Common Urological Presentations

Question 1

Urological symptoms

Answer 1

Generally STIs, UTIs

• Frequency
• Urgency - urge incontinence?
• Nocturia
• Weak stream - BPH, prostate cancer
• Intermittent - BPH, prostate cancer
• Straining - BPH, prostate cancer
• Emptying - BPH, prostate cancer

Pain
Pain on urinating?
Haematuria?

Urge, stress incontinence

Uremia - N+V, fatigue, anorexia, weight loss, muscle cramps, itch, confusion

Question 2

Systemic review

Answer 2

Systemic

• weight loss - uremia, malignancy?
• fevers, rigors - pyelo, UTI?

CV

• chest pains - uremic pericarditis?
• palpitations - electrolyte imbalances?
• SOB - pulmonary edema from renal failure?

GI

• abdo pain - peritoneal dialysis linked infection?
• N+V, anorexia, itch => uremia?

Neuro
-confusion - uremic enceph

MSK

• wasting - ESRF
• uremic frost
• muscle weakness - electrolyte imbalance

Question 3

Exploration of PC

Answer 3

SOCRATES - can also be used for other symptoms

Onset and time course

Character

• dull, throbbing, sharp?
• constant or comes and go

Radiation

Associated symptoms

Exacerbating or relieving factors

Severity

Question 4

Key question to ask in incontinence presentations

Answer 4

Onset

Triggers

• physical exertion => stress
• none => urge, overflow

Volume

• trickle => stress
• variable => urge but small, overflow

Urgency

• yes => urge
• no => overflow, stress

Nocturia => urge

Use of pads
Any episodes where they have not made it to the bathroom on time.

ASSESS FOR CAUDA EQUINA

• saddle anaesthesia
• leg weakness, tingling
• back pain

ALWAYS ASK ABOUT IMPACTS ON LIFE!

Urological cause - prostate, UTI
Neurological PHx
Pregnancy Hx
Pelvic surgery

Question 5

Differences between the types of incontinence

Answer 5

Stress

• triggered by coughing, laughing, physical mv => small trickle
• older age, female, vaginal delivery, obese, pregnant, pelvic surgery?

Urge

• sudden frequent urge to go pee => very little urine
• nocturia
• bladder oversensitivity from infection, neuro disorders

Mixed - symptoms of both

Overflow - bladder never completely empties
-outflow blockage, neuromuscular disorder

Question 6

Past medical history

Answer 6

Any medical conditions
Past hospital visits, urological procedures, surgeries

Are you taking any medication, inhalers, OTC, herbal supplements, contraception?

Urological conditions

• recurrent UTIs
• incontinence
• prostate disease - BPH, prostate cancer
• renal disease - stones, pyelo, CKD
• diabetes
• bleeding disorders

Medication with urological impacts

• diuretics => nocturia, AKI?
• Ab (-zosin) => treat BPH
• ACEi, NSAIDs => nephrotoxics
• ABx - prophylaxis for recurrent UTIs

Question 7

Family history

Answer 7

Urological disease

-kidney, bladder, prostate problems

Question 8

Social history

Answer 8

General

• house, flat => stairs, lifts?
• support network
• ADLs => self care, housework, food shopping
• carers

Smoking - BLADDER CANCER
Alcohol - MALIGNANCY RISK
Rec drugs

Fluids - dehydration => increased UTI, AKI risk

Work
-what does their job involve industrial dyes, textiles, rubber, plastics, leather => bladder cancer risk

Question 9

Red flag conditions to screen for

Answer 9

Cauda equina

• saddle anaesthesia
• back pain
• leg weakness, tingling

Malignancy - HAEMATURIA
-but could be UTI, catheter trauma

Prostate cancer => PSA, DRE abnormal
Bladder or renal cancer 
-45, VH no UTI
-60 NVH + painful urination/high WCC
Testicular cancer => non painful enlargement/change in shape or texture

Pyelonephritis - back pain, fever rigors, N+V

Question 10

Further actions to consider

Answer 10

Male ext genitalia exam
DRE

Urinedip and MSU
PSA

Bladder scan
Uroflowmetry

Question 11

GP management of common conditions

• UTI
• incontinence

Answer 11

UTI

• ABx - nitrofurantoin 3days
• Increase fluids
• Wiping from front to back

Bladder diary
Stress incontinence
-pelvic floor training
-reduce caffeine
Urge
-bladder retraining
-anticholinergics
SE - dry mouth, blurry vision, constipation, urinary retention, confusion