Urological

Question 1

What are LUTS?

Answer 1

Filling - urgency, frequency, nocturia
Voiding - dysuria, hestiancy, poor flow, incomplete emptying, dribbling, straining, spraying
Incontinence - stress, urge, overflow, continuous, enuresis (nocturnal bedwetting)

Question 2

HPC of urinary tract calculi? (renal pain)

Answer 2

Pain felt:
Radiating from loin to groin or in the back
Renal obstruction - loin
Mid ureter - mimics appendicits/diverticulitis
Lower ureter - scrotum/penile tip/labia majora pain
Bladder or urethra - pelvic pain
Associated features - often restless, dysuria, N+V
Risk factors - male, dehydration, diet (chocolate, tea, rhubarb, calcium etc), catheter
Associated conditions -
Recurrent UTI, hypercalcaemia, gout, RTA
DH - diuretics, antacids, steroids, aspirin

Question 3

HPC of haematuria?

Answer 3

Timing - onset, duration, previous episodes, progression, following trauma/exercise
Character - amount, point in stream (start/mid/end), clots
Associated features - painful = stone/infection, painless = carcinoma of urinary tract; fever/rigors
DH - anticoagulant record/INR, rifampicin (orange)
SH - beetroot excess?

Question 4

HPC of LUTS?

Answer 4

Timing - onset, duration, previous episodes, progression, triggers ie getting home
UTI - fever, acute confusion, pain, haematuria
Cancer screen - incl bone pain
Neurological symptoms - leg weakness/paresis, bowel/sexual dysfunction, perianal sensation
Extent of symptoms and impact on ADLs, mood etc
PMH - DM, CKD (anaemia/uraemia/hypervolaemia/acidaemia)

Question 5

What other questions are important in a urological history?

Answer 5

Sexual and obstetric history - STI, parity
DM?
Allergies to iodine? (if contrast is to be used for further analysis)
Occupation - dyes/aromatic amine exposure
FHx - PKD