Male Urinary Tract (IPSS)

Form only to be completed if requested by the practice.

If you have been advised by the surgery to submit Male Urinary Tract (IPSS) review please use this form.

Male Urinary Tract (IPSS)

Male Urinary Tract (IPSS)

Urinary Tract Review

Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating? *
Over the past month, how often have you had to urinate again less than two hours after you finished urinating? *
Over the past month, how often have you found that you stopped and started again several times when you urinated? *
Over the past month, how often have you found it difficult to postpone urination? *
Over the past month, how often have you had a weak urinary stream? *
Over the past month, how often have you had to push or strain to begin urination? *
Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning? *
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 that? *
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