History taking on Prostate

problem
Dr Vandana
Common conditions
BPH
Cancer
Presenting complaint
Difficulty passing urine
Urine infection related
Weakness
Bone pain
Pathological fracture
Aim
Take history from a patient presenting with
obstructive urinary symptoms
PC
Difficulty passing urine
Patient particulars
Age
Gender
HPC
Lower urinary tract symptoms:
a) Obstructive urinary symptoms:
Hesitancy – difficulty starting the stream of urine
Straining – forcing to urinate
Weak stream – comes close to the toilet
Prolonged voiding
Terminal dribbling – few drops comes out at the end when they
think it is finished (dripping of urine after mainstream is complete)
Double voiding – after passing urine, they go again to pass
Colour – any blood?
Amount
HPC cont…
Lower urinary tract symptoms:
b) Irritative urinary symptoms:
frequency
urgency – need to go urgently (sudden intense desire
to go)
nocturia – awakening at night to void
Amount - small voided volumes
colour – dark yellow? Any blood?
smell
HPC cont..
Other symptoms which can be present in both:
Dysuria
Incontinence
Colour – blood
HPC cont…
Progress – Is it there every time? Is it worsening?
Any pain?
Some patients can come with sudden urinary retention
meaning can’t pass anything at all suddenly and this can
be very painful.
 This can happen on the background of:
 chronic obstructive symptoms – acute on chronic

 Without any previous obstructive symptoms – like after using

medicines
DDx
Prostate – BPH, cancer, infection (Prostatitis)
Bladder – UTI, Stones, Cancer
Urethra – stones, urethral stricture eg after STIs
Drugs
Nerves – eg. SCI, diabetes, stroke
Trauma
ROS
General: Fever, appetite, weight loss, trauma

HEENT:

Chest

Abdomen - Back pain/loin pain/abdominal pain; BO – constipation can

sometimes result in sudden urinary retention

Pelvic - Discharge from urethra

Ext - Bone pain, weakness in the legs

PMHx
Any operation
UTIs
STIs
Recent catheterisation
Comorbid illness esp diabetes, stroke
Trauma
Meds
Sympathomimetic eg pseudoephedrine – stimulate
sphincter contraction
Parasympathetolytic eg loratidine – inhibit detrusor
contraction
FHx
BPH
Cancer
Stones
SHx
Smoke/alcohol
Sexual partners
Water intake/Diet
Social support – Who will take care? Finance?