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IPSS

    Determine Your Enlarged Prostate Symptoms

    Over The Past Month

    Not At All
    0

    Less Then one Time In Five
    1

    Less then half the Time
    2

    About half the Time
    3

    More then half the Time
    4

    Almost Always
    5

    Incomplete emptying - How often have you had the sensation of not emptying your bladder completely after you finished urinating?

    0

    1

    2

    3

    4

    5

    Frequency - How often have you had to urinate again less than two hours after you finished urinating?

    0

    1

    2

    3

    4

    5

    Intermittency - How often have you found you stopped and started again while urinating?

    0

    1

    2

    3

    4

    5

    Urgency - How often have you found it difficult to postpone urination?

    0

    1

    2

    3

    4

    5

    Weak stream - How often have you had a weak urinary stream?

    0

    1

    2

    3

    4

    5

    Straining - How often have you had to push or strain to begin urination?

    0

    1

    2

    3

    4

    5

    Sleeping - How many times did you typically get up to urinate at night?

    0

    1

    2

    3

    4

    5

    1-7 mild symptoms | 8-19 moderate symptoms | 20-35 severe symptoms

    Regardless of the score, if your symptoms are bothersome you should notify your doctor

    Quality Of Life (QOL)

    Over The Past Month

    Delighted

    Pleased

    Mostly satisfied

    Mixed

    Mostly Dissatisfied

    Unhappy

    Terrible

    If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? (check one)

    Delighted

    Pleased

    Mostly satisfied

    Mixed

    Mostly Dissatisfied

    Unhappy

    Terrible

    Have you tried medications to help your symptoms? (Yes or No)

    Yes

    No

    Did these medications help your symptoms? (check One)

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    No Relief

    Complete Relief

    Would you be interested in learning about a minimally invasive option that could allow you to avoid or discontinue enlarged prostate medications? (check Yes or No)

    Yes

    No