Male Urinary Tract (IPSS)




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Who should complete this form?

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

What is the IPSS score?
The IPSS questionnaire allows your GP to better understand the severity of your water work symptoms. It is used for men who are having problems that are likely to be related to 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.

Urinary Tract Review

Over the past month...

IPSS Score

Mild Symptoms

Your IPSS Score is 

Moderate Symptoms

Your IPSS Score is 

Severe Symptoms

Your IPSS Score is 

Quality of Life (QoL)

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This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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