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    Urinary Symptoms During The Past Month

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    MIHAELA
    This document contains a men's health assessment questionnaire for a patient. It includes the American Urological Association Symptom Index (AUA-SI) which has 7 questions about urinary symptoms over the past month. Each question is scored from 0 to 5. The total score is calculated and can indicate mild, moderate, or severe symptoms. It also asks how bothersome any urinary trouble has been in the last month.

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    Urinary Symptoms During The Past Month

    Uploaded by

    MIHAELA
    111 views1 page
    This document contains a men's health assessment questionnaire for a patient. It includes the American Urological Association Symptom Index (AUA-SI) which has 7 questions about urinary symptoms over the past month. Each question is scored from 0 to 5. The total score is calculated and can indicate mild, moderate, or severe symptoms. It also asks how bothersome any urinary trouble has been in the last month.

    Original Title

    AUA-Score

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    This document contains a men's health assessment questionnaire for a patient. It includes the American Urological Association Symptom Index (AUA-SI) which has 7 questions about urinary symptoms over the past month. Each question is scored from 0 to 5. The total score is calculated and can indicate mild, moderate, or severe symptoms. It also asks how bothersome any urinary trouble has been in the last month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    111 views1 page

    Urinary Symptoms During The Past Month

    Uploaded by

    MIHAELA
    This document contains a men's health assessment questionnaire for a patient. It includes the American Urological Association Symptom Index (AUA-SI) which has 7 questions about urinary symptoms over the past month. Each question is scored from 0 to 5. The total score is calculated and can indicate mild, moderate, or severe symptoms. It also asks how bothersome any urinary trouble has been in the last month.

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    Patient Name _______________________________________________ Date ______________________

    MEN'S HEALTH ASSESSMENT QUESTIONAIRE


    American Urological Association Symptom Index (AUA-SI)
    Circle the answer that best describes your symptoms
    Less than More
    Less than About half Almost
    Urinary symptoms during the past month Not at all
    1 time in 5
    half the
    the time
    than half
    Always
    time the time
    1. How often have you had a sensation of not emptying
    0 1 2 3 4 5
    your bladder completely?

    2. How often did you urinate more than once within a 2-


    0 1 2 3 4 5
    hour period?

    3. How often have you stopped and started several times


    0 1 2 3 4 5
    while urinating?

    4. How often have you had difficulty postponing


    0 1 2 3 4 5
    urination?

    5. How often have you had a weak urinary stream? 0 1 2 3 4 5

    6. How often did you strain to begin to urinate? 0 1 2 3 4 5

    7. How many times did you get up during the night to


    0 1 2 3 4 5
    urinate?

    Symptom Score: Total Score : _____________


    1-7 mild * 8-19 moderate * 20-35 severe
    If your score is 8 or above you should see a urologist for
    evaluation. Please call Alpine Urology to make an appointment
    BOTHER ASSESSMENT QUESTION

    Overall, how bothersome has any trouble urination been during the last month?

    O Not at all bothersome O Bothers me a little O Bothers me some O Bothers me a lot

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