Genitourinary History Flashcards
Define what the following means:
- Dysuria
- Haematuria
- Nocturia
- Anuria
- Oliuria
- Polyuria
- Dysuria: pain when urinating
- Haematuria: blood in urine
- Nocturia: frequent urinating at night
- Anuria: no urinating
- Oliguria: low output of urine
- Polyuria: excessive or abnormally large passage of urine
What are symptoms to ask about with respect to urination ? (i.e. which questions would you ask)
♦ Do you ever have pain passing urine (i.e. dysuria) ?
♦ Do you frequently wake up at night to pass urine (i.e. nocturia) ?
♦ Have you noticed any blood in your urine (haematuria) ?
♦ Are you passing more urine than usual (polyuria) ?
♦ Are you passing less urine than usual (oliguria) ?
♦ Have you stopped passing urine ? (anuria)
♦ Frequency of urination ?
♦ Any terminal dribbling ? (i.e. prostatic phenomenon, once finish urinating, more pee comes out that they were not expecting)
♦ Any hesitancy ? (delay before being able to pass urine)
♦ Any pain ? (dysuria is pain when passing urine, but can be other pain e.g. suprapubic, flank/loin pain)
♦ Incontinence ?
♦ Urgency ?
♦ Incomplete emptying ? (retention)
♦ Any changes in stream flow ? (e.g. when they were younger strong flow, now poorer)
♦ Any other symptoms (fatigue, nausea, malaise…)
Distinguish between microscopic and macroscopic haematuria.
Micro= patients won’t know, need to pick it up with urine dip stick test
Macro (i.e. frank)= patients notice it
What is polyuria defined that in terms of liters ?
Greater than 2.5-3 L in 24 hours
Identify possible causes of anuria and oliguria.
- Obstruction (if suprapubic pain with intense desire to micturate)
- HypoV (if dry/dehydrated)
- Acute Kidney Injury/Renal failure
What must a doctor do next if a patient mentions they have been feeling pain ?
Ask SOCRATES questions
Identify and describe the main types of incontinence.
1) Stress
- Result of sphincter weakness
- Small leak of urine when intra-abdominal P rises (e.g. coughing, sneezing, laughing)
2) Urge
- Usually due to detrusor instability
- Strong desire/rush to void (didn’t get there in time)
3) Overflow
- Usually due to outflow obstruction
- Leakage of small amounts only, with palpable distended bladder
4) Neurological
- Different types, depending on cause and accompanying neurological deficit
- E.g. distended atonic bladder with large residual V (due to autonomic neuropathy), loss of sensation and unexpected lack of control (due to spinal cord injury)
5) Mixed
Explain the importance of asking about catheters as part of the GU medical history.
Risk of infection is significant
Define intermittent self catheterisation.
Patient puts it in when need to pass urine
True or false: urine dip will always be + for infection with a catheter (without it meaning there necessarily is an infection).
True.
What are possible associated symptoms in addition to the GU symptoms mentioned ?
Vomiting Nausea Fatigue Malaise Anorexia Weight Loss
Identify common/ serious presentations of urinary problems, and what they indicate.
Dysuria, with frequency, urgency, and suprapubic discomfort: UTI, cystitis
Systemic upset, fever, rigors, vomiting, flank pain: pyelonephritis
Slow flow, hesitancy, terminal dribbling, incomplete emptying, nocturia: enlarged prostate (Benign Prostatic Hypertrophy, prostate cancer)
Painless frank haematuria: consider bladder cancer
Identify symptoms of upper urinary tract obstruction, as well as potential causes for it.
- Dull ache in flank/loin
- Polyuria → Anuria
-Causes: tumour (renal, ureter), stricture, calci
Identify symptoms of bladder outlet obstruction, as well as potential causes for it.
- Hesitancy
- Poor stream
- Terminal dribbling
- Sense of incomplete emptying
- Possible retention (+overflow)
- Infection
-Causes: benign prostatic hypertrophy, prostate cancer, pelvic tumor (gynae)
Identify possible symptoms to enquire about in a man’s reproductive system medical history.
- Urethral discharge
- Testicular pain
- Testicular lumps
- Joint, eye, GI symptoms
- Rash/ulcers
- Itch
- Smell
- Infertility/Fertility problems
- Urinary symptoms
- Abdominal pain
- Systemic upset
- Partner affected ?
Identify possible questions about urethral discharge in men.
Amount, smell, boody ?
Identify possible questions about testicular pain.
Any link to trauma ?
Link to other illness ?
Speed of onset/severity ?
Associated swelling/redness/tenderness ?
Identify possible questions about testicular lumps.
- Unilateral/bilateral
- Location
- Associated symptoms ?
- Hard/soft
- Regular/irregular
What is a possible diagnosis with testicular lumps ?
Testicular cancer
What is a possible diagnosis with joint/eye/GI symptoms for men ?
If associated with urethral discharge, consider Reiter’s syndrome
What is a possible diagnosis with genital rash/ulcers ?
Consider genital herpes (HSV)/genital warts (HPV, vesicular rash)
Identify possible questions about itches as a reproductive issue for men ?
Associated rash ?
Discharge ?
Identify possible questions to ask about infertility/fertility problems ?
> 12 months ?
Any children with previous partners ?
Identify any common/serious presentations of reproductive problems, stating what each indicates.
- Pelvic, perineal or scrotal pain, fever, systemic upset: acute prostatitis
- Chronic pelvic/perineal/scrotal pain and urinary symptoms: chronic prostatitis
- Discharge, dysuria, other urinary symptoms: urethritis (either STI or UTI)
- Painless hard swelling of body or testis: consider testicular cancer
- Acutely painful swollen unilateral testicle: consider testicular torsion
