Patient Assessment Tool--Urinary Function Assessment

Date: _______________ Name: _________________________________________

Over the past month or so, how often have you...

Symptom 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. ...had a sensation of not emptying your bladder completely after you finished urination? 0 1 2 3 4 5
2. ...had to urinate again less than two hours after you finished urinating? 0 1 2 3 4 5
3. ...found you stopped and started again several times when you urinated? 0 1 2 3 4 5
4. ...found it difficult to postpone urination? 0 1 2 3 4 5
5. ...had a weak urinary stream? 0 1 2 3 4 5
6. ...had to push or strain to begin urination? 0 1 2 3 4 5
7. ...had to usually get up to urinate from the time you went to bed until you got up in the morning? 0
(none)
1
(once)
2
(twice)
3
(3 times)
4
(4 times)
5
(5 times or more)

Score=sum of answers to questions 1 through 7: ______

>=8 Moderate symptoms
>=20 Severe symptoms

(From Barry M, Fowler F Jr, O'Leary M, et al: "The American Urological Association symptom index for benign prostatic hyperplasia." Journal of Urology 148:1549-1557, 1992.)
Formatted for the WWW and posted 3/2/97; renamed 2/27/00 by Robert S. Stall, M.D. | Dr. Stall's Home Page