Urological History

Question 1

What questions should be asked about pain in a urological history?

Answer 1

Use the SOCRATES mnemonic. The pain of a ureteric calculus is felt in the renal angle and radiates to the hypochondrium, groin or genitalia. It is associated with nausea and/or vomiting. Intermittent pain is seen with polycystic kidney disease when it accompanies bleeding into, or rupture of, a cyst.

Question 2

What are LUTS?

Answer 2

Filling: urgency, frequency, nocturia Voiding: dysuria (pain), hesitancy, poor flow, incomplete emptying, dribbling (terminal/postmicturition), straining to urinate, spraying of urine Incontinence: stress, urge, overflow, continuous, nocturnal enuresis (nocturnal bedwetting)

Question 3

What questions should be asked about haematuria?

Answer 3

Ask about: Duration, Timing within the stream (initial/continual/terminal), Presence of clots Pain (painful haematuria may suggest a renal calculus or infection; painless haematuria, may suggest a carcinoma of the kidney or bladder, or prostatic bleeding) Fever and rigors Trauma / exercise

Question 4

What are symptoms of a UTI?

Answer 4

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 5

What are symptoms of Chronic Renal Failure?

Answer 5

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 6

How do we complete a urological HPC?

Answer 6

Specifically enquire about past episodes (recurrent UTIs, renal calculi etc.), and their onset and duration. If appropriate, enquire about the patient’s sexual history (STDs), and obstetric history Is the patient diabetic?

Question 7

What drug history and allergies questions are key for a urological history?

Answer 7

Certain medication can affect the colour of the urine (e.g. rifampicin).
Enquire about allergies to iodine if contrast is to be used for investigations

Question 8

What social history questions are key for a urological history?

Answer 8

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.

Question 9

What family history questions are key for a urological history?

Answer 9

As any medical history however do focus on any familial renal or urological condition for example Polycystic kidney disease is familial.