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International Prostate Symptom Score (I-PSS)

Home » Forms » International Prostate Symptom Score (I-PSS)

"*" indicates required fields

Name*

First Last

Date of Birth*

Day

Month

Year

Email

Name of your Urologist

Please select the most appropriate answer and your total score will be calculated at the end

1. Incomplete emptying

Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?*

0: None 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

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

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

2. Frequency

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

0: None 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

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

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

3. Intermittency

Over the past month, how often have you found you stopped and started again several times when you urinated?*

0: None 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

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

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

4. Urgency

Over the last month, how difficult have you found it to postpone urination?*

0: None 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

4. Urgency.
Over the last month, how difficult have you found it to postpone urination

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

5. Weak stream

Over the past month, how often have you had a weak urinary stream?*

0: None 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

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

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

6. Straining

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

0: None 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

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

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost Always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

None at all | Less than 1 time in 5 | Less than half the time | About half the time | More than half the time | Almost always

7. Nocturia

Over the past month, how many times per night did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?*

0: None

1: 1 time

2: 2 times

3: 3 times

4: 4 times

5: 5 or more times

7. Nocturia.
Over the past month, how many times per night did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?

None | 1 time | 2 times | 3 times | 4 times | 5 or more times

None | 1 time | 2 times | 3 times | 4 times | 5 or more times

None | 1 time | 2 times | 3 times | 4 times | 5 or more times

None | 1 time | 2 times | 3 times | 4 times | 5 or more times

None | 1 time | 2 times | 3 times | 4 times | 5 or more times

None | 1 time | 2 times | 3 times | 4 times | 5 or more times

Total I-PSS Score:

Total I-PSS Score

0-7 Mildly Symptomatic
8-19 Moderately Symptomatic
20-35 Severely Symptomatic

0-7 Mildly Symptomatic
8-19 Moderately Symptomatic
20-35 Severely Symptomatic

0-7 Mildly Symptomatic
8-19 Moderately Symptomatic
20-35 Severely Symptomatic

8. 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?*

Delighted

Pleased

Mostly satisfied

Mixed, about equally

Mostly dissatisfied

Unhappy

Terrible

8. 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?

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

Delighted | Pleased | Mostly satisfied | Mixed, about equally | Mostly dissatisfied | Unhappy | Terrible

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Malvern VIC 3144
Phone: 03 8506 3600
Fax: 03 8506 3699
Email: reception@aua.com.au

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