|
|
|
|
|
|
|
|
|
Circle one number on each line
and total score below.
|
|
|
|
|
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Total Score
Questions 1-7: |
Not
at
all
|
Less
than
1
time
in 5
|
Less
than
half
the
time
|
About
half
the
time
|
More
than
half
the
time |
Almost
always
|
1. Over the past month, how often
have you had a sensation of not
emptying your bladder completely
after you finished urinating? |
0
|
1
|
2
|
3
|
4
|
5
|
|
2. Over the past month, 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, 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, how often
have you found it difficult to
postpone urination? |
0
|
1
|
2
|
3
|
4
|
5
|
5. Over the past month, how often
have you had a weak urinary
stream? |
0
|
1
|
2
|
3
|
4
|
5
|
6. Over the past month, how often
have you had to push or strain to
begin urination? |
0
|
1
|
2
|
3
|
4
|
5
|
For question 7 please indicate
your response |
None
|
1
time
|
2
times
|
3
times
|
4
times
|
5
times
|
7. Over the past 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? |
|
|
|
|
|
|
Source: American Urological Association
Return to Symptoms
For more information about the Department of Urology, contact:
Phone: 214-648-4765, FAX: 214-648-4789
Mailing Address: 5323 Harry Hines Blvd., J8.148, Dallas, TX 75390-9110
