Male Urinary Tract (IPSS) Assessment Form

Male Urinary Tract (IPSS) Assessment Form

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

Name
Please enter your full legal name
Date of Birth
Please enter your Date of Birth in the format DD/MM/YYYY

Urinary Tract Review

Please fill out the form below
How often does your bladder not feel empty when finished passing urine?
How often do you need to pass urine within 2 hours of last urinating?
How often does the flow stop and start when passing urine?
How often is it hard to delay passing urine?
How often is the flow poor?
How often do you need to push or strain to begin?
How often do you need to pass urine after going to bed?
Consent