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1. Prostate Symptom and Quality of Life Scores ?
In the past Month Not at all Less than 1 in 5 times Less than half the time About half the time More than half the time Almost always Incomplete emptyingFrequencyIntermittencyUrgencyWeak StreamStrainingTotal Prostate Symptom ScoreDelighted Pleased Mostly Satisfied Mixed Mostly Dissatisfied Unhappy Terrible Quality of Life Score ?Total Quality of Life ScoreIPSS Score vs Quality of Life Score
Mild IPSS Score ?Moderate IPSS Score ?High IPSS Score ? -
2. Other Urological Symptoms
Incontinence Yes No Urge Incontinence Stress Incontinence Overflow Incontinence Bed Wetting Introduction
Please record other relevant symptoms here; these will need to be considered when contemplating specialist investigations or a urological referral, there is a free text box for other symptoms you elicit.
An accessible record of IPSS and other symptoms can be useful when tracking or monitoring a patient over time, sometimes many years.
Other
Urological Symptoms ?Yes No Urinary Dysuria Haematuria Urinary Spraying Haematospermia Ejaculation Dysfunction / Pain Testicular Pain Perineum Pain Sleep Apnoea Erectile Dysfunction -
3. Clinical Features ?
Renal Examination Penis Examination Testes Examination Abdominal Examination (DRE) Prostate Examination -
4. Personal and Family History ?
This section provides a reference for further reviews on your patient. Version 2 will present decision support (and patient text) for Sexually Transmitted Disease and links to Cardiovascular Assessment and Alcohol Cessation programmes.
Cystoscopy Surgery TURP Radical Prostacetomy Bladder Neck Incision Bladder Surgery Renal Surgery Other Surgery Vasectomy Family Prostate History