Urinary Tract Symptoms

Question 1

How are LUTS classified?

Answer 1

Lower urinary tract symptoms:

• storage symptoms
• voiding symptoms

Question 2

What are the storage LUTS?

Answer 2

Urgency
Frequency
Nocturia
Urge incontinence

Question 3

What are the voiding LUTS?

Answer 3

Hesitancy 
Intermittency
Straining
Poor flow (10ml/s)
Terminal dribbling
Incomplete emptying

Question 4

How is haematuria classified?

Answer 4

Visible haematuria - pink, red or dark brown urine due to blood
Non-visible haematuria - on urinalysis
- symptomatic or
- asymptomatic

Question 5

When is urgent referral to urology indicated for haematuria?

Answer 5

Age 45 or over with either:
- unexplained visible haematuria without UTI
- visible haematuria that persists or recurs after successful treatment of UTI
Age 60 or over with unexplained non-visible haematuria and either dysuria or a raised WCC

Question 6

What are the gold standard investigations for haematuria?

Answer 6

Lower urinary tract:
- flexible cystoscopy

Upper urinary tract:

• US KUB for non-visible haematuria
• CT urogram for visible haematuria

Question 7

What are the features of acute urinary retention?

Answer 7

Acute suprapubic pain
Inability to micturate
Palpable distended bladder

Question 8

Which investigations should be done for a patient in urinary retention?

Answer 8

PR exam - prostate enlargement or constipation
Post-void bedside bladder scan to show volume of retained urine
Routine bloods
Catheter specimen of urine (CSU)
If high pressure retention (backing up to kidneys) –> US KUB for hydronephrosis

Question 9

What are the features of chronic urinary retention?

Answer 9

Painless inability to pass urine
(may be able to pass small volumes but significant residual volume)
Bladder distention –> bladder desensitisation
Overflow incontinence
Nocturnal enuresis

Question 10

What should you look for on inspection of a scrotal lump?

Answer 10

6 S’s:

• site
• size
• shape
• symmetry
• skin changes
• scars

Question 11

What should you look for on palpation of a scrotal lump?

Answer 11

3 T’s + CAMPFIRE:

• tenderness
• temperature
• transillumination
• consistency
• attachments
• mobility
• pulsation
• fluctuation
• irreducibility
• regional lymph nodes
• edge

Question 12

What is the first line investigation for the majority for scrotal lumps?

Answer 12

USS of scrotum