnosis and treatment of a 72-year-old woman with a 3 cm low-grade T1 tumor located in the bladder dome and without muscle present in the resected specimen. Some factors would suggest a good prognosis; some suggest a high risk for recurrence and progression. We discuss age, gender, and tumor size (or, as a possible surrogate, tumor weight) as prognostic factors. Furthermore, variability in grading and staging and the diagnosis of low-grade T1 are addressed. Tumor location as a prognostic factor and the prognostic importance and technical aspects of the tumor resection are discussed. In light of a complete resection, re-resection, random biopsies and the value of fluorescence cystoscopy are reviewed and commented. Finally, we review additional therapies such as intravesical chemotherapy, BCG, and radical surgery in different clinical scenarios.