Douglas F. Milam M.D.
Urologic Surgery
IPSS/AUA SYMPTOM SCORE
DATE: ______ /_______/_______ |
Place Sticker Here |
URINARY SYMPTOM SCORE
less more
than than about than
not at 1 time half the half the half the almost
all in 5 time time time always
1. Over the past month or so, how
often have you had a sensation of
not emptying your bladder
completely after you finish urinating? 0 1 2 3 4 5
2. Over the past month or so, how
often have you had to urinate again
less than two hours after you
finished urinating? 0 1 2 3 4 5
3. Over the past month or so how
often have you found you stopped
and started again several times
when you urinated? 0 1 2 3 4 5
4. Over the past month or so, how
often have you found it difficult to
postpone urination? 0 1 2 3 4 5
5. Over the past month or so, how
often have you had a weak urinary
stream? 0 1 2 3 4 5
6. Over the past month or so, how
often have you had to push or strain
to begin urination? 0 1 2 3 4 5
7. Over the last month, how many times did you most typically get up to urinate from the time you went
to bed at night until the time you got up in the morning?
0 None 1 One time 2 Two times 3 Three times 4 Four times 5 Five times
AUA Symptom Score = Sum of questions 1 –7 ___________.
8. Quality of life due to urinary symptoms |
Delighted |
Pleased |
Mostly satisfied |
Mixed – about equally satisfied and dissatisfied |
Mostly dissatisfied |
Unhappy |
Terrible
|
If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
Reference: Barry MJ, et al. (1992). American Urological Association symptom index for benign prostatic hyperplasia. Journal of Urology, 148(5): 1549–1557.
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