Questionnaire: How satisfied are you with your current BPH treatment?

The following questionnaire will help you assess how satisfied you are with your current BPH treatment. Use this information to open a conversation with your doctor about BPH treatment options. It is not intended to replace a discussion with your doctor.

  1. Do you take medication for BPH?
    • Yes
    • No
    • Not sure
    Do you have side effects from the medication?
    • Yes
    • No
    • Not sure
    Which ones?
    • Headaches
    • Abnormal ejaculation
    • Stuffy nose
    • Dizziness
    • Impotence
    • Tiredness
    • Loss of libido (sex drive)
    • Other(s)
    Please rate how bothersome the side effects are.
    • Not at all bothersome
    • Not bothersome
    • Neutral
    • Somewhat bothersome
    • Very bothersome
  2. Do you have urinary symptoms of BPH, such as a frequent and/or urgent need to urinate?
    • Yes
    • No
    • Not sure
    How bothersome are your urinary symptoms?
    • Not at all bothersome
    • Not bothersome
    • Neutral
    • Somewhat bothersome
    • Very bothersome
  3. Overall, how happy or unhappy are you with your current BPH treatment?
    • Very happy
    • Happy
    • Neutral
    • Unhappy
    • Very unhappy
  4. How interested are you in finding out about BPH treatments, besides medication?
    • Not at all interested
    • Not interested
    • Neutral
    • Somewhat interested
    • Very interested