| AUA
SYMPTOM INDEX FOR BPH
| Patient
Name:________________________ |
Date
of Visit:___________ |
Urinary
Symptoms |
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 |
| 1.
Over the past month, how often have you had the sensation
that your bladder was not completely empty after you finished
urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 2.
Over the past month, how often have you had to urinate
again less than two hours after you last finished urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 3.
Over the past month, how often have you found you stopped
and started again several times while urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 4.
Over the past month, how often have you found it difficult
to postpone urination? |
0 |
1 |
2 |
3 |
4 |
5 |
| 5.
Over the past month, how often have you had a weak urinary
stream? |
0 |
1 |
2 |
3 |
4 |
5 |
| 6.
Over the past month, how often have you had to push or
strain to begin urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 7.
Over the last month, how many times did you typically
get up at night 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 |
| TOTAL
AUA Symptom Score = Sum of questions 1 – 7 ___________ |
From
the American Urological Association (AUA) Symptom Index for
BPH - Appendix A
Click
here to view a printable version |
