Other urinary symptoms

Question 1

Key history in other urinary symptoms

Answer 1

Duration
Obstructive symptoms (hesitancy, diminished stream, sense of incomplete bladder emptying,
straining, postvoid dribbling)
Irritative symptoms (urgency, frequency, nocturia)
Constitutional symptoms
Bone pain
Medications
Hx of UTIs, urethral stricture, or urinary tract instrumentation; stones, diabetes, alcoholism

Question 2

Key physical exam in other urinary symptoms

Answer 2

Vital signs; abdominal exam (including suprapubic percussion to assess for a distended bladder); genital
and rectal exams; focused neurologic exam

Question 3

60 yo M with nocturia, urgency, weak stream and terminal dribbling
+ no weight loss, fatigue or bone pain
+ two prior episodes of urinary retention requiring catheterization

Answer 3

Benign prostatic hyperplasia (BPH)
Prostate cancer
UTI
Bladder stones

Rectal exam
UA
CBC, BUN/Cr, PSA
U/S—prostate (transrectal)
Alkaline phosphatase

Question 4

71 yo M with nocturia, urgency, weak stream, terminal dribbling, hematuria and lower back pain for last four months
+ weight loss and fatigue

Answer 4

Prostate cancer
BPH
Renal cell carcinoma
UTI
Bladder stones

Rectal exam
UA
CBC, BUN/Cr, PSA
U/S—prostate (transrectal)
CT—pelvis
Prostate biopsy
Alkaline phosphatase
MRI - spine

Question 5

18 yo M with burning sensation during urination and urethral discharge
+ unprotected sex with new partner

Answer 5

Urethritis
Cystitis
Prostatitis

Genital and rectal exams
UA and urine culture
Gram stain and culture of urethral discharge
Chlamydia and gonorrhea PCR

Question 6

45 yo diabetic F with dysuria, urinary frequency, fever, chills and nausea over last three days
+ left CVA tenderness on exam

Answer 6

Acute pyelonephritis
Nephrolithiasis
Renal cell carcinoma
Lower UTI (cystitis, urethritis)

UA, urine culture and sensitivity
Blood culture
CBC
BUN/Cr
U/S—renal
CT—abdomen

Question 7

55 yo F with urinary leakage after exercise
+ loses small amount of urine when coughing, laughing or sneezing
+ vague low back pain
+ Hx of multiple vaginal deliveries
+ mother had same problem after menopause

Answer 7

Stress incontinence
Mixed incontinence
Urge incontinence
Overflow incontinence
Functional incontinence
UTI
DM

UA, urine culture
BUN/Cr
Urodynamic testing
IVP
Cystourethroscopy

Question 8

33 yo F with urinary leakage
\+ unable to suppress urge to urinate and loses large amounts of urine without warning
\+ Hx of UTIs and FHx of DM
\+ drinks eight cups of coffee daily
\+ under stress

Answer 8

Urge incontinence
Mixed incontinence
Stress incontinence
Overflow incontinence
Functional incontinence
UTI
DM

CBC, electrolytes, BUN/Cr, glucose, UA, urine culture, urodynamic testing, IVP, cystourethroscopy