Medically Fit For Exams
Medically Fit For Exams

Urological history taking

 

  • Wash hands and introduce yourself
  • Check the patient’s name and DOB
  • Ask if it’s okay to talk to them before they see the doctors

 

History of presenting complaint

Site

Onset

Character

Radiation

Associated symptoms

Time-course

Exacerbating/relieving factors

Severity

  • Ask what’s brought them in today
  • Ask them to tell you more about it
  • If pain is a major presentation, use the SOCRATES mnemonic
  • Ask about specific urological symptoms
    • Dysuria (pain/discomfort/burning using SOCRATES)
    • Fever (if UTI is suspected)
    • Urgency
    • Change in frequency
    • Nocturia
    • Colour:
      • Dark (dehydration, liver disease)
      • Haematuria (rosé, clots)
    • Smell
    • Incontinence
    • Hesitancy/stream changed/dribbling
    • Nausea/vomiting/loss of appetite (pyelonephritis)
  • If any of these symptoms are present, explore them further
    • Onset/duration
    • Progressive?
    • Have they occurred before?
    • Severity
    • Intermittent or continuous?
    • Precipitating and relieving factors
  • Summarise presenting complaint

 

Systems enquiry

  • Systemic
    • Weight loss, fever
  • Neurological
    • Headaches, faints, fits, changes to sensation or movement
  • Respiratory
    • SOB, cough
  • Cardiovascular
    • Chest pain, palpitations
  • GI
    • Pain, change in bowel habits
  • Musculoskeletal
    • Aches, pains

 

Past medical history

  • Ask if they have any health problems
  • Ask if they’ve had other urological problems before:
    • UTIs
    • Kidney problems
    • Incontinence
    • Prostate problems
  • Ask about relevant diseases:
    • Diabetes
    • Hypertension
    • Cancer

 

Family history

  • Family history of any problems with their waterworks
    • Including kidney stones
  • Any serious illness in close family

 

Drug history

  • Are they taking any regular medication?
    • Diuretics – increase frequency
  • Do they take any over the counter medication?
  • Do they take any supplements?

 

Allergies

  • Do they have any allergies?
    • If yes, to what? What happens?

 

Social history

  • Smoker?
  • Alcohol?
  • Occupation?
  • With whom/where they live (especially for older patients)
  • Travel to Africa/Asia/South America (schistosomiasis)

 

Summary

  • Ask if the patient has any questions or anything they’re concerned about
  • Ask if there’s anything else that you haven’t asked
  • Summarise again if necessary
  • Thank the patient for talking to you

 

 

 

Understanding urological symptoms

 

Benign prostatic hypertrophy

  • Stream changes/dribbling
  • Hesitancy
  • Frequency
  • Nocturia
  • Erectile dysfunction
  • Overflow incontinence/urgency
  • Older male
  • NEXT STEPS
    • PR
    • Abdominal exam
    • PSA

 

Prostate cancer

  • As above
  • Systemic cancer symptoms
    • Weight loss
    • Fatigue
  • NEXT STEPS
    • PR
    • Abdominal exam
    • PSA

 

UTI/cystitis

  • Burning/itching
  • Urgency
  • May have a smell
  • Purulent discharge/urine (urethritis)
  • Fever if systemic infection (urosepsis)
  • NEXT STEPS
    • Consider antibiotics, especially if immunosuppressed
    • If >45 with recurrent UTI with visible haematuria: 2 week wait urology referral

 

Bladder cancer

  • Painless haematuria
  • History of aromatic amine exposure
    • Painters/decorators
    • Dye washers
  • History of schistosomiasis
  • Feeling of incomplete voiding
  • Systemic cancer symptoms
    • Weight loss
    • Fatigue
  • NEXT STEPS
    • 2 week wait referral if
      • >45 with visible haematuria with no known cause
      • >45 with visible haematuria with recurrent UTI
      • >65 with non-visible haematuria AND dysuria OR raise white cell count

 

Uretal/urethral stenosis

  • Cramping pain
  • Overflow incontinence
  • Retention
  • NEXT STEPS
    • Imaging

 

Renal calculus

  • Severe loin to groin pain
    • In waves and fluctuating severity
  • Radiation from abdomen
  • Dysuria
  • Nausea and vomiting
  • Pink, red or brown urine
  • NEXT STEPS
    • Ultrasound, CT

 

Pyelonephritis

  • Fever
  • Nausea/vomiting
  • Appetite loss
  • Loin pain
    • Treatment with antibiotics
    • Ultrasound to rule out calculi

 

Diabetes

  • Polyuria
  • Polydipsia
  • Weight loss
  • Fatigue
  • NEXT STEPS
    • Fasting glucose and HbA1c

 

Kidney failure

  • Polyuria + nocturia
  • May have oliguria if GFR is very low
  • Nausea/vomiting
  • Anorexia/weight loss
  • Itching
  • Leg swelling
  • Pulmonary oedema
  • Anaemia
  • NEXT STEPS
    • Determine cause: ultrasound/CT etc
Urological history taking.docx
Microsoft Word document [15.7 KB]
Understanding urological symptoms.docx
Microsoft Word document [14.8 KB]

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