Urinary Tract (LUTS) Questionnaire Urinary 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 alwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNeverHow often do you need to pass urine within 2 hours of last urinating?*Almost alwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNeverHow often does the flow stop and start when passing urine?*Almost alwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNeverHow often is it hard to delay passing urine?*Almost alwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNeverHow often is the flow poor?*Almost alwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNeverHow often do you need to push or strain to begin?*Almost alwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNeverHow often do you need to pass urine after going to bed?*More than 44321Never
