Practice ABC of urology

Urological evaluation

BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.333.7565.432 (Published 24 August 2006) Cite this as: BMJ 2006;333:432
  1. Hugh N Whitfield

    The most common urological complaints that need referral to a primary care doctor or urological surgeon can be divided into those referable to the lower urinary tract and those referable to the upper urinary tract. Although a careful history may be diagnostic in patients with, for example, renal colic or testicular torsion, often non-specific features are more difficult to unravel.

    Recording frequency of micturition on a “time and volume” chart can be useful

    Symptoms

    The bladder has been described as an unreliable witness. Sensory innervation is mediated largely through parasympathetic nerves, with pain from overdistension mediated through the sympathetic nervous system. The precision with which the site and cause of symptoms in the lower and upper urinary tracts can be identified from this autonomic innervation is limited. Similar symptoms may occur as the result of different pathology. Urological evaluation on the basis of symptoms depends on understanding how much reliance can be placed on the patient's account of symptoms, and on the doctor phrasing questions so that the patient is clear about their meaning.

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    Urological symptoms

    Obstructive symptoms

    Hesitancy of micturition can be a reliable symptom. The patient can quantify accurately a delay in initiation of the urinary stream. Most men can describe whether their urinary stream is fast or slow—that is, strong or weak. Patients can confirm if their urinary stream is intermittent, and this is a good indicator of obstruction. A feeling of incomplete bladder emptying correlates poorly with objective findings on ultrasound examination.

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    Obstructive symptoms

    Irritative symptoms

    A burning sensation on micturition is common in patients with a lower urinary tract infection. A similar sensation can occur in the absence of infection, however, and infection can occur in the absence of any discomfort.

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    Irritative symptoms

    The term “dysuria” is often applied to a burning sensation on micturition, but it means different things …

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