Prostate Symptom Score Index : Self Assessment Form

Name

Email

Age
Incomplete emptying - Over the past month, how often have you had a sensation of not emptying your bladder completely after urinating?
Frequency - Over the past month, how often have you had to urinate again less than two hours after you finished urinating?
Intermittency - Over the past month, how often have you found you stopped and started again several times when you urinated?
Urgency - Over the last month, how difficult have you found it to postpone urination?
Weak Stream - Over the past month, how often have you had a weak urinary stream?
Straining - Over the past month, how often have you had to push or strain to begin urination?
Nocturia - Over the past month, how many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?
Total IPSS Score - 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?

Total Score :
0-7 mildly symptomatic - should be aware and see your doctor if necessary
8-19 moderately symptomatic - should contact your doctor to prevent any worse symptoms
20-35 severely symptomatic - MUST seek medical help immediately and begin treatment