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Common urinary histories

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 (β€˜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 incontinenceΒ 
  • 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

  • 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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Now try some stations!

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

One Comment

  1. Deng Manyuon Mabok Jalpuol says:

    Medical student

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