Bladder Leakage Quiz in 5 Minutes - ArtificialUrinarySphincter.com.au

Step 1 of 11

Which best describes your situation?(Required)

I have bladder leakage

I am a caregiver for a man who suffers with bladder leakage

Neither apply to me

How long has bladder leakage been an issue?(Required)

0 - 6 months

6 - 12 months

More than 1 year

How frequently does the bladder leakage occur?(Required)

Never

About once a week or less

Two or three times a week

About once a day

Several times a day

All the time

Please estimate how much urine usually leaks during an episode, whether protection is worn or not.(Required)

None

A small amount

A moderate amount

A large amount

Using the scale below, tell us how much bladder leakage interferes with your regular life.(Required)

(0=No Interference, 5=Moderate Interference, 10=Major Interference)

When does the bladder leakage occur? Please select all that apply.(Required)

Never - does not leak

Before I can get to the toilet

When I cough or sneeze

When I am sleeping

When I am physically active

For no obvious reason

All the time

If you or the person you care for was treated for prostate cancer, which treatment was received? Please select all that apply.

Radical prostatectomy

Radiation therapy

Combination therapy (i.e., Radiation and surgery)

Medication

None, I have not had prostate cancer

Other

If a radical prostatectomy was performed, how long ago was it?(Required)

0-6 months

6-12 months

1-5 years

5+ years

Can’t remember

I have not had a radical prostatectomy

Select all treatments that have been tried to manage the bladder leakage.

Lifestyle changes (less fluid intake, dietary tweaks)

Bladder muscle exercise regime (Kegels)

Absorbent products (pads or diapers)

External collection device (urinary catheter)

Penile Clamp

Male sling

Artificial urinary sphincter

Other

How would the sufferer feel if their current urinary condition was permanent and not treatable?(Required)

Pleased

Okay

Undecided, don’t know

Unhappy

Terrible

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Email(Required)

Have you seen your GP?(Required)

Phone(Required)

Consent(Required)

I accept the Privacy Policy | Terms & Conditions(Required)

Consent(Required)

I accept the Terms of Consultation Confidentiality.(Required)

Terms of Consultation Confidentiality

By checking this box, you acknowledge and understand that your consultation is strictly confidential and solely between you and your physician. It’s important to recognize that your doctor is the primary source of information and is familiar with your medical history and needs. Please note that Rigicon, Inc. does not assume any liability or responsibility regarding the consultation or any medical procedures. We strongly encourage you to discuss all aspects of your treatment with your doctor.