Male Urinary Tract (IPSS)

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)

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Urinary Tract Review

How often does your bladder not feel empty when finished passing urine?

Almost Always

More than half the time

About half the time

Less than half the time

Less than 1 in 5 times

None

How often do you need to pass urine within 2 hours of last urinating?

Almost Always

More than half the time

About half the time

Less than half the time

Less than 1 in 5 times

None

How often does the flow stop and start when passing urine?

Almost Always

More than half the time

About half the time

Less than half the time

Less than 1 in 5 times

None

How often is it hard to delay passing urine?

Almost Always

More than half the time

About half the time

Less than half the time

Less than 1 in 5 times

None

How often is the flow poor?

Almost Always

More than half the time

About half the time

Less than half the time

Less than 1 in 5 times

None

How often do you need to push or strain to begin?

Almost Always

More than half the time

About half the time

Less than half the time

Less than 1 in 5 times

None

How often do you need to pass urine after going to bed?

More than 4

4

3

2

1

None

*

I confirm that the information provided is accurate to the best of my knowledge