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)

What is the IPSS score?

The IPSS questionnaire allows your urologist to better understand the severity of your water work symptoms. It is used for men who are having problems which may indicate an enlarged prostate. It is helpful in determining which treatment option is best for you and then monitoring any improvement.

What does it involve?

There are 7 questions relating to different symptoms you might be experiencing and one question relating to your overall quality of life. Once you have scored each question the values are added together to give an indication of the severity of your symptoms. Please complete the form and bring it with you to your outpatient appointment.

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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? *

Quality Of Life Due to Urinary Symptoms

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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Please upload any information relevant to your urinary trace review.
Maximum upload size: 67.11MB