Urology History Taking Flashcards
Key points to cover in history
Age, occupation - occupational exposures
PC
-intermittent (sharp/colicky/dull)
Red flags - neurosigns, hematuria, pain
Past urological/abdo/pelvis surgery
Comorbidities and PMHx - fitness for potential surgery
FHx - urological cancers
DHx, allergies
SHx -
- smoking/alcohol status
- mobility, carers, relationships
LUTS presentation -storage -voiding -post micturition -overactive bladder How would these presentations all differ from each other
Storage - frequency, urgency incontinence, nocturia, dysuria
OAB - same as storage but no pain
Voiding - weak stream, intermittent, straining
Post micturition - dribble
UUTS presentation
Loin/flank pain
- can be constant/intermittent (colic)/dull
- can radiate to lower abdo, groin, testes, labia
Infection symptoms
Dysuria
Haematuria
Obstruction => EMERGENCY
Differentials for UUTS presentation
Renal/ureteric colic - intermittent sharp pain, bleeding
Pyelonephritis - fever, flank pain, chills
Retroperitoneal fibrosis - diffuse flank pain, not colicky, weight loss, constitutional symptoms
MSK pain
Lower lobe pneumonia
GI - appendicitis/cholecystitis/diverticulitis
GU pathology
Leaking AAA in older adults
Renal colic presentation
Colicky loin pain => groin
N+V
Worst pain ever
Microhematuria
Important questions to ask if blood found in urine
-possible causes
VH or NVH? When in stream Pain? Duration AC/AP use? Past urological procedures
Cancer UTI Stones Trauma Renal source
Common urological examinations you can do
Abdominal exam
-assess flanks
External genitalia
DRE
Anal tone - neurological cause?
Focused neurological examination
Differentiating between enalrged kidneys and spleens
Kidney
- not mobile on respiration
- ballotable
- ipsilateral extension
- may be able to palpate upper border
- no notch
- may be resonant to percussion due to bowel gas above
Spleen
- mobile on respiration
- unballotable
- RIF extension
- cannot palpate upper border
- notch
- dull on percussion
Examination of the bladder
- normal findings
- abnormal findings
Not usually palpable - in pelvis
As it gets distended => intrabdominal
- palpable
- dull to percussion
Basic urological investigations
Specialised urological investigations
Imaging
Urine dipstick Bladder diary - track frequency, volume IPSS - prostate symptom score ICIQ - questionnaire on incontinence U&E, PSA
Flow rate, post void residual measurements
Urodynamics - real time Xray
Template perineal prostatic biopsy
US
CT
MRI prostate
