Frequency/ Dysuria/ Nocturia

Question 1

Timeframe

Answer 1

Duration
Onset
Progression
Timing

Question 2

Urination

Answer 2

Urinary volume and frequency- what’s their normal

Catheter?- ask as may not be able to see it (leg bag)

Question 3

Systems review

Answer 3

General- FWARJCT

Urological

Storage- frequency, volume, urgency, nocturia, incontinence
Infection- dysuria, haematuria, odour, discharge
Prostatic/ voiding- hesitancy, poor flow, dribbling, feeling of incomplete voiding

Men- ask about BPH symptoms, nocturia, painful ejaculation (prostatitis)
Females- have you gone through menopause yet, pain worse during period, stop after period

Question 4

Cystitis

Answer 4

Dysuria

Frequency and urgency

Question 5

Urethritis

Answer 5

Dysuria

Purulent urethral discharge

Question 6

Pyelonephritis

Answer 6

Dysuria and loin pain
Fever, chills, rigours
Vomiting

Question 7

BPH

Answer 7

Poor flow and terminal dribbling
Hesitancy
Overflow incontinence
Elderly male

Question 8

Other differentials

Answer 8

Detrusor instability
Prostatitis
Pregnancy
Diuretics or caffeine

Question 9

Symptom analysis (esp. if dysuria)

Answer 9

SOCRATES

Question 10

Patients perspective

Answer 10

Feelings and impact on life

ICE

Question 11

Background

Answer 11

PMH- previous UTI STI renal catheters calculus trauma etc.
DH
FH
SH

Question 12

Timing of pain

Answer 12

Pain at stat of urination- urethritis

Pain post voiding- cystitis

Question 13

UTI

Answer 13

Cystitis- urinary frequency, urgency, dysuria
Fever and suprapubic pain
Cloudy, bloody urine with foul odour
Confusion

Question 14

Pyelonephritis

Answer 14

Very unwell- fever rigors n and v flank pain radiating to back
Dysuria frequency urgency nocturia haematuria may be present

Question 15

STI

Answer 15

Vaginal or urethral discharge, young sexually active patients with recent exposure, unprotected sex, new partners
Dyspareunia, painful ejaculation
Reactive arthritis- secondary to STI or gastroenteritis (conjunctivitis seen in RA, not SA)

Question 16

Renal calculi

Answer 16

May have dysuria

Question 17

Endometriosis

Answer 17

Chronic pelvic pain that peaks before menstruation and then dissipates
Dyspareunia, dysmenorrhea, dysuria, subfertility, lower abdominal pain

Question 18

Atrophic vaginitis

Answer 18

Amenorrhoea, poor tissue elasticity, vaginal dryness, pain

After menopause, can cause dysuria

Question 19

BPH

Answer 19

Get dysuria dye to uti, secondary to stasis

Question 20

Investigations

Answer 20

Abdominal examination, urine analysis with culture microscopy and sensitivities, DRE (prostate)
Urethral and high vaginal swabs and PCR
Bloods- FBC UE CRP PSA culture
Abdominal USS and CTKUB