Urology History Taking: Notes for OSCEs

Overview

When taking a history regarding the genitourinary system, many personal and potentially awkward questions need to be asked including regarding sexual activity. Care should be taken to ensure the privacy and comfort of assessing patients.

A helpful way to alleviate the awkwardness and avoid the patient feeling like they have been singled out or judged is by normalising questions and prefacing them with something such as “This is something we ask all patients”. This allows for sensitive and non-judgmental discussion of these topics and is likely to help get better answers from the patient.

This topic covers a general urological history and questions may need refining depending on what the predominant feature is. More specific urology histories and differential diagnoses can be found here.

History of Presenting Complaint

Overview

With each symptom, always (if relevant) ask about:

• When did it start?
• Did it come on suddenly or gradually?
• Is it continuous or intermittent?
• Has this ever happened before?

General urological features

General features should be sought to help with narrowing down what to ask:

• Is there dysuria?
• Is there urinary frequency?
• Is there nocturia?
• Is there any haematuria?
• Is there any urethral discharge?
• Are there problems with the urinary stream?
• Is there any urinary incontinence?
• Is there any abdominal, pelvic, or groin pain or discomfort?
• Are there any abdominal, pelvic, or groin lumps?

Lower urinary tract symptoms

• Are there any storage symptoms?
  • Urgency, urinary incontinence?
  • Urinary frequency, nocturia?
  • Feeling the need to pass urine again just after passing urine?
  • Have they passed urine involuntarily? (suggests chronic urinary retention)
• Are there any voiding symptoms?
  • Weak stream, hesitancy, intermittent stream, splitting or spraying?
  • Straining?
• Are there any post-micturition symptoms?
  • Dribbling after passing urine, feelings of incomplete emptying?

Urinary incontinence

• Identify the type of urinary incontinence:
  • Stress incontinence:
    • Does incontinence occur when coughing, sneezing, straining, or laughing?
  • Urge incontinence:
    • Do they feel a sudden and intense need to pass urine?
    • Do they make it to the toilet in time?
  • Overflow incontinence:
    • Do they have difficulties passing urine (such as straining, feeling of incomplete emptying)?
  • Continuous (true) incontinence:
    • Does urine leak continuously or intermittently depending on position? (may suggest a fistula, such as a vesicovaginal fistula)
  • Functional incontinence:
    • Are they able to get to the toilet in time?
    • Is there anything that they feel stops them from being able to get to the toilet? 
• Ask about the severity of incontinence:
  • How often are they incontinent?
  • Do they use pads or change clothing?
  • Are they avoiding usual activities due to incontinence?
  • How has this affected their life?

Scrotal/groin pain and lumps

Discussed in more detail here:

• Assess pain using SOCRATES
• Are there any swellings or masses?
• Are there any associated features such as nausea or vomiting, abdominal pain, or discharge? 
• Has there been any antecedent trauma?

Erectile dysfunction

• Try to identify whether an organic cause or psychogenic cause is predominant:
  • Organic causes – gradual onset of symptoms, lack of/reduced erection, low-normal libido
  • Psychogenic causes – sudden symptoms, low libido, sufficient spontaneous or self-stimulated erections
• Identify any issues relating to sexual intercourse such as:
  • Problems with sexual desire, satisfaction, or pain
  • Cultural or religious beliefs
• Identify any contributing life events such as:
  • Stresses, difficulties with intimacy, problems with relationships, previous sexual trauma or abuse, anxiety/depression

Review of systems

• Screen for general features:
  • Constitutional features – such as fever, night sweats, and weight loss. These may suggest malignancy
• Screen for pain:
  • Is there any abdominal, pelvic, or back pain? 

Past Medical History

Questions include:

• Do they have any other medical conditions?
  • New back pain in someone with a history of prostate cancer can suggest bone metastases
• Have they ever had any previous surgery?
• Do they take any regular medications?
• Do they take any over-the-counter medications, herbal remedies, or supplements?

Family History

• Is there any family history of anything similar?

Allergy History

• Are they allergic to anything?
  • What happens during the allergic reaction?

Social History

• Do they smoke?
  • If so, how much and how long?
• Do they drink alcohol?
  • If so, how much and how long?
• Do they use any illicit drugs?
  • If so, how much and how long?
• What is their occupation?
• Have they been exposed to any chemicals at work?
  • Exposure to aromatic amines such as dyes and rubber manufacturing materials can increase the risk of bladder cancer
• Who’s at home?
  • What support do they have?
• How has this impacted their activities of daily living?
• Has there been any recent foreign travel?
  • Travelling to an area endemic to schistosomiasis can increase the risk of bladder cancer