History Taking In Urology-undergraduate

Personal history: Patient name, age, job, marital status and

habits as smoking. Complaint: in chronological order. Present history: Details of the complaint and its course and

treatment received. Family history: History of similar diseases in the family. Past History: History of previous diseases (e.g. diabetes,

tuberculosis, hypertension, similar condition like stone passing) and previous operations.

Upper tract symptoms: Renal pain: Characters of pain: Localized to renal angle, dull

aching in nature, constant (does not change with change of position).

Mechanism: Sudden stretch of the renal capsule by hematoma, renal infections, impacted stone.

Renal colic: Characters of colic: Colicky in nature, referred from

renal angle to anterior abdominal wall down to the scrotum in male or labia majora in female.

Mechanism: Hyper-peristalsis to push a foreign body (e.g. stone, pus clump, fungus ball, blood clot).

Irritative symptoms: Dysuria: Painful difficult micturition as in case of

cystitis. The term of burning during micturition is used commonly in place of dysuria.

Frequency: Diminished interval between voiding. Mechanism: decreased bladder capacity: Temporary: As in spasm of detrusor muscle in cystitis,

Neurogenic bladder, large bladder stone, large residual urine.

Permanent: As in contracted bladder. Causes of contracted bladder: Bilharzial cystitis,

Tuberculous cystitis, Interstial cystitis, Post-irradiation to the pelvis, Intravesical chemotherapy or surgical (partial cystectomy).

We can classify in another way: Pressure on the bladder from outside:

Most common is pregnancy, retroperitoneal tumors.

Diseases in the wall: Spasm of detrusor muscle, or contracted bladder and bladder tumors.

Diseases in the lumen: Large bladder stone, or large residual urine.

Urgency: Increased desire to voiding. As in case of cystitis, there is increase in bladder pressure due to spasm of detrusor muscle leading to increase in desire. If the pressure increases more, it will overcome urethral resistance resulting in incontinence (urge incontinence).

Nocturia: Increase frequency by night time. This might be due to increase urine output by night as in case of heart failure or due to decrease in bladder capacity due to large residual urine as in benign prostatic hyperplasia.

Hesitancy: Delay in the start of act of micturition due to infravesical obstruction e.g. BPH.

Changes in the characters of the stream: Decreased force and caliber of the stream of urine.

Interruption of the stream: As in case of ball valve mechanism due to enlarged middle lobe of the prostate, or bladder stone. Also due to contraction of urethral sphincters during voiding as in Neurogenic bladder.

Post-voiding dribbling of urine. Straining during voiding.

Hematuria: The presence of blood in urine. It should be differentiated from Red urine (Foods e.g. Beet roots, drugs as phenolphthaline products or azo dyes, hemoglobinuria or excess urates in urine).

Urinary incontinence: Involuntary loss of urine per urethra:

Urge incontinence, Stress incontinence, Total incontinence.

Necroturia: The presence of necrotic tissue in urine which means malignancy.

Pneumaturia: The presence of air in urine due to infection by gas forming organism, fistula between gastrointestinal tract and urinary tract or iatrogenic after endoscopy or catheterization.

Polyuria: Increase in 24 hour urine output to more than 2500 ml.

1. Psychogenic: as in psychogenic polydepsia.2. Neurogenic: As in ADH deficiency due to lesions of posterior

pituitary.3. Nephrogenic: As in early renal failure due to destruction of

ADH receptors. 4. Osmotic: As in case of diabetes mellitus. Anuria & oliguria: Oliguria means reduction of 24 hour urine

to < 400 ml. Anuria means reduction of urine output to < 100 ml.

Causes are either: Pre-renal, Renal or Post-renal.Urine retention: Inability to pass urine in spite of presence of

desire.It should be differentiated from anuria.It is either Acute: diagnosed by the patient, orChronic discovered by the examining doctor (patient is

unaware of it).

General examination. Special examination: Bi-manual examination of the kidneys: Characters of renal swelling: Intra-abdominal. Mobile with respiration. Direction of enlargement downwards. Fills the renal angle. Band of resonance in front. Dull renal angle on percussion.

Bladder examination: Examination of the supra-pubic area for

bladder swellings as in urine retention or bladder masses.

Characters of bladder swelling: Intra-abdominal. Globular (except in tumors may be

irregular). Pelvi-abdominal (you can not get below it). Bi-Manually palpable (simultaneous digital

rectal examination and abdominal examination).

Genital examination: (should be in supine and in standing positions).

Examination of the penis: For size, curvature, cordee and examination of external urethral meatus for size, discharge, and site (e.g hypospadias or epispadias).

Examination of the scrotum and its contents.

Digital rectal examination: Examination of anal tone, prostate, seminal

vesicles, and bladder base.