Questions 1–3 pertain to symptoms prior to artificial urinary sphincter (AUS) implantation, 4–32 pertain to symptoms after AUS implantation 1. Did you wear protective pads for urine leakage, if so, how many in 24 hours? 2. Did you ever use a penile clamp for protection? 3. Did you ever use a condom catheter for protection? 4. How often do you urinate during the day? 5. How many times per night do you wake up to urinate? 6. Do you ever leak urine? If so, how much? 7. Do you wear protective pads for urine leakage, if so, how many in 24 hours? 8. Do you ever use a penile clamp for protection? 9. Do you ever use a condom catheter for protection? 10. How often do you leak urine? (never, about once a week or less often, 2-3 times a week, about once a day, several times a day, all the time) 11. How much urine do you usually leak (whether you wear protection or not)? (none, a small amount, a moderate amount, a large amount) 12. Overall, how much does urine leakage interfere with your everyday life? (0=not at all, to 10=a great deal) 13. When does urine leak? Please circle all answers that apply to you. (never – urine does not leak, leaks before you can get to the toilet, leaks when you cough or sneeze, leaks when you are asleep, leaks when you are physically active/exercising, leaks when you have finished urinating and are dressed, leaks for no obvious reason, leaks all the time)

(Responses for questions 14–26: not at all, slightly, moderately, greatly)Has urine leakage affected your ... 14. Ability to do household chores (cooking, housecleaning, laundry)? 15. Physical recreation such as walking, swimming, or other exercise? 16. Entertainment activities (movies, concerts, etc)? 17. Ability to travel by car or bus more than 30 minutes from home? 18. Participation in social activities outside your home? 19. Emotional health (nervousness, depression, etc)? 20. Feeling frustrated? Do you experience, and if so, how much are you bothered by ... 21. Frequent urination? 22. Urine leakage related to the feeling of urgency? 23. Urine leakage related to physical activity, coughing, or sneezing? 24. Small amounts of urine leakage (drops)? 25. Difficulty emptying your bladder? 26. Pain or discomfort in the lower abdomen or genital area? 27. Knowing what you know now, would you have an artificial urinary sphincter placement again? (yes, undecided, no) 28. Would you recommend the artificial urinary sphincter to a friend? (yes, yes with reservation, undecided, no) 29. Circle the one answer that best describes how your urinary tract condition is now, compared with how it was before you had the operation. (very much better, much better, a little better, no change, a little worse, much worse, very much worse) 30. Overall, how bothersome has any trouble with urination been during the last month? (not bothersome at all, bothers me a little, bothers me some, bothers me a lot) 31. If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about it? 32. Feel free to take this opportunity to make any comments you may have.