Frequency / dysuria / nocturia

Exploring symptom

• Timeframe
  • Duration
  • Onset (sudden or gradual)
  • Progression
  • Timing (intermittent or continuous)
• Urination
  • Try to quantify urinary volume and frequency
  • Any catheter

Relevant system reviews

• General
  • Fever, sweats, rigors
• Urological
  • Storage: frequency, volume, urgency, nocturia, incontinence
  • Infection: dysuria, haematuria, odour
  • Prostatic/voiding (if male): hesitancy, poor flow/dribbling, feeling of incomplete emptying

Differential diagnoses and clues

Urological:

Cystitis	-Dysuria (‘burning pain on urination’) -Frequency and urgency
Urethritis	-Dysuria -Purulent urethral discharge
Pyelonephritis	-Dysuria and loin pain -Fever/chills/rigors -Vomiting
Benign prostatic hyperplasia	-Poor flow and terminal dribbling -Hesitancy -Overflow incontinence  -Elderly male

Others:

Other differentials

Anxiety, Detrusor instability, Bladder/lower urethral calculus, Prostatitis, Pregnancy, Drugs (e.g. diuretics, excess caffeine)

Haematuria

Exploring symptom

• Timeframe
  • Duration
  • Onset (sudden or gradual)
  • Progression
  • Timing (intermittent or continuous)
• Haematuria
  • Try to quantify bleeding
  • Thick blood or discoloured urine
  • Any clots? – increase risk of urinary retention
  • Catheterised?
  • Anaemia symptoms (tiredness, breathlessness on exertion)

Relevant system reviews

• General
  • Fever, sweats, weight loss, rashes, joint pain/swelling
• Urological
  • Storage: frequency, volume, urgency, nocturia, incontinence
  • Infection: dysuria 
  • Prostatic/voiding (if male): hesitancy, poor flow/dribbling, feeling of incomplete emptying

Differential diagnoses and clues

Urological:

Bladder transitional cell carcinoma	-Painless haematuria -History of aromatic amine exposure (e.g. dye washers, painters, decorators)
Renal cell carcinoma	-Flank pain/mass -May have fever/hypertension/weight loss
Urethral trauma, e.g. by catheter	-History of catheter use or trauma
UTI	-Frequency/dysuria/urgency
Urethritis	-Dysuria -Purulent urethral discharge
Calculi	-Loin to groin pain

Others: 

Urological	Glomerulonephritis, Benign prostatic hyperplasia/prostate cancer, Polycystic kidney disease, Schistosomiasis, Urinary tract, TB
Miscellaneous	Haematological e.g. anticoagulation, sickle cell, coagulopathy, Strenuous exercise, Infective endocarditis, Drugs (e.g. sulphonamides, cyclophosphamide, NSAIDs), Menstruation, Rhabdomyolysis

Polyuria

Exploring symptom

• Timeframe
  • Duration
  • Onset (sudden or gradual)
  • Progression
  • Timing (intermittent or continuous)
• Polyuria
  • Try to quantify urinary volume and frequency
  • Try to quantify fluid intake
  • Other symptoms

Relevant system reviews

• General
  • Fever, sweats, weight loss, malaise, rashes, joint pain/swelling
• Urological
  • Storage: urgency, nocturia 
  • Infection: dysuria, haematuria, odour 
  • Prostatic/voiding (if male): hesitancy, poor flow/dribbling, feeling of incomplete emptying

Differential diagnoses and clues

Endocrine:

Diabetes mellitus	-Polydipsia/thirst and polyuria -Weight loss and tiredness -Visual disturbance
Diabetes insipidus	-Polydipsia/thirst and polyuria

Urological:

Chronic kidney disease

-Non-specific symptoms, e.g. fatigue, weakness, pruritus, dyspnoea

Others:

Other differentials

UTI, Cushing’s syndrome, Psychogenic polydipsia, Drugs (e.g. diuretics, alcohol, lithium, tetracyclines), Postobstructive diuresis (life-threatening complication of relieving urinary obstruction)

Incontinence

Exploring symptom

• Timeframe
  • Duration
  • Onset (sudden or gradual)
  • Progression
  • Timing (intermittent or continuous)
• Incontinence
  • Pattern of incontinence, e.g. loss with effort or no control at all
  • Can they feel when they need to urinate
  • Try to quantify urinary volume and frequency
  • Bowel habit (any constipation?)

Relevant system reviews

• Urological
  • Storage: frequency, volume, urgency, nocturia 
  • Infection: dysuria, haematuria, odour
  • Prostatic/voiding (if male): hesitancy, poor flow/dribbling, feeling of incomplete emptying

Differential diagnoses and clues

Urological:

Stress incontinence	-Incompetent sphincter	-Small losses with effort, e.g. coughing, bending, exertion -Risk factors: multiple pregnancies, post-menopause, pelvic floor trauma
Urge incontinence	-Detrusor instability -Spinal cord pathology (e.g. cord compression, cord injury, MS)	-Urge to pass urine followed by uncontrollable bladder emptying
Overflow incontinence	-Prostatic hypertrophy -Stricture or stone -Spinal cord pathology	-Dribbling and poor stream -Hesitancy -Elderly male or history of obstruction
Mixed incontinence	-Mix of above types
True incontinence	-Vesicovaginal or ureterovaginal fistula	-Continuous urine leak

Others:

Other differentials

Post-prostatectomy or other pelvic surgery, Bladder stone / tumour, Fistula, Psychogenic

Retention

Exploring symptom

• Timeframe
  • Duration
  • Onset (sudden or gradual)
  • Progression
  • Timing (intermittent or continuous)
• Retention
  • Any constipation
  • Previous catheterisation

Relevant system reviews

• Urological
  • Storage: frequency, volume, urgency, nocturia, incontinence 
  • Infection: dysuria, haematuria, odour
  • Prostatic/voiding (if male): hesitancy, poor flow/dribbling, feeling of incomplete emptying

Differential diagnoses and clues

Urological:

Prostatic hypertrophy	-History of hesitancy, poor flow and terminal dribbling -Elderly male
Urethral stricture	-History of trauma or recurrent catheterisation
Bladder neck obstruction (e.g. tumour, calculus)	-May have haematuria
UTI	-Dysuria

Others:

Urinary	Constipation (common), Prostatitis, Pelvic mass, Genital Herpes, Clot retention (after bleed, e.g. from tumour), Phimosis
Neurological	MS, Spinal cord injury/compression
Drugs	Anticholinergic drugs

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