National Institutes of Health Chronic Prostatitis Symptom Scale (NIH-CPSI)
Pain or Discomfort Symptom Score
1. In the last week, have you experienced pain or discomfort in the following areas?
A. Area between testicles and anus (perineum) Yes (1) No (0)
B. Testicles Yes (1) No (0)
C. Head of penis (not related to urination) Yes (1) No (0)
D. Below the waist, on the pubic bone or in the bladder area Yes (1) No (0)
2. In the last week, do you have the following symptoms?
A. Pain or burning sensation when urinating Yes (1) No (0)
B. Pain or discomfort during or after orgasm (ejaculation) Yes (1) No (0)
3. In the last week, have you had frequent pain or discomfort in these areas mentioned above?
None (0); Rarely (1); Sometimes (2); Often (3); Frequently (4); Almost always (5)
4. Please describe the average level of pain or discomfort you have felt in the last week.
□ □ □ □ □ □ □ □ □ □ □
0 2 3 4 5 6 7 8 9 10 (points)
(0 no pain) (10 worst pain) Score = ( ) n
Urination symptom score
5.In the last week, do you often have a feeling of incomplete urination?
None (0); Less than 1 out of 5 times (1); Less than half the time (2); About half the time (3); More than half the time (4); Almost every time (5)
6. In the last week, how often did you urinate within two hours?
None (0); Less than 1 out of 5 times (1); Less than half the time (2); About half the time (3); More than half the time (4); Almost every time (5)
Rating = ( ) n
Impact of symptoms
7. In the last week, have you been prevented from doing things by clinical symptoms?
None (0); Only a little (1); Sometimes (2); A lot (3)
8… In the last week, do you often think about your symptoms?
None (0); Only a little (1); Sometimes (2); A lot (3)
Rating = ( ) n
Quality of life
9. How would you feel if the rest of your life would be accompanied by the same clinical symptoms now as in the recent week?
Very happy (0); Pleasant (1); More satisfied (2); Fair (3); Not very satisfied (4); Unpleasant (5); Very fearful (6) Rating = ( ) Total rating = ( )
———- ———- ———- ———- —
The NIH-CPSI score study results include.
1 , Pain and discomfort scores included scores for 1A, 1B, 1C, 1D, 2A, 2B, 3, and 4, with a sum of 0 to 21 for each problem score.
2, Urinary symptom scores included a sum of 0 to 10 for 5 and 6 question scores.
3. The clinical symptoms impact on quality of life score included a sum of 0 to 12 for question 7, 8, and 9 response scores.
The reporting form of the scores included.
1.The points of the above three areas were reported separately, with subscores of 0 to 21 for pain; 0 to 10 for voiding symptoms; and 0 to 12 for impact of symptoms on quality of life.
2.The two scores of pain and discomfort and voiding symptoms were added together and reported in the range of 0 to 31. The points for mild disease were in the range of 0 to 9; the points for moderate degree were in the range of 10 to 18; and the points for severe patients were in the range of 19 to 31.
3.Report the total score in the range of 0 to 43; the score for mild is from 1 to 14; the score for moderate is from 15 to 29; the score for severe patients is from 30 to 43. The higher the total score, the more serious the patient’s clinical symptoms or condition.