Common Urinary Histories

Presenting Exploding symptom Relevant system reviews Commonest differentials Clues to differential complaint Grouping Differentials Frequency/ Timing General Urological Cystitis •Dysuria (“burning pain on urination”) dysuria/ •When started •Fever, sweats •Frequency and urgency nocturia •Acute/ gradual onset Urethritis •Dysuria •Duration Urological •Purulent urethral discharge •Progression •Storage: frequency, volume, Pyelonephritis •Dysuria •Intermittent or continuous urgency, nocturia •Loin pain •Infection: dysuria, haematuria •Fever/chills/rigors Urination •Prostatic/voiding (if male): •Vomiting •Try to quantify urinary hesitancy, poor flow/dribbling, Benign prostatic •Poor flow and terminal dribbling volume and frequency feeling of incomplete emptying hyperplasia •Hesitancy •Any catheter •Overflow incontinence •Elderly male Other Anxiety differentials Detrusor instability Bladder/ lower urethral calculus Prostatitis Pregnancy Drugs (e.g. diuretics)

Haematuria Timing General Urological Bladder transitional •Painless haematuria •When started •Fever, sweats, rashes, joint cell carcinoma •History of aromatic amine exposure (e.g. •Acute/ gradual onset pain/swelling dye washers, painters, decorators) •Duration Urethral trauma •History of catheter use or trauma •Progression Urological e.g. by catheter •Intermittent or continuous •Storage: frequency, volume, UTI •Frequency/dysuria/urgency urgency, nocturia Urethritis •Dysuria Haematuria •Infection: dysuria •Purulent urethral discharge •Try to quantify bleeding •Prostatic/voiding (if male): Calculi •Loin to groin pain •Thick blood or discoloured hesitancy, poor flow/dribbling, Other Urological urine feeling of incomplete emptying differentials Glomerulonephritis •Any catheter Benign prostatic hyperplasia/ prostate cancer •Anaemia symptoms: Renal cell carcinoma tiredness, breathlessness on Polycystic kidney disease exertion Schistosomiasis Renal TB Misc Haematological e.g. anticoagulation, sickle cell, coagulation disorders Strenuous exercise Infective endocarditis Drugs (e.g. sulphonamides, cyclophosphamide, NSAIDs) Mensturation

Polyuria Timing General Endocrine Diabetes mellitus •Polydipsia/ thirst •When started •Fever, sweats, malaise, rashes, •Polyuria •Acute/ gradual onset joint pain/swelling •Weight loss and tiredness •Duration •Visual disturbance •Progression Urological Diabetes insipidus •Polydipsia/ thirst •Intermittent or continuous •Storage: urgency, nocturia •Polyuria •Infection: dysuria, haematuria Urological Chronic kidney •Non-specific symptoms e.g. fatigue, Polyuria •Prostatic/voiding (if male): disease weakness, puritis, dyspnoea •Try to quantify urinary hesitancy, poor flow/dribbling, Other Cushing’s syndrome volume and frequency feeling of incomplete emptying differentials Psychogenic polydipsia •Try to quantify fluid intake Drugs (e.g. diuretics, alcohol, lithium, tetracyclines) •Other symptoms

Incontinence Timing Urological Stress •Incompetent •Small losses with effort e.g. coughing, •When started •Storage: frequency, volume, incontinence sphincter bending, exertion •Acute/ gradual onset urgency, nocturia •Risk factors: multiple pregnancies, post- •Duration •Infection: dysuria, haematuria menopause •Progression •Prostatic/voiding (if male): Urge •Detrusor instability •Urge to pass urine followed by •Intermittent or continuous hesitancy, poor flow/dribbling, incontinence (e.g. idiopathic, uncontrollable bladder emptying feeling of incomplete emptying cystitis, stone) Incontinence •Hyperreflexia (e.g. •Pattern of incontinence e.g. MS, CVA, spinal cord loss with effort or no control injury) at all Overflow •Prostatic •Dribbling & poor stream •Can they feel when they incontinence hypertrophy •Hesitancy need to urinate •Stricture or stone •Elderly male or history of obstruction •Try to quantify urinary True •Fistula between •Continuous urine leak volume and frequency incontinence bladder and vagina •Bowel habit (any or urethra constipation?) Mixed - •Mix of above types incontinence

Other Post-prostatectomy or other pelvic surgery differentials Bladder stone/ tumour Fistula Post-pelvic fracture Psychogenic

© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision Retention Timing Urological Urological Prostatic •History of hesitancy, poor flow and terminal •When started •Storage: frequency, volume, hypertrophy dribbling •Acute/ gradual onset urgency, nocturia •Elderly male •Duration •Infection: dysuria, haematuria Urethral stricture •History of trauma or recurrent •Progression •Prostatic/voiding (if male): catheterisation •Intermittent or continuous hesitancy, poor flow/dribbling, Bladder neck •May be haematuria feeling of incomplete emptying obstruction (e.g. Retention tumour, calculus) •Any constipation UTI •Dysuria Other Urinary differentials Constipation (common) Prostatitis Pelvic mass Genital herpes Clot retention (after bleed e.g. from tumour) Phimosis Neurological MS Spinal cord compression Drugs Anticholinergic drugs