Male Urinary Tract (IPSS)

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

Please Note – once you have submitted this information, any reply or acknowledgement from us will be sent to the email address you provide at top of the form. This response may include personal and sensitive information about you. We therefore strongly advise that you provide a personal email address that only you have access to. If you do not wish for us to communicate with you via email, please do not use this form and call us instead.

Male Urinary Tract (IPSS)

Male Urinary Tract (IPSS)

About You

Please use this date format: DD/MM/YYYY.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

Urinary Tract Review

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?
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