list the key features of taking a urological history:
Storage: Frequency, nocturia, urgency and enuresis (involuntary leakage of urine)
Voiding: Hesitancy, poor flow, intermittency, terminal dribbling, dysuria and haematuria.
Post void: post micturition dribbling (terminal dribbling), incomplete emptying.
Cloudy urine? Think UTI
Occupational/environmental exposure? Plastics factory, azo dyes, rubber manufacturer- think bladder cancer. Recent travel to Egypt, swimming in lakes- think schistosomiasis.
Shakes/rigors? think infection to kidney (pyelonephritis)
Family history- any genetically inherited diseases e.g polycystic kidney disease, bladder cancer.
Social history- smoking? alcohol consumption?
Voiding: Hesitancy, poor flow, intermittency, terminal dribbling, dysuria and haematuria.
Post void: post micturition dribbling (terminal dribbling), incomplete emptying.
Cloudy urine? Think UTI
Occupational/environmental exposure? Plastics factory, azo dyes, rubber manufacturer- think bladder cancer. Recent travel to Egypt, swimming in lakes- think schistosomiasis.
Shakes/rigors? think infection to kidney (pyelonephritis)
Family history- any genetically inherited diseases e.g polycystic kidney disease, bladder cancer.
Social history- smoking? alcohol consumption?
DESCRIBE THE SYMPTOMS ASSOCIATED WITH UTI:
Lower urinary tract symptoms (LUTS):
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Ascending infection (pyelonephritis):
(Clinical note: pyelonephritis can cause oedema, this must be drained and is a serious condition!!) |
list the key features of a focussed history on haematuria
- Frank/visible (LUTS) v microscopic/dipstick (UUTS)
- Timing: Not an exact science- beginning of the stream suggests urethra or prostate; throughout the stream suggests bladder, ureter, or kidneys; terminal bleeding suggests schistosomiasi
- Clots (higher up and larger volume)
- Pain (stones or infection)
- Frequency and duration
- Important historical findings include fever, back pain, dysuria, urgency, frequency (urinary tract infection); renal colic or previous nephrolithiasis (renal stone disease); weight loss, especially with abdominal pain (renal cell carcinoma); or weight loss with a significant smoking history, analgesic abuse, or exposure to industrial dyes (bladder carcinoma)
- Oedema, hypertension (glomerulonephritis)
- Recent trauma or vigorous exercise (rhabdomyolysis)
- Drugs- analgesics (papillary necrosis), cyclophosphamide (hemorrhagic cystitis), anticoagulants, and drugs known to cause acute interstitial nephritis.
- A personal or family history of hematuria with deafness or ocular abnormalities (Alport's syndrome), or hematuria with progressive chronic renal failure (polycystic kidney disease), should be sought, as well as a family history of sickle hemoglobin.
- Recent foods such as beetroots can cause red urine!!
Obstructive symptoms
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irritative symptoms
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Explain the likely cause underlying the patient’s symptoms:
Burning sensation- stimulation of pain receptors in the urethra due to inflammation
Left sided back ache which moved to his groin- (loin to groin) Nerve roots T10 to L2 and L1 supply the renal capsule and ureters. Renal pain is felt over the corresponding dermatomes (lower back and groin)
Chills and uncontrollable shaking- systemic symptoms, indication of infection of the upper urinary tract.
Left sided back ache which moved to his groin- (loin to groin) Nerve roots T10 to L2 and L1 supply the renal capsule and ureters. Renal pain is felt over the corresponding dermatomes (lower back and groin)
Chills and uncontrollable shaking- systemic symptoms, indication of infection of the upper urinary tract.
Differentials:
Pyelonephritis
Renal colic (stones): sudden onset, severe writhing pain, loin-groin, haematuria, sympathetic stimulation (sweating, fear, vomiting), tenderness over renal angle.
Renal cell cancer: Pain of gradual onset, may be painless haematuria, possible mass. Adults- clear cell carcinoma, children- Wilms.
Renal infarction: unilateral flank pain and haematuria.
UTI
Trauma
Dietary: beetroot
Drug related: e.g. Rifampicin (TB), Ketamine.
Bladder cancer: storage symptoms (frequency and urgency), painless haematuria, UTI. Transitional cell carcinoma.
Renal colic (stones): sudden onset, severe writhing pain, loin-groin, haematuria, sympathetic stimulation (sweating, fear, vomiting), tenderness over renal angle.
Renal cell cancer: Pain of gradual onset, may be painless haematuria, possible mass. Adults- clear cell carcinoma, children- Wilms.
Renal infarction: unilateral flank pain and haematuria.
UTI
Trauma
Dietary: beetroot
Drug related: e.g. Rifampicin (TB), Ketamine.
Bladder cancer: storage symptoms (frequency and urgency), painless haematuria, UTI. Transitional cell carcinoma.