History taking: Urology
Keeping with the generic principles of history taking, I would like to emphasise a bit more on specifics of urological history.
Urology involves the genito-urinary tract, therefore everything from kidney downwards to the urethra and also the male external genitalia. I am primarily concentrating on the urinary part of the anatomy and will cover the genital part in another blog.
LUTS: Lower Urinary Tract Symptoms
These can be classified as either irritative v/s obstructive symptoms or storage v/s voiding symptoms.
Storage symptoms: frequency
urgency
dysuria
nocturia
Voiding symptoms: poor stream
stop-start micturition
hesitancy
terminal/post-micturitional dribbling
sensation of incomplete ‘emptying’
overflow incontinence
Haematuria:
The reason this is a different question in the history is because it can originate from anywhere along the entire urinary tract. I would refer to the blog on haematuria history taking for further information.
Constitutional symptoms:
The importance of asking these questions is because urological cancers can often only present with these symptoms e.g. prostate cancer. Ageing men have BPH, which develops from transitional zone of the prostate and causes LUTS, but prostate cancer develops in the peripheral zone and is more often found incidentally!
Questions include weight loss, loss of appetite, night sweats, malaise, fatigue.
Systemic symptoms:
Fever with rigors/chills, ‘hot & cold’, generally feeling ‘unwell’, etc.
These symptoms would suggest an underlying infection.
Past medical and drug history:
Neurological history and previous urological history is important.
Family history:
The importance of this is in urological cancers as well as in urolithiasis (urinary stone disease). Prostate cancer (CaP) is of high importance in family history followed by renal cancers. Bladder cancers do not have a high degree of inheritance. An important point here to mention is that family history of prostate cancer means diagnosis of CaP in the relative at relatively younger age, not at 90 yrs of age!!!
Social history:
Smoking is the most important factor in this section. Smoking is the strongest factor associated with bladder cancer. A detailed smoking history includes how many cigarettes/day, whether cigarettes or roll-ups, how long has the person being smoking for, etc. When a patient says he/she has given up smoking, then it is all the more important to ask the above questions as well as when he/she gave up smoking.
I hope this format helps you all in urological history taking. As ever, I would say please practice, practice and practice. The more practice you will do, the more slick and efficient you will get. All the best.
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