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

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

© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision