ChinaProsteDRcSd.

B (8421-w)
Levl36,MnarCitbk15JAmpg04Ku Malysi Tel:60321974Fax Please

China Prostate Disease Research Centre Sdn.Bhd (842441-w)

Level 36, Menara Citibank,165 Jalan Ampang, 50450 Kuala Lumpur, Malaysia

Tel:603 2169 7749

Fax:603 2169 7769

H/P:017-3884998

Prostate Disease Questionare

tick the blank after symptoms you Age: Symptoms Distending pain in theswollen lower abdomen Pain in the smaller abdomen Distention and pain of the Small testicle invisible testicle Testicle scleroses Red and swollen testicle varicocele Cutting operation Stinging pain in the urethra Hot sensation during urination Distention in the groin Pain in the groin lymph scleroses Distention and pain in the perineum Sagging sensation in the anus hemorrhoids Lumbar pain Body fatigue Declined Sex function Premature ejaculation Weak erection spermatorrhea Painful ejaculation Blood in the semen Frequent urine at daytime testicle have been suffering. Origin: 20 days

ProstaeDiQun
NameAg No.Sympts

Name: No. 1 2 3

1Distendgpa 4 theswolnrabdm 5 2Painthesmlrbdo 6 3Distenoadpfh 7 tesicl 8 4Smaltesic 5invsbletc

9 10 11

6Testiclro 12 7Redanswoltic 13 8varicoel 14 9Cutingopera 15 10Stingpahe 16 uretha 1Hotsenaidurg

17 18 19

urinato 20 12Distenohgr 21 13Painthegro 22 14lymphscero 23 15Distenoadph 24 perinum 16Saginsetoh anus 17hemorids 18Lumbarpin 19Bodyfatigue
25 26

14lymphscero 15Distenoadph perinum 16Saginsetoh anus

27 28 / / Urgent urine Discontinous urine Urine intermit Urine wait urine incontinence stringy urine stream Forceless discharge of urine Post-voiding dribble Urine bifurcation Bed-wetting Profuse urination at night Bloody urine Urinary turbidity thirsty and drink much Dry stooltimes/day Watery stooltimes/day Colitis Time for the first morning urine Restless sleep Night sweat Cold hand and feet in the daytime Fear of cold in winter Frequent urine in cold weather Prostate calcification

17hemorids 29 18Lumbarpin 30 19Bodyfatigue 31 20DeclindSxfuto 32 21Prematujclion 33

34

2Weakrction 35 23spermatoh 36 24Painfulejcto 37 25Blodinthesm 38 26Frequntiadym 27Urgentui

39 40 41

28Disconture 42 29Urinetm 43
44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

Bladder stone? Size? Kidney stone? Size? Urethra stone Self-abuse habit Unsafe sex Gonococcus infection cured

Chlamydia infection (cured) parotitis

60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92

Have children? Times for microwave test Sperm survive rate(low) Ejaculation times Perineum blockage Conduct drug to the urethra Urine conduction Prostate operation Tumour operation haematemesis Bloody ejection Blood in the stool Congestive heart failure myocardial infarction tuberculosis hepatitis Tummy bug Insufficiency of the spleen nephritis Take finasteride,Proscar, MK 906? Take tamsulosingHydrochloride Release Capsule? Take phenoxybenzamine,Bensylyt?

high blood pressure low blood pressure coronary heart disease diabetes eat acridity food Urine sugar Drink alcohol Have spicy food? excessive sex activities? Endure the ejaculation?