International Prostate Symptom Score (IPSS) Questionnaire

How Severe Are Your Symptoms ?

First Name: Last Name: Phone Number: Email:

1. Incomplete Emptying: Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
Not 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 2 hours after you finished urinating?
Not 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?
Not 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 past month, how often have you found it difficult to postpone urination?
Not 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?
Not 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?
Not 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. Sleeping: Over the past month, how many times did you most typically get up to urinate from the time you went to bed?
None
1 time
2 times
3 times
4 times
5 or more times

8. Quality of Life: If you were to spend the rest of your life with your unrinary condition the way it is now, how would you feel about that?
Delighted
Pleased
Mostly Satisfied
Mixed
Mostly Dissatisfied
Unhappy
Terrible

Total Score: 0

Symptom Category:

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