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NIH
Chronic Prostatitis Symptom Index
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Developed by the NIDDK-funded
Chronic Prostatitis Collaborative Research Network
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| Pain or discomfort |
| 1. In the last week, have you experienced
any pain or discomfort in the following areas? |
Yes |
No |
| Area between rectum and testicles
(perineum)
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1 |
0 |
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| Testicles
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1 |
0 |
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| Tip of the penis (not related to urination)
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1 |
0 |
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| Below your waist, in your pubic or bladder area
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1 |
0 |
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| 2. In the last week, have you experienced: |
Yes |
No |
| Pain or burning during urination?
|
1 |
0 |
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| Pain or discomfort during or after sexual climax (ejaculation)?
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1 |
0 |
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| 3. How often have you had pain
or discomfort in any of these areas over the last week?
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| Never |
0 |
|
| Rarely |
1 |
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| Sometimes |
2 |
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| Often |
3 |
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| Usually |
4 |
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| Allways |
5 |
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| 4. Which number best describes your AVERAGE pain or discomfort
on the days that you had it over the last week? |
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| Urination |
| 5. How often have you had a sensation
of not emptying your bladder completely after you finished urinating
during the last week?
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| Not at all |
0 |
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| Less than 1 time in 5 |
1 |
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| Less than half time |
2 |
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| About half time |
3 |
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| More than half time |
4 |
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| Almost allways |
5 |
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Modified with permission
from Litwin MS, McNaughton-Collins M ' Fowler FJ, et al. The NIH
Chronic Prostatitis Symptom index (NIH-CPSI). Development and
validation of a new outcomes measure. J Urol. In press. |
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6. How often have you had to urinate
again less than 2 hours after you finished urinating, over the
last week?
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| Not at all |
0 |
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| Less than 1 time in 5 |
1 |
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| Less than half time |
2 |
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| About half time |
3 |
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| More than half time |
4 |
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| Almost allways |
5 |
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| Impact of symptoms |
7. How much have your symptoms
kept you from doing the kinds of things you would usually do,
over the last week?
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| None |
0 |
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| Only a little |
1 |
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| Some |
2 |
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| A lot |
3 |
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8. How much did you think about
your symptoms during the last week?
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| None |
0 |
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| Only a little |
1 |
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| Some |
2 |
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| A lot |
3 |
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| Quality of life |
| 9. If you were to spend the rest
of your life with your symptoms just the way they have been during
the last week, how would you feel about that ?
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| Delighted |
0 |
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| Pleased |
1 |
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| Mostly satisfied |
2 |
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| Mixed (about equally satisfied and dissatisfied) |
3 |
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| Mostly dissatisfied |
4 |
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| Unhappy |
5 |
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| Terrible |
6 |
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| Scoring the Symptom Index Domains |
| Pain: Total of items 1a, 1b, 1c, 1d, 2a,
2b, 3, and 4 |
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| Urinary symptoms: Total of items 5 and 6 |
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| Quality of life impact: Total of items 7,
8, and 9 |
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| Pain and urinary score: Total of item 1 to
6 |
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| Total score: |
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(1) Calculate and report 3 separate scores (pain,
urinary symptoms, and quality of life)
(2) Calculate and report a pain and urinary score (range 0-31),
referred to as the "symptom scale score."
- mild = 0-9
- moderate = 10-18
- severe = 19-31
(3) Calculate and report total score (range 0-43), referred
to as the "total score." Assess patients at baseline
and follow them over time using each patient as his own control.
Can also use to compare to "norms" established and
published.
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