Male urinary tract (IPSS) review

What is your name?

First name

Last name

What is your date of birth?

For example, 31 3 1980

Day

Month

Year

What is your sex?

As recorded on your medical record

Male

Female

Other

What is your postcode?

The one used to register with your GP

What is your phone number?

What is your email address?

Anyone else with access to your email account may see responses sent to you

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?

Confirmation

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