|
How often over the past month, |
Not at all |
Rarely |
Less than half |
About half |
More than half |
Almost always |
|
Have you felt that you did not empty your bladder completely? |
|
|
|
|
|
|
|
Have you had to pass water more than once in two hours? |
|
|
|
|
|
|
|
Has the flow stopped and started? |
|
|
|
|
|
|
|
Did you have to rush quickly to get to the toilet? |
|
|
|
|
|
|
|
Was the force of the stream reduced? |
|
|
|
|
|
|
|
Did you have difficulty starting to pass water? |
|
|
|
|
|
|
|
At night, did you get up to pass water? |
|
|
|
|
|
|
Total IPSS Score (Maximum: 35)…………………………..
HOW WOULD YOU FEEL IF YOU HAD TO SPEND THE REST OF YOUR LIFE WITH YOUR WATERWORKS THE SAME AS THEY ARE NOW?
|
Mostly satisfied |
Satisfied |
Mixed |
Dissatisfied |
Mostly Dissatisfied |
Unhappy |
Terrible |
|
0 |
1 |
2 |
3 |
4 |
5 |
6 |
0-7 = Mildly Symptomatic
8-19 = Moderately Symptomatic
20-35= Severely Symptomatic
Adapted from The Princess of Wales Urology Dept Prostate Symptom Score Sheet