11/13/24, 8\:13 PM Guide | Urological history

Urological history

Table of contents

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain that you’d like to take a history from the patient.
Gain consent to proceed with history taking.
General communication skills
It is important you do not forget the general communication skills which are relevant to all patient encounters.
Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because
you're running through a checklist in your head doesn't mean this has to be obvious to the patient).
Some general communication skills which apply to all patient consultations include\:
Demonstrating empathy in response to patient cues\: both verbal and non-verbal.
Active listening\: through body language and your verbal responses to what the patient has said.
An appropriate level of eye contact throughout the consultation.
Open, relaxed, yet professional body language (e.g. uncrossed legs and arms, leaning slightly forward in the chair).
Making sure not to interrupt the patient throughout the consultation.
Establishing rapport (e.g. asking the patient how they are and o
Signposting\: this involves explaining to the patient what you have discussed so far and what you plan to discuss next.
Summarising at regular intervals.

Presenting complaint

Use open questioning to explore the patient’s presenting complaint\:
“ W h a t’ s b r o u g h t y o u i n t o s e e m e t o d a y ?”
“ T e l l m e a b o u t t h e i s s u e s y o u’ v e b e e n e x p e r i e n c i n g.”
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presenting complaint if required\:
“ O k , c a n y o u t e l l m e m o r e a b o u t t h a t ?”
“ C a n y o u e x p l a i n w h a t t h a t p a i n w a s l i k e ?”
Open vs closed questions
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History taking typically involves a combination of open and closed questions. Open questions are e
consultations, allowing the patient to tell you what has happened in their own words. Closed questions can allow you to
explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation.
Closed questions can also be used to identify relevant risk factors and narrow the di

History of presenting complaint

Patients with urological pathology can present with a wide variety of symptoms, which we've summarised below.
Key urological symptoms
Pain when passing urine (dysuria)\:
Commonly caused by urinary tract infections (UTIs), but it is also important to consider prostatitis and sexually
transmitted infections (STIs)
Can also be a symptom of bladder cancer
Passing blood in the urine (haematuria)\:
Can be due to infection, renal stones or malignancy of the kidney, ureter or bladder
Passing too much urine. This could be due to\:
Over-production of urine (polyuria), causes of which include diabetes mellitus, diabetes insipidus, hypercalcaemia and
the use of diuretics
Passing urine too frequently due to reduced bladder capacity (urinary frequency), causes of which include UTI,
overactive bladder and constipation (because a loaded rectum or colon puts pressure on the bladder and reduces its
capacity)
Tip\: to help distinguish between these two, it is helpful to ask patients if they are passing large quantities of urine each
time they go to the toilet or if they are getting the urge to pass urine frequently but are only passing small quantities.
Asking the patient to complete a bladder diary can also be helpful.
Finding it di
These symptoms occur predominantly in male patients and are collectively known as lower urinary tract symptoms
(LUTS)
They are most commonly caused by an enlarged prostate gland, which compresses the urethra. This may be due to
benign prostatic hypertrophy or hyperplasia (BPH) or prostate cancer.
When patients are unable to fully empty their bladder during the day, they may then have to get up at night,
sometimes multiple times, to pass urine (nocturia)
Being completely unable to pass urine (urinary retention)
Patients in retention require a catheter urgently to relieve back pressure on the kidneys
Retention is most commonly seen in male patients and can be due to prostate enlargement, UTI, prostatitis or
constipation
Retention can also be caused by drugs with anti-muscarinic e
incontinence (e.g. solifenacin)
In both male and female patients, retention can also have a neurological cause, such as cauda equina syndrome - this
is a neurosurgical emergency
Passing urine unintentionally (incontinence)\:
Patients may describe urge incontinence, where they feel an urgent need to pass urine but cannot get to the toilet in
time, which causes involuntary leaking of urine. This is commonly due to overactive bladder (OAB)
Patients may also experience stress incontinence, where weakness of pelvic
when coughing, sneezing or exercising. This most commonly a
birth.
Incontinence can also have neurological causes, either spinal (e.g. cauda equina syndrome or multiple sclerosis) or
conditions adementia, trauma, hydrocephalus).
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Systemic symptoms caused by an underlying urological disease\:
Fevers and rigors\: typically associated with pyelonephritis
Nausea and vomiting\: typically associated with pyelonephritis
Weight loss\: associated with malignancy and uraemia
Uraemic symptoms\: nausea, vomiting, fatigue, anorexia, weight loss, muscle cramps, pruritis and confusion

