Dorema Surgery

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IPSS (International prostate symptom score)

Your doctor may ask you to fill out the IPSS questionnaire as part of a discussion about your prostate health. This will allow them to get an idea of the type of symptoms you are experiencing, as well as to track any changes in the severity of symptoms over the years.

As part of the assessment into prostate health you can request a prostate specific antigen (PSA) blood test. It is important you understand the advantages and disadvantages of having this test so please have a read of this leaflet.

Please make sure you arrange an appointment to discuss your symptoms once you’ve completed the form (unless already discussed with your doctor) as doing the questionnaire won’t automatically generate a response from the surgery.

International Prostate Symptom Score (IPSS)

For confidentiality please only enter your first and last initials
In the format DD/MM/YYYY
Incomplete emptying(Required)
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?
Frequency(Required)
Over the past month, how often have you had to urinate again less than two hours after you finished urinating?
Intermittency(Required)
Over the past month, how often have you found you stopped and started again several times when you urinated?
Urgency(Required)
Over the last month, how difficult have you found it to postpone urination?
Weak stream(Required)
Over the past month, how often have you had a weak urinary stream?
Straining(Required)
Over the past month, how often have you had to push or strain to begin urination?
Nocturia(Required)
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 the way it is now, how would you feel about that?
Consent(Required)

Date published: 21st March, 2023
Date last updated: 21st March, 2023