1. Incomplete Emptying
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?
Choose answer 0. Not 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
2. Frequency
Over the past month, how often have you had to urinate again less than two hours after you have finished urinating?
Choose answer 0. Not 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
3. Intermittency
Over the past month, how often have you found you stopped and started again several times when you urinated?
Choose answer 0. Not 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
4. Urgency
Over the past month, how often have you found it difficult to postpone urination?
Choose answer 0. Not 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
5. Weak Stream
Over the last month, how often have you had a weak urinary stream?
Choose answer 0. Not 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
6. Straining
Over the past month, how often have you had to push or strain to begin urination?
Choose answer 0. Not 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
Quality of Life due to Urinary Symptoms
If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?
Choose answer 0.Delighted 1.Pleased 2.Mostly satisfied 3.Mixed 4.Mostly unhappy 5.Unhappy 6.Terrible