International Prostate Symptom Score (I-PSS) | Australian Urology Associates

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International Prostate Symptom Score (I-PSS)

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YOUR UROLOGIST

Dr Ross Snow

Prof Mark Frydenberg

Dr Uri Hanegbi

Dr Karen McKertich

Dr Adam Landau

Dr Briony Norris

YOUR PERSONAL DETAILS

First name*

Surname*

DOB

MM slash DD slash YYYY

Email

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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