Urology history and examination

Question 1

Urological symptoms.

a) Storage LUTS
b) Voiding LUTS
c) Systemic/other

Answer 1

a) Nocturia, urgency, frequency, incontinence
b) Hesitancy, straining, poor stream, splitting/spraying, terminal dribbling, incomplete emptying
c) Dysuria, haematuria, fever, rigors, pain (flank, groin, abdo, scrotal, back pain in prostate bony mets, etc.), nausea and vomiting

Question 2

Past medical history (PMHx).

a) Urological
b) Other

Answer 2

a) Urological diseases:
- Recurrent urinary tract infections (UTIs)
- Incontinence – stress vs. urge vs. mixed vs. functional
- Prostate issues – BPH / prostate cancer
- Renal – stones / pyelonephritis / CKD
- Surgical history – cystoscopy / bladder surgery / renal surgery

b) Diabetes - predisposes to UTIs
Acute hospital admissions? – when and why

Question 3

Drug history (DHx) - causes

a) Causes of retention/overflow incontinence
b) Causes of stress incontinence
c) Nephrotoxic drugs
d) Contributors to nocturia

Answer 3

e) Diuretics – may contribute to nocturia / incontinence
d)
Nephrotoxic agents – e.g. ACE inhibitor – consider suspension
Antibiotics – those with recurrent UTIs take prophylactic antibiotics

Question 4

Drug history (DHx) - treatments

a) Urinary frequency/nocturia/incontinence - main class, example (other drug, with receptor)
b) Nocturia/nocturnal enuresis
c) Prostate enlargement - 2 classes with examples
d) Stress incontinence in females

Answer 4

a) Antimuscarinics (e.g. oxybutynin, solifenacin, tolterodine), beta-3-agonist (mirabegron)
b) Desmopressin
c) Alpha-adrenoreceptor antagonists (e.g. tamsulosin), 5-alpha-reductase inhibitors (5-ARIs, e.g. finasteride)
d) Duloxetine

Question 5

Tamsulosin vs. finasteride

• Benefit of tamsulosin
• Drawback of tamsulosin

Answer 5

• Tamsulosin is quicker to act (may be used to treat acute retention) whereas finasteride takes months
• Side effects (postural hypotension - dizziness, falls)

Question 6

Social history (SHx).

a) Incontinence, frequency, urgency, etc.
b) Bladder cancer
c) Travel to Africa - consider…?

Answer 6

a) Alcohol, caffeine,
b) Smoking, occupational (industrial dyes/ textiles/ rubber/ plastics/ leather tanning)
c) Schistosomiasis - abdo pain, haematuria, dysentery, squamous bladder cell Ca, renal failure, liver failure

Question 7

Examination.

a) Genital
b) Abdominal
c) Other

Answer 7

a) Penis (phimosis, ulcers, etc.), vagina, scrotum, testes, epididymis, groins (hernias),
b) Abdomen scars, tenderness, palpable/percussible (tender) bladder, renal angle tenderness/mass
c) DRE (prostate, tone, sensation, impacted faeces, rectal tumours, etc.), neurological

Question 8

Bedside investigations.

a) Main one
b) Other

Answer 8

a) Urine dipstick - blood (UTI, malignancy, stones, GN), leukocytes/nitrites (UTI), protein (renal), glucose (DM), ketones, ….plus pregnancy test in women
b) Bladder scan - bladder volume (normal capacity around 300 - 400mL) and residual volume (should be less than 100mL)

Question 9

Complex (tertiary) investigations.

Answer 9

Imaging:

• USS - cysts, hydronephrosis, other masses
• MRI (prostate Ca screen)
• CT KUB (renal calculi) - beware contrast nephropathy
• MCUG (paediatric UTI - reflux)
• DMSA (paediatric UTI - kidney damage)

Other tests:

• Urodynamics (storage symptoms: incontinence, urgency, etc.)
• Cystoscopy (haematuria 2 week wait)