DR. MED.

BERNHARD

SCHOENSEE

Specialist for Urology

Private Consultant at Hackescher Markt

Berlin-Mitte



DR. MED.

BERNHARD

SCHOENSEE

Specialist for Urology

Private Consultant at Hackescher Markt

Berlin-Mitte

For your visit.....


- You can eat an drink before a blood sample is taken,

- It is best to come with a full (better filled) bladder, as it is best for various examinations,

- We ask you to fill out our questionnaire on health data (anamnesis sheet) in advance if possible.

Anamense / medical history


For an optimal preparation of your visit, we offer you the opportunity to provide all important information relaxed in advance.

You can fill out the patient data and questions about health (anamnesis) conveniently and send online form earthfriendly.

You are also welcome to print out the form and fill it in and bring it with you to the appointment.


Further down on the page you will find special questionnaires such as the AMS questionnaire, IIEF-5 score , IPSS questionnaire and a Voiding Protocoll

Medical history / patient data

Questions about chronic diseases

Alternatively, you can download the questionnaire here:


International Prostate Symptom Score (IPSS)


The International Prostate Symptom Score (IPSS) is an eight-question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the lower urinary tract symptoms of benign prostatic hyperplasia (BPH).

It contains seven questions related to symptoms related to BPH and one question related to the patient's perceived quality of life.

This questionnaire was created in 1992 by the American Urological Association.

Zero to five points are awarded for each of the seven symptoms: residual urine sensation, repeated urge to urinate two hours after the last visit to the toilet, stuttering urine, inability to delay urination, weak stream, pressure when urinating and frequency of nocturnal urination. According to this point system, patients are divided into those with mild (IPSS <8), moderate (IPSS = 8-19) and severe (IPSS = 20-35) symptoms.

The questionnaire can be filled out again at different times in order to document a comparison of the symptoms and their severity over months or years and thus show the course of the disease.

IPSS Questionaire

0 = Not at all;  1 = less than 1 in 5 times;  2= Less than half the time;  3 = about halt the time;  4 = more than half the time;  5 = almost always

Quality of life due to urinary symptoms

Alternatively, you can download the questionnaire here:

The international index of erectile function (IIEF)  (1)


The IIEF deals with the relevant areas of male sexual function (i.e. erectile function, orgasm function, sexual desire, gender satisfaction and overall satisfaction), is psychometrically based and validated in 10 languages. This questionnaire can easily be administered by yourself in research or in the clinical setting. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.


(1) Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A.The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction; Urology. 1997 Jun;49(6):822-30. doi: 10.1016/s0090-4295(97)00238-0.



International Index of Erectile Function (IIEF-5)

Please select an answer which describes the best your situation in the last month:

For the next questions select one of the following options:

0 = no sexual activity   -  1 = never or almost never - 2 = a few times - much less than half the time  - 3 = sometimes - about halt the time - 4 = most time - much more than half the time -  5 = almost always / always            

Alternatively, you can download the questionnaire here

Download IIEF-5

AMS Fragebogen (The Aging Males´ Symptoms rating scale)(1)

The AMS questionnaire is used to record age-related complaints which, among other causes, can also be caused by reduced testosterone serum levels. The following questions relate to complaints you may currently have and have been drawn up on the basis of an international standard. For each complaint, please tick the extent to which you are affected by it. If you do not have a complaint, please tick “none”. We recommend filling out the questionnaire online (this saves paper and protects our environment), or you can download the questionnaire at the bottom of the page, print it out and take it with you to the doctor's consultation. We will discuss your answers together.

(1) The Aging Males' Symptoms rating scale. Cultural and linguistic validation into English; Heinemann et al., The Aging Male 2001; 4 (1): 14 - 22. This version of the questionnaire shown here differs slightly from the original questionnaire. New text

AMS questionnaire

Select severity : none = 1; mild = 2;  moderate = 3; severe = 4; very severe = 5

Questions about the physical condition

Questions about mental well-being

Questions about sexual wellbeing:

Alternatively, you can download the questionnaire here:

Download AMS questionnaire

Voiding Log / Bladder Record


A Voiding Log or Bladder Record is a detailed record of the excretion of fluids. Our micturition log also includes a drinking log in which you record over a defined period of time how much fluid you have consumed at what time. The micturition protocol is an important basis for diagnosing and treating problems with micturition.


Here you can download the protocol including short instructions:



Download Voiding Log / Bladder Record
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