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UROLOGICAL HISTORY (And Assessment)

This document provides guidance on taking a urological history. It outlines general pointers, classifications of lower urinary tract symptoms, components of the urological review of systems including storage, voiding, infective, urine, discharge, gastrointestinal, and sexual symptoms. It also discusses eliciting further details on assessments, reviewing other systems, and considering risk factors. The examination section briefly outlines male genitalia, prostate, and abdominal exams and mentions common blood and urine tests.

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97 views2 pages

UROLOGICAL HISTORY (And Assessment)

This document provides guidance on taking a urological history. It outlines general pointers, classifications of lower urinary tract symptoms, components of the urological review of systems including storage, voiding, infective, urine, discharge, gastrointestinal, and sexual symptoms. It also discusses eliciting further details on assessments, reviewing other systems, and considering risk factors. The examination section briefly outlines male genitalia, prostate, and abdominal exams and mentions common blood and urine tests.

Uploaded by

arian
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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UROLOGICAL HISTORY (and assessment)

Sources: Toronto Notes, my notes

General Pointers

WIPERQQ
 Introduce yourself, establish rapport
 Elicit patient’s name and age

PC and HPC
 Start with an open question
 Elicit all the patient’s presenting complaints
 Important parameters for history [CCDAR]
 Clarify
 Chronology
 Descriptors
 Assoc Sx
 ROS

CLASSIFICATION OF LUTS
STORAGE VOIDING POST-MICTURITION
Frequency Strainining Post-void dribbling
Urgency Hesitancy
Nocturia Stream – poor or intermittent
Incontinence Incomplete emptying
Terminal dribbling

Urological ROS
 Mnemonic: [IO, I Urinate Dis Gross Stuff)
o Irritative/Infective – upper and lower
o Obstruction
o Incontinence/Infective
o Urine
o Discharge
o GI symptoms
o Sexual problems
Storage set / Irritative / Frequency, urgency (rushing to washroom), nocturia, incontinence
Lower UTI *Dysuria is technically not a storage symptom
[FUNIS]
Frequency, Urgency, *Strangury is a combination of symptoms: e.g. painful voiding, straining to
Nocturia, Incontinence void, frequent passage of small volumes, urgency, feeling of incomplete
emptying
Incontinence Urge: Urgency
Stress: leakage wit coughing/sneezing/laughing
Overflow: constant dribbling
**Most impt qn: what protection do you need to cope with the leakage?
Voiding set / Start hesitancy, straining, poor stream, terminal dribbling*, feeling of
Obstructive incomplete voiding
[SHED] *Additional POST-MICTURITION symptom = post-void dribbling i.e.
Stream dribbling AFTER passing urine, vs terminal dribbling i.e. dribbling at the
changes/Straining, end of the stream
Hesitancy, incomplete
Empting, Dribbling
Infective UPPER UTI
- Fever
- Loin pain *at this point: can also ask about pelvic pain, back pain
 If present  SOCRATES
- Renal colic
LOWER UTI
- Dysuria
Urine Colour, Blood
(Appearance, volume, - If blood, ask (1) Pain: painful or painless? (2) Appearance: fresh red/coke
smell) coloured, any clots? (3) Timing: part of stream in which it occurs
Volume
Smell (foul smelling)
Discharge Penile / vaginal discharge
Sores/ulcers around genital area

Further details on AS
GI Nausea and vomiting
Abdominal/pelvic pain/back pain**
 If present  SOCRATES
 If back pain  ask about leg weakness
Other bowel dysfunction
Sexual / Genital MALE: Erectile dysfunction, ejaculation problems (painful, retrograde, failure,
premature), infertility
FEMALE: Menstrual questions (e.g. menopause/dysmenorrhoea), Prolapse

Further details on ROS


ROS Malaise/fatigue
Fevers, chills, rigors, night sweats
LOW LOA

Other relevant aspects of history


Think about risk factors:
- PMH: Past urological disease [MINT: Malformation, infection/inflammation, Neoplasia, Trauma],
 UTIs, renal colic
 DM, HTN, vascular disease
- PSH
- DH: prescribed, OTCs/recre, allergies
- FH: PKD, bladder cancer
- SH:
 lifestyle factors e.g. smoking, alcohol
 Employment: chemical/dye exposure

Don’t forget to ICE


SUMMARISE
THANK PATIENT

UROLOGICAL EXAMINATION
- Male genitalia
- PR exam
- Abdominal exam

- Some investigations to mention


 Bloods: U+E, PSA
 Urine: dipstick, MC&S

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