Patient BPH Questionnaire

AUA Symptom Score Questionnaire

The American Urological Association (AUA) has created this symptom index to give you and your physician at Advanced Vascular an understanding of the severity of your enlarged prostate symptoms.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Over the past month, how often have you been bothered by the following problems?*

	None	Less than 1 time in 5	Less than half the time	About half the time	More than half the time	Almost Always
Incomplete Emptying: Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
Frequency: Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating?
Intermittency: Over the past month, how often have you found that you stopped and started again several times when you urinated?
Urgency: Over the past month, how often have you found it difficult 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?
Nocturia: Over the past month, 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?

Symptom Severity Score: 0 to 7 (Mild), 8 - 19 (Moderate), 20 to 35 (Severe)
If you scored 8 points or higher, you should consult your physician. Please give us a call at 678.344.8900 to schedule an appointment