Urinary Tract (LUTS) QuestionnaireUrinary Tract (LUTS) Review ONLY USE THIS FORM IF YOU HAVE BEEN ASKED BY THE SURGERY TO DO SO PLEASEFull Name:*Date of Birth:*How often does your bladder not feel empty when finished passing urine?* Almost always More than half the time About half the time Less than half the time Less than 1 in 5 times NeverHow often do you need to pass urine within 2 hours of last urinating?* Almost always More than half the time About half the time Less than half the time Less than 1 in 5 times NeverHow often does the flow stop and start when passing urine?* Almost always More than half the time About half the time Less than half the time Less than 1 in 5 times NeverHow often is it hard to delay passing urine?* Almost always More than half the time About half the time Less than half the time Less than 1 in 5 times NeverHow often is the flow poor?* Almost always More than half the time About half the time Less than half the time Less than 1 in 5 times NeverHow often do you need to push or strain to begin?* Almost always More than half the time About half the time Less than half the time Less than 1 in 5 times NeverHow often do you need to pass urine after going to bed?* More than 4 4 3 2 1 Never