SOCRATES

The SOCRATES acronym is a useful tool for exploring each of the patient’s presenting symptoms in more detail. It is most
commonly used to explore pain, but it can be applied to other symptoms, although some of the elements of SOCRATES may
not be relevant to all symptoms.
Site
Ask about the location of the symptom\:
“ W h e r e i s t h e p a i n ?”
“ C a n y o u p o i n t t o w h e r e y o u e x p e r i e n c e t h e p a i n ?”
Onset
Clarify how and when the symptom developed\:
“ D i d t h e p a i n c o m e o n s u d d e n l y o r gr a d u a l l y ?”
“ W h e n d i d t h e p a i n
“ H o w l o n g h a v e y o u b e e n e x p e r i e n c i n g t h e p a i n ?”
Character
Ask about the speci
“ H o w w o u l d y o u d e s c r i b e t h e p a i n ?” (e.g. dull ache, throbbing, sharp)
“ I s t h e p a i n c o n s t a n t o r d o e s i t c o m e a n d g o ?”
Radiation
Ask if the symptom moves anywhere else\:
“ D o e s t h e p a i n s p r e a d e l s e w h e r e ?”
Associated symptoms
Ask if there are other symptoms which are associated with the primary symptom\:
“ A r e t h e r e a n y o t h e r s y m p t o m s t h a t s e e m a s s o c i a t e d w i t h t h e p a i n ?”
Time course
Clarify how the symptom has changed over time\:
“ H o w h a s t h e p a i n c h a n g e d o v e r t i m e ?”
Exacerbating or relieving factors
Ask if anything makes the symptom worse or better\:
“ D o e s a n y t h i n g m a k e t h e p a i n w o r s e ?”
“ D o e s a n y t h i n g m a k e t h e p a i n b e t t e r ?”
Severity
Assess the severity of the symptom by asking the patient to grade it on a scale of 0-10\:
“ O n a s c a l e o f 0-1 0 , h o w s e v e r e i s t h e p a i n , i f 0 i s n o p a i n a n d 1 0 i s t h e w o r s t p a i n y o u’ v e e v e r e x p e r i e n c e d ?”

Ideas, concerns and expectations

A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to
gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the
consultation.
The exploration of ideas, concerns and expectations should be
This will help ensure your consultation is more natural, patient-centred and not overly formulaic.
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It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided several
examples for each of the three areas below.
Ideas
Explore the patient’s ideas about the current issue\:
“ W h a t d o y o u t h i n k t h e p r o b l e m i s ?”
“ W h a t a r e y o u r t h o u g h t s a b o u t w h a t i s h a p p e n i n g ?”
“ I t’ s c l e a r t h a t y o u’ v e g i v e n t h i s a l o t o f t h o u gh t a n d i t w o u l d b e h e l p f u l t o h e a r w h a t y o u t h i n k m i gh t b e go i n g o n .
”
Concerns
Explore the patient’s current concerns\:
“ I s t h e r e a n y t h i n g , i n p a r t i c u l a r , t h a t’ s w o r r y i n g y o u ?”
“ W h a t’ s y o u r n u m b e r o n e c o n c e r n r e g a r d i n g t h i s p r o b l e m a t t h e m o m e n t ?”
“ W h a t’ s t h e w o r s t t h i n g y o u w e r e t h i n k i n g i t m i g h t b e ?”
Expectations
Ask what the patient hopes to gain from the consultation\:
“ W h a t w e r e y o u h o p i n g I’ d b e a b l e t o d o f o r y o u t o d a y ?”
“ W h a t w o u l d i d e a l l y n e e d t o h a p p e n f o r y o u t o f e e l t o d a y’ s c o n s u l t a t i o n w a s a s u c c e s s ?”
“ W h a t d o y o u t h i n k m i g h t b e t h e b e s t p l a n o f a c t i o n ?”

Summarising

Summarise what the patient has told you about their presenting complaint. This allows you to check your understanding of
the patient’s history and provides an opportunity for the patient to correct any inaccurate information.
Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Continue to periodically
summarise as you move through the rest of the history.

Signposting

Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to
discuss next. Signposting can be a useful tool when transitioning between di
provides the patient with time to prepare for what is coming next.
Signposting examples
Explain what you have covered so far\:
a c h i e v e t o d a y .
”
“ O k , s o w e’ v e t a l k e d a b o u t y o u r s y m p t o m s , y o u r c o n c e r n s a n d w h a t y o u’ r e h o p i n g w e
What you plan to cover next\:
c u r r e n t l y t a k e .
”
“ N e x t I’ d l i k e t o d i s c u s s y o u r p a s t m e d i c a l h i s t o r y a n d t h e n e x p l o r e w h a t m e d i c a t i o n s y o u

