Urological Histories

Question 1

What possible PCs might a urological Hx present with?

Answer 1

LUTS:
- Filling - Frequency / Urgency / Nocturia

• Voiding - Dysuria / Hesitancy / Poor flow /
  Incomplete emptying / Dribbling
  (terminal/postmicturition) / Straining to
  urinate / Spraying of urine
• Incontinence - Stress/ Urge / Overflow /
  Continuous / Nocturnal enuresis
  (nocturnal bedwetting)

Haematuria

Fever + rigors

Nausea + Vomiting

Wt loss

Question 2

Name 7 Uraemic sx

Answer 2

Nausea + vomiting

Wt loss

Fatigue

Anorexia

Muscle cramps

Pruitis

Confusion

Question 3

When using SOCRATES what would indicate the following?
a) Ureteric calculus
b) PKD - bleeding into / rupture of a cyst

Answer 3

a) Pain felt in the renal angle + radiates to the hypochondrium groin or genitalia.
It is associated with nausea and/or vomiting.

b) Intermittent pain

Question 4

What do you want to ask about HAEMATURIA?

Answer 4

Duration

Timing within the stream -> initial / continual /
terminal

Presence of clots

Pain
-> may suggest a renal calculus or infection

Painless
-> may suggest a carcinoma of the kidney /
bladder / prostatic bleeding

Fever and rigors

Trauma / exercise

Question 5

What sx are associated w/ UTIs that you would want to ask about?

Answer 5

Dysuria

Frequency

Urgency

Strangury -
-> Painful passage of small quantities of urine
which are expelled slowly by straining with
severe urgency; it is usually accompanied with
the sensation of incomplete micturition.

Fever

Acute confusion (especially in the elderly)

Question 6

What sx are associated w/ CHRONIC RENAL FAILURE that you would want to ask about?

Answer 6

Oliguria

Nocturia

Polyuria (increased volume of urine production secondary to the urea solute load)

Anorexia

Insomnia

Metallic taste in the mouth

Vomiting

Anaemia (due to erythropoietin deficiency)

Fatigue

Pruritis

Oedema

Bruising and bleeding due to abnormal platelet function

Sallow complexion (yellow-grey tinge)

Uraemic fetor

Question 7

What do you want to ask about in the PMH section of a Uro Hx?

Answer 7

Past episodes + onset + duration
-> Recurrent UTIs
-> Renal calculi etc.

If appropriate, enquire about the patient’s sexual history (STDs) + obstetric history

DM

Question 8

What do you want to ask about in the DHx section of a Uro Hx?

Answer 8

Certain medication can affect the colour of the urine -> rifampicin

Diuretics -> nocturia -> AKI

Alpha blockers -> BPH

ABx -> prophy?

NEPHROTOXIC MEDS -> ACEi / NSAIDS (= AKI/CKI)

ALLERGIES
-> Iodine if contrast is to be used for
investigations

Question 9

What do you want to ask about in the FHx section of a Uro Hx?

Answer 9

Familial renal / urological conditions -> PKD

Question 10

What do you want to ask about in the SHx section of a Uro Hx?

Answer 10

Smoking

Alcohol

Travel

Occupation
-> full history as certain industries e.g. rubber and
dyes may lead to renal and/or bladder cancer

Sexual history.

Enquire about diet.
-> Does the patient eat excessive beetroot as it
can colour the urine red.

Recreational drugs

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