EFTA00314102.pdf

tiA Mount Sinai ERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) Chairman 04mt a UMW/ Mahn School a was* at MOM Sina Ph: (212)241-0955 NAME Jeffrey Epstein DATE July 25, 2016 The questionnaire below was developed by the American Urological Association (AUA) to help men evaluate the severity of their symptoms from benign hyperplasia (BHP). This self-administered test can help determine which treatment s needed, if any. Symptoms are classified as mild (1 to 7), moderate (8 to 19), or severe (20 to 35). Generally, no treatment is needed if symptoms are mild; moderate symptoms usually call for some form of treatment; and severe symptoms indicate that surgery is most likely to be effective. Over the past month, how often have you had a sensation of 0 O1 not emptying your bladder completely after you finished urinating? 0 Q2 Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? 0 Q3 Over the past month, how often have you found you stopped and started again several times when you urinated? 0 Q4 Over the past month, how often have you found it difficult to postpone urination? 0 Q5 Over the past month, how often have you had a weak urinary stream? 0 Q6 Over the past month, how often have you had to push or strain to begin urination? Over the past month, how many times did you most typically 0 Q7 get up to urinate from the time you went to bed at night until the time you got up in the morning? 0 TOTAL SCORE How would you feel if you had to live with your urinary 0 Q8 condition the way it is now, no better, no worse, for the rest of your life? O Not at all 1 Less than 1 time in 5 2 Less than half the time 3 About half the time &More than half the time 5 Almost always O Not at all 1 Less thanl time m5 2 less than half the time (5) About half the time Z More than half the tirrie 5 Almost always O Not at all 1 Less than 1 ume ns 2 Less than half the time 3 About half the time More than half the time SS Almost always O 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 ® Almost always O Not at all 1 Less than 1 time vi 5 2 Less than half the time 3 About half the time 4 More than half the time il\Almost always O 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 O None 1 One time ,..2‘ Two tenet la) Three times 4 Four times S Five times ir O Delighted 1 Pleased 2 Mostly satisfied Mixed al Mostly Dissatisfied 5 Unhappy 6 Terrible Source: Amer:can Urological Association EFTA00314102