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Common urinary histories

History taking > Common presenting complaints

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

Other urological differentials

  • Detrusor instability

  • Bladder/lower urethral calculus

  • Prostatitis

Others

Others

  • Anxiety

  • 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

History of catheter use or trauma (For example, by catheter)

UTI

Frequency / dysuria / urgency

Urethritis

  • Dysuria

  • Purulent urethral discharge

Calculi

Loin to groin pain

Other urological differentials

  • Glomerulonephritis

  • Benign prostatic hyperplasia/prostate cancer

  • Polycystic kidney disease

  • Schistosomiasis

  • Urinary tract TB

Others

Others

  • 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

UTI

  • Frequency

  • Dysuria

  • Infective symptoms, e.g. fever

Post-obstructive diuresis

A life-threatening complication of relieving urinary obstruction

  • Recently relieved urinary obstruction

Others

Others

  • Cushing’s syndrome

  • Psychogenic polydipsia

  • Drugs (e.g. diuretics, alcohol, lithium, tetracyclines)

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

Occurs due to pelvic floor weakness

  • Continuous urine leak

Urge incontinence

Occurs due to detrusor instability or spinal cord pathology (e.g. cord compression, cord injury, MS)

  • Urge to pass urine followed by uncontrollable bladder emptying

Overflow incontinence

Occurs due to prostatic hypertrophy, stricture or stone, or spinal cord pathology

  • Dribbling and poor stream

  • Hesitancy

  • Elderly male or history of obstruction

Mixed incontinence

  • Mix of other types

True incontinence

Occurs due to vesicovaginal or ureterovaginal fistula

  • Dysuria

  • Purulent urethral discharge

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

Prostatic hypertrophy

  • History of hesitancy, poor flow and terminal dribbling

  • Elderly male

Urethral stricture

History of trauma or recurrent catheterisation

Bladder neck obstruction

For example, due to tumour or calculus

  • May have haematuria

UTI

Dysuria

Other urological differentials

  • Prostatitis

  • Pelvic mass

  • Genital Herpes

  • Clot retention (after bleed, e.g. from tumour)

  • Phimosis

Others

Others

  • Constipation

  • Neurological (e.g. MS, Spinal cord injury/compression)

  • Anticholinergic drugs

Here are three questions

A 40 year old male patient presents with abdominal pain. Which features would make you suspicious of renal colic?

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What would be in your differential for this patient?

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Please describe the difference between urethritis, cystitis and pyelonephritis. Please name an infective cause of each.

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Now try some stations!

  1. Renal colic
  2. UTI
  3. Pyelonephritis
  4. Try more now!

Common presenting complaints

One Comment

  1. Deng Manyuon Mabok Jalpuol says:
    18 October 2023 at 17:25

    Medical student

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