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History taking
Dr.Santosh Jha
TMU
• The urologist has the ability to make the initial
evaluation and diagnosis and to provide
medical and surgical therapy for all diseases of
the genitourinary (GU) system
• A complete history can be divided into the
chief complaint and history of the present
illness, the patient's past medical history, and
a family history
Chief Complaint and Present Illness
• The chief complaint is a constant reminder to
the urologist as to why the patient initially
sought care
• In obtaining the history of the present illness,
the duration, severity, chronicity, periodicity,
and degree of disability are important
considerations
Pain
• Pain arising from the GU tract may be quite
severe and is usually associated with either
urinary tract obstruction or inflammation
• Inflammation of the GU tract is most severe when
it involves the parenchyma of a GU organ
• Tumors in the GU tract usually do not cause pain
unless they produce obstruction or extend
beyond the primary organ to involve adjacent
nerves.
Renal Pain
• Pain of renal origin is usually located in the ipsilateral
costovertebral angle just lateral to the sacrospinalis muscle
and beneath the 12th rib.
• Pain is usually caused by acute distention of the renal
capsule, generally from inflammation or obstruction
• Pain of renal origin may be associated with gastrointestinal
symptoms because of reflex stimulation of the celiac
ganglion and because of the proximity of adjacent organs
(liver, pancreas, duodenum, gallbladder, and colon).
• Renal pain may also be confused with pain resulting from
irritation of the costal nerves, most commonly T10-T12.
Ureteral Pain
• Ureteral pain is usually acute and secondary to
obstruction.
• The pain results from acute distention of the
ureter and by hyperperistalsis and spasm of
the smooth muscle of the ureter as it
attempts to relieve the obstruction, usually
produced by a stone or blood clot.
Vesical Pain
• Vesical pain is usually produced either by over distention of the bladder as
a result of acute urinary retention or by inflammation.
• Constant suprapubic pain that is unrelated to urinary retention is seldom
of urologic origin.
•
Inflammatory conditions of the bladder usually produce intermittent
suprapubic discomfort.
• Thus, the pain in conditions such as bacterial cystitis or interstitial cystitis
is usually most severe when the bladder is full and is relieved at least
partially by voiding.
• Patients with cystitis sometimes experience sharp, stabbing suprapubic
pain at the end of micturation, and this is termed strangury
Prostatic Pain
• Prostatic pain is usually secondary to inflammation
with secondary edema and distention of the
prostatic capsule.
• Pain of prostatic origin is poorly localized, and the
patient may complain of lower abdominal, inguinal,
perineal, lumbosacral, and/or rectal pain
• Prostatic pain is frequently associated with irritative
urinary symptoms such as frequency and dysuria,
and, in severe cases, marked prostatic edema may
produce acute urinary retention
Penile Pain
• Pain in the flaccid penis is usually secondary to
inflammation in the bladder or urethra, with
referred pain that is experienced maximally at
the urethral meatus
Testicular Pain
• Scrotal pain may be either primary or referred.
• Primary pain arises from within the scrotum and is usually
secondary to acute epididymitis or torsion of the testis or testicular
appendices.
• Chronic scrotal pain is usually related to noninflammatory
conditions such as a hydrocele or a varicocele, and the pain is
generally characterized as a dull, heavy sensation that does not
radiate.
• Because the testes arise embryologically in close proximity to the
kidneys, pain arising in the kidneys or retroperitoneum may be
referred to the testes.
Hematuria
• Hematuria is the presence of blood in the urine; greater than three
red blood cells per high-power microscopic field (HPF) is significant
• Is the hematuria gross or microscopic?
• At what time during urination does the hematuria occur (beginning
or end of stream or during entire stream)?
•
• Is the hematuria associated with pain?
•
Is the patient passing clots? If the patient is passing clots, do the
clots have a specific shape?
Timing of Hematuria
• Initial hematuria usually arises from the urethra
(usually secondary to inflammation)
• Total hematuria is most common and indicates that
the bleeding is most likely coming from the bladder
or upper urinary tracts
• Terminal hematuria occurs at the end of micturition
and is usually secondary to inflammation in the area
of the bladder neck or prostatic urethra.
Gross versus Microscopic Hematuria
• The chances of identifying significant
pathology increase with the degree of
hematuria.
Lower Urinary Tract Symptoms
• Irritative Symptomsfrequency,dysuria,nocturia,
• Obstructive Symptoms- Decreased force of
urination, hesitancy, Intermittency, Postvoid
dribbling, Straining
Incontinence
• Urinary incontinence is the involuntary loss
of urine
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Continuous Incontinence.
Stress Incontinence.
Urgency Incontinence
Overflow Urinary Incontinence
Enuresis
• Enuresis refers to urinary incontinence that
occurs during sleep.
• It occurs normally in children up to 3 years of
age but persists in about 15% of children at
age 5 and about 1% of children at age 15
Sexual Dysfunction
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Loss of Libido.
Impotence.
Failure to Ejaculate.
Absence of Orgasm.
Premature Ejaculation.
Hematospermia
• Hematospermia refers to the presence of
blood in the seminal fluid.
• It almost always results from nonspecific
inflammation of the prostate and/or seminal
vesicles and resolves spontaneously, usually
within several weeks.
Pneumaturia
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Pneumaturia is the passage of gas in the urine
Instrumentation
Fistula between the intestine and the bladder
Diverticulitis
Carcinoma of the sigmoid colon, and regional
enteritis (Crohn's disease)
Urethral Discharge
• Urethral discharge is the most common
symptom of venereal infection.
Fever and Chills
• Fever and chills may occur with infection
anywhere in the GU tract but are most
commonly observed in patients with
pyelonephritis, prostatitis, or epididymitis
Medical History
• Patients with diabetes mellitus frequently
develop autonomic dysfunction that may result in
impaired urinary and sexual function
• Patients with hypertension have an increased risk
of sexual dysfunction because they are more
likely to have peripheral vascular disease and
because many of the medications that are used
to treat hypertension frequently cause impotence
• Multiple sclerosis
Family History
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Adult polycystic kidney disease,
Tuberous sclerosis,
Von Hippel-Lindau disease,
Renal tubular acidosis, and
Cystinuria
It has been recognized that 8% to 10% of men
with prostate cancer have a familial form of the
disease that tends to develop about a decade
earlier than the more common type of prostate
cancer
Medications
• Most of the antihypertensive medications
interfere with erectile function, and changing
antihypertensive medications can sometimes
improve sexual function
Previous Surgical Procedures
• Surprises that occur in the operating room are
unhappy ones.
• Smoking and Alcohol Use
• Allergies