International prostate symptom score (IPSS)
Name: Date: Less than 1 time in 5 About half the time More than half the Less than half the
Not at all
Almost always
Incomplete emptying
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?
0 0 0 0 0 0
1 1 1 1 1 1
2 2 2 2 2 2
3 3 3 3 3 3
4 4 4 4 4 4
5 5 5 5 5 5
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?
5 times or more
4 times
2 times
3 times
1 time
Nocturia
Over the past month, 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
Mixed about equally satisfied and dissatisfied Mostly dissatisfied
Quality of life due to urinary symptoms
Delighted Mostly satisfied Pleased
Unhappy
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; 8-19 moderately symptomatic; 20-35 severely symptomatic.
Terrible
Your score
None
Your score