Prostate_Questionaire

Prostatic Questionaire:

Name:

Date:

Take this quiz to help you and your doctor decide whether you could
benefit from treatment.

Please circle the answer that best represents your response to each of the
following questions. The questions are designed to gauge the severity of
any symptoms you may be experiencing.

Scores :

0 - Not at all

1 - Less than 1 time in 5

2 - Less than half the time

3 - About half the time

4 - More than half the time

5 - Almost always

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QUESTIONS -

1. INCOMPLETE EMPTYING
Over the past month, how often have you had a sensation of not emptying
your bladder completely after you have finished urinating?

Score = O      1      2      3      4      5

2 .FREQUENCY
Over the past month, how often have you had to urinate again less than 2
hours after you have finished urinating?

Score = O      1      2      3      4      5

3. INTERMITTENCY
Over the past month, how often have you found you stopped and started
again several tiles when you urinated?

Score = O      1      2      3      4      5

4. URGENCY
Over the past month, how often have you found it difficult to postpone
urination?

Score = O      1      2      3      4      5

5 .WEAK STREAM
Over the past month, how often have you had a weak urinary stream?

Score = O      1      2      3      4      5

6 .STRAINING
Over the past month, how often have you had to push or strain to begin
urination?

Score = O      1      2      3      4      5

7 .NOCTURIA
Over the past month, how many tiles did you most typically get up to
urinate from the tile you went to bed at night until the time you got up in the
morning?

Score = O      1      2      3      4      5

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Your Total Score is calculated by adding up the numbers you circled
above.

Total Score = ______

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QUALITY OF LIFE DUE TO URINARY SYMPTOMS
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 - Delighted

1 - Pleased

2 - Mostly Satisfied

3 - Mixed

4 - Mostly Dissatisfied

5 - Unhappy

6 - Terrible

PROSTATIC QUESTIONAIRE: