American Urological Association BPH Symptom Questionnaire

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American Urological Association (AUA) BPH Symptom Questionnaire

Today's date:    
Last name: First: MI:
Date of birth: ID#:
 
Initial symptom assessment
  or
reassessment/monitoring
 
Treatment:

Watchful Waiting
Alpha Blocker
Balloon Dilation 		  TUIP
Open Surgery
 
Other Treatment
Treatment started / Date of Surgery
 

AUA SYMPTOM SCORE

7 Questions to be answered. Select 1 number on each line.
 
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 or so, how often have you had the sensation of not emptying your bladder completely after you finished urinating?
0
1
2
3
4
5

 
   
2. Over the past month or so, how often have you had to urinate again less than two hours after you finished urinating?
0
1
2
3
4
5

 
   
3. Over the past month or so, how often have you found you stopped and started again several times when you urinated?
0
1
2
3
4
5

 
   
4. Over the past month or so, how often have you found it difficult to postpone urination?
0
1
2
3
4
5
   
5. Over the past month or so, how often have you had a weak urinary stream?
0
1
2
3
4
5
   
6. Over the past month or so, how often have you had to push or strain to begin urination?
0
1
2
3
4
5
   
7. Over the past month or so, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
0
1
2
3
4
5
   
 
Add the score for each number above and write the total in the space to the right.
Total
 
Symptom Score =
 1-7 Mild
8-19 Moderate
20-35 Severe
   
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