Dr. Lee J. Monlezun Jr. M.D. FACOG  

Bladder Trouble?

Answer the questions below to find out if Co2RE Laser Vaginal Rejuvenation treatment is right for you!


Dr. Lee J. Monlezun, Jr. M.D. FACOG
(A Professional Medical Corporation- Gynecology and Infertility)
A Diplomate of the American Board of Obstetrics and Gynecology
801 W Bayou Pines Dr. Lake Charles, LA 70601
phone:337-439-3205 fax: 337-439-0807
www.drmonlezun.com


Please answer yes or no to the following A and B questions.

           

            A. Have you noticed any blood in your urine or “pink” urine?          YES OR NO


            B. Did you have pain with urination?                                                   YES OR NO


If you answered “yes” to A and B, we recommend you seek medical attention immediately.

If you answered “no” to both questions, please continue by answering the questions below. 


Circle the number in the column that best applies and write it in the far-right score box. Total your score at the bottom.


0 =NOT A PROBLEM 

5 = LESS THAN ONCE A WEEK

10 =1-2 DAYS PER WEEK

15 =3-4 DAYS PER WEEK

20 =5+ DAYS PER WEEK


How Often in the Past 4 Weeks:  


Did you wake up at night to urinate two or more times?

0

5

10

15

20

 

Did you have a sudden and uncomfortable feeling that you had to urinate soon?

0

5

10

15

20

 

Where you bothered or concerned about bladder control?

0

5

10

15

20

 

Did you lose or leak urine for any reason?

0

5

10

15

20

 

Did you wear a pad or other material to absorb urine you may have lost?

0

5

10

15

20

                                                                     

                                             TOTAL

                                             SCORE 

 

 

 

If your score is over 60, you may benefit from care or treatment.

        Recommendation: Have Bladder Scan done during today’s visit and schedule and CMG.


If your score is between 21-60, you may benefit from care or treatment. 
        Recommendation: Have Bladder Scan done during today’s visit.


If your score is less than 21, you are less likely to need any treatment.


Please discuss these results with your healthcare professional 

Only a healthcare professional can evaluate or diagnose your bladder health.

Effective treatment is available for almost all bladder disorders.