Systemic enquiry

A systemic enquiry involves performing a brief screen for symptoms in other body systems which may or may not be relevant
to the primary presenting complaint. A systemic enquiry may also identify symptoms that the patient has forgotten to mention
in the presenting complaint.
Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience.
Some examples of symptoms you could screen for in each system include\:
Systemic\: fevers (e.g. UTI), weight change (e.g. malignancy)
Cardiovascular\: palpitations (e.g. electrolyte derangement), chest pain (e.g. uraemic pericarditis)
Respiratory\: dyspnoea (e.g. pulmonary oedema secondary to renal failure)
Gastrointestinal\: abdominal pain (e.g. peritoneal dialysis associated peritonitis)
Neurological\: confusion (e.g. uraemic encephalopathy), back pain, leg weakness, paraesthesia (possibly suggesting a
neurological cause for urinary symptoms, e.g. cauda equina syndrome).
Musculoskeletal\: muscle wasting (e.g. end-stage renal failure)
Dermatological\: uraemic frost (e.g. end-stage renal failure)
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Past medical history

Ask if the patient has any medical conditions\:
" D o y o u h a v e a n y m e d i c a l c o n d i t i o n s ?"
" A r e y o u c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e g u l a r l y ?"
If the patient does have a medical condition, you should gather more details to assess how well controlled the disease is and
what treatment(s) the patient is receiving. It is also important to ask about any complications associated with the condition
including hospital admissions.
Ask if the patient has previously undergone any surgery or procedures (e.g. transurethral resection of the prostate - TURP)\:
" H a v e y o u e v e r p r e v i o u s l y u n d e r g o n e a n y o p e r a t i o n s o r p r o c e d u r e s ?"
" W h e n w a s t h e o p e r a t i o n / p r o c e d u r e a n d w h y w a s i t p e r f o r m e d ?"
Allergies
anaphylaxis).
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. mild rash vs
Examples of relevant medical conditions
Medical conditions relevant to urological disease include\:
Recurrent UTIs
Urinary incontinence
Prostate disease (e.g. benign prostatic hyperplasia, prostate cancer)
Renal disease (e.g. renal stones, pyelonephritis, chronic kidney disease)
Diabetes
Bleeding disorders (e.g. haemophilia)

Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies\:
“ A r e y o u c u r r e n t l y t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s o r o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
If the patient is taking prescribed or over the counter medications, document the medication name, dose, frequency, form
and route.
Ask the patient if they're currently experiencing any side e
" H a v e y o u n o t i c e d a n y s i d e e
Medication examples
Medications relevant to patients with urological issues include\:
Diuretics (e.g. furosemide)\: a common cause of nocturia and can cause acute kidney injury
Alpha-blockers\: commonly used to treat prostatic enlargement
Nephrotoxic medications (e.g. ACE inhibitors, NSAIDs)\: may cause acute or chronic kidney injury
Antibiotics\: commonly required for recurrent UTIs and may be prescribed as prophylaxis
Antimuscarinic medications (e.g. solifenacin, oxybutynin)\: prescribed for overactive bladder, mirabegron is also
commonly used for overactive bladder.
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Family history

Ask the patient if there is any family history of urological disease\:
" H a v e a n y o f y o u r

Social history

Explore the patient's social history to understand their social context and identify potential urological risk factors.
General social context
Explore the patient's general social context including\:
the type of accommodation they currently reside in (e.g. house, bungalow) and if there are any adaptations to assist them
(e.g. stairlift)
who else the patient lives with and their personal support network
what tasks they are able to carry out independently and what they require assistance with (e.g. self-hygiene, housework,
food shopping)
if they have any carer input (e.g. twice daily carer visits)
Smoking
Record the patient's smoking history, including the type and amount of tobacco used.
Calculate the number of 'pack-years' the patient has smoked for to determine their risk pro
pack-years = [number of years smoked] x [average number of packs smoked per day]
one pack is equal to 20 cigarettes
Smoking is a signi
Alcohol
Record the frequency, type and volume of alcohol consumed on a weekly basis.
Alcohol is a signi
bladder.
Recreational drug use
Ask the patient if they use recreational drugs and if so determine the type of drugs used and their frequency of use. Ketamine
use is a particular risk factor for urological symptoms, as it causes bladder in
Diet and
Ask if the patient what their diet looks like on an average day, including
Patients who are chronically dehydrated are at increased risk of UTIs and renal impairment.
Ca
Occupation
Ask about the patient's current occupation to clarify what their job role involves.
Working with industrial dyes, textiles, rubber, plastics and leather tanning are associated with an increased risk of bladder
cancer.

Closing the consultation

Summarise the key points back to the patient.
Ask the patient if they have any questions or concerns that have not been addressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
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Reviewer

Dr Lara Stewart
GP
Source\: geekymedics.com
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