Online Consultation

    PERSONAL INFORMATION

    CASE HISTORY

    Sr.

    Signs & Symptoms

    YES (Y) / NO(N)

    Duration

    1

    Frequency of urination

    2

    Urgency

    3

    Nocturia (Frequency during the night)

    4

    Incontinence (Leakage of urine)(Urge / Stress / Nocturnal)

    5

    Pelvic pain

    6

    Incomplete emptying of the bladder

    7

    Episodes of near retention

    8

    Voiding small volume of urine

    9

    Spraying / Double streaming

    10

    Haematuria (Blood in urine)

    11

    Burning & Dysuria

    12

    Straining

    13

    Hesitancy (Difficulty in starting flow)

    14

    Poor flow of urine

    15

    Dribbling of urine

    16

    Intermittency (Interrupted flow)

    17

    Haemospermia (Blood in the semen)

    18

    Retrograde ejaculation (semen doesn’t express during sexual activity)

    19

    Reduced ejaculation force

    20

    Discharge from the urethra

    21

    Pain in the Scrotum / Testicles

    22

    Dyspareunia (Painful sexual activity)

    23

    Fever with chills & rigors

    OTHER INFORMATION

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