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
- Dysuria (‘burning pain on urination’)
- Frequency and urgency
- Dysuria
- Purulent urethral discharge
- Dysuria and loin pain
- Fever/chills/rigors
- Vomiting
- Poor flow and terminal dribbling
- Hesitancy
- Overflow incontinence
- Elderly male
- Detrusor instability
- Bladder/lower urethral calculus
- Prostatitis
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
- Renal cell carcinoma
- Urethral trauma
- UTI
- Urethritis
- Calculi
- Other urological differentials
- Painless haematuria
- History of aromatic amine exposure (e.g. dye washers, painters, decorators)
- Flank pain/mass
- May have fever/hypertension/weight loss
For example, by catheter
- History of catheter use or trauma
- Frequency/dysuria/urgency
- Dysuria
- Purulent urethral discharge
- Loin to groin pain
- Glomerulonephritis
- Benign prostatic hyperplasia/prostate cancer
- Polycystic kidney disease
- Schistosomiasis
- Urinary tract TB
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
- Polydipsia/thirst and polyuria
- Weight loss and tiredness
- Visual disturbance
- Polydipsia/thirst and polyuria
Urological
- Non-specific symptoms, e.g. fatigue, weakness, pruritus, dyspnoea
- Frequency
- Dysuria
- Infective symptoms, e.g. fever
A life-threatening complication of relieving urinary obstruction
- Recently relieved urinary obstruction
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
Occurs due to pelvic floor weakness
- Continuous urine leak
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
Occurs due to prostatic hypertrophy, stricture or stone, or spinal cord pathology
- Dribbling and poor stream
- Hesitancy
- Elderly male or history of obstruction
- Mix of other types
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
- History of hesitancy, poor flow and terminal dribbling
- Elderly male
- History of trauma or recurrent catheterisation
For example, due to tumour or calculus
- May have haematuria
- Dysuria
- Prostatitis
- Pelvic mass
- Genital Herpes
- Clot retention (after bleed, e.g. from tumour)
- Phimosis
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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