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Education And Debate


BMJ 1996; 312 doi: (Published 16 March 1996) Cite this as: BMJ 1996;312:695
  1. Chris Dawson,
  2. Hugh Whitfield

    Common complaints and symptoms

    A concise but thorough history should be taken detailing the onset of the problem, the severity and duration of the complaint, and any relevant medical history and family history.

    Common reasons for referral to urologist

    • Obstructive symptoms

    • Irritative bladder symptoms

    • Incontinence

    • Renal colic

    • Haematuria

    • Sexual dysfunction

    Obstructive symptoms

    Several symptoms indicate bladder outflow obstruction (for example, due to benign prostatic hyperplasia): a delay before the flow of urine begins (hesitancy); a poor flow when passing urine; an inability to maintain flow throughout the prolonged act of voiding (intermittency) owing to the bladder being unable to maintain a high enough detrusor pressure; if a residual volume is left, a desire to pass urine shortly after finishing voiding (pis-en-deux).

    Obstructive symptoms

    • Hesitancy

    • Poor flow

    • Intermittency

    • Pis-en-deux

    • Post micturition dribble

    Irritative symptoms

    Patients may feel a burning sensation in the urethra during voiding (dysuria) or a sudden desire to void (urgency). Most adults void no more than once at night, and more than this can be considered to be nocturia. Urine production at night is increased in elderly people, patients with congestive heart failure, and those who habitually consume night time drinks.

    Cystitis and other inflammatory conditions may give rise to the symptoms above, but the symptoms may also be present in patients with bladder outflow obstruction or carcinoma in situ of the bladder (malignant cystitis).

    Irritative symptoms

    • Dysuria

    • Urgency

    • Nocturia


    Incontinence that is precipitated by physical activity is termed stress incontinence. Urge incontinence occurs when a leakage of urine follows an urgent desire to urinate and is pathognomonic of an unstable bladder. This commonly develops de novo in women (in whom it is termed idiopathic bladder instability) but may be present in men secondary to bladder outflow obstruction or in patients with a neuropathic bladder. Some women may have both stress incontinence and urge incontinence. Continuous incontinence is typically seen in patients with a urinary fistula. …

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