EFTA00314102.pdf

t iA Chairman 04mt a UMW/ Mahn School a was* at MOM Sina Ph: (212)241-0955 Mount Sinai ERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) Jeffrey Epstein NAME DATE July 25, 2016 The questionnaire below was developed by the American Urological Association (AUA) to help men evaluate the severity of their symptoms from benign hyperplasia (BHP). This self-administered test can help determine which treatment s needed, if any. Symptoms are classified as mild (1 to 7), moderate (8 to 19), or severe (20 to 35). Generally, no treatment is needed if symptoms are mild; moderate symptoms usually call for some form of treatment; and severe symptoms indicate that surgery is most likely to be effective. O Not at all 1 Less than 1 time in 5 Over the past month, how often have you had a sensation of 2 Less than half the time 0 O1 not emptying your bladder completely after you finished 3 About half the time &More than half the time urinating? 5 Almost always O Not at all 1 Less thanl time m5 2 less than half the time 0 Over the past month, how often have you had to urinate again Q2 (5) About half the time less than 2 hours after you finished urinating? Z More than half the tirrie 5 Almost always O Not at all 1 Less than 1 ume ns 0 Q3 Over the past month, how often have you found you stopped 2 Less than half the time 3 About half the time and started again several times when you urinated? More than half the time SS Almost always O Not at all 1 LESS than 1 time in 5 Over the past month, how often have you found it difficult to 2 Less than half the time 0 Q4 3 About half the time postpone urination? 4 More than half the time ® Almost always O Not at all 1 Less than 1 time vi 5 2 Less than half the time 0 Over the past month, how often have you had a weak urinary Q5 3 About half the time stream? 4 More than half the time il\Almost always O Not at all 1 Less than 1time in 5 2 Less than half the time 0 Over the past month, how often have you had to push or strain Q6 3 About half the time to begin urination? 4 More than half the time 5 Almost always O None 1 One time Over the past month, how many times did you most typically ,..2‘ Two tenet 0 Q7 get up to urinate from the time you went to bed at night until la) Three times 4 Four times the time you got up in the morning? S Five times 0 TOTAL SCORE ir O Delighted 1 Pleased How would you feel if you had to live with your urinary 2 Mostly satisfied Mixed 0 Q8 condition the way it is now, no better, no worse, for the rest of al Mostly Dissatisfied your life? 5 Unhappy 6 Terrible Source: Amer:can Urological Association EFTA00314102