VN Mount Sinai! NTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) NAME Jeffrey Epstein Chairman Dept of Urology Icahn Schoo! of Medicine at Mount Sinai Ph: (212) 241-9955 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 is 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. 0 ai 0 a 0 3 0 a4 0 as 0 a6 o @ 0 0 Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? Over the past month, how often have you found you stopped and started again several times when you urinated? Over the past month, how often have you found it difficult to postpone urination? Over the past month, how often have you had a weak urinary stream? 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 get up to urinate from the time you went to bed at night until the time you got up in the morning? TOTAL SCORE oh How would you feel if you had to live with your urinary Q8 condition the way it is now, no better, no worse, for the rest of your life? Source: American Urological Association © Not atall 1 Less than i time inS 2 Less than half the time 3 About half the time @ More than half the time 5 Almost always O Not ataill 1 Less than 1 time in S 2 Less than half the time About half the time More than half the time 5 Almost always O Not atall 1 Less than 1timeinS 2 Less than half the time 3 About half the time More than half the time Almost always O Notatall 1 Less than ltimeinS 2 Less than half the time 3 About half the time 4 More than half the time (GB) Almost always O Notatall 1 Less than 1 time in S 2 Less than half the time 3 About half the time 4 More than half the time f g Z i EFTA00314102