Table of Contents
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 |
