1. Urinary symptoms and infections
2. Stones and obstruction
3. Prostate and male lower urinary tract disorders
4. Hematuria and uro-oncology
5. Kidney, bladder, testicular, and penile conditions
6. Urologic emergencies
7. Pediatric urology and congenital disorders
8. Procedures: imaging, cystoscopy, catheterization, surgery, and urology referral

1. Urinary symptoms and infections
2. Stones and obstruction
3. Prostate and male lower urinary tract disorders
4. Hematuria and uro-oncology
5. Kidney, bladder, testicular, and penile conditions
6. Urologic emergencies
7. Pediatric urology and congenital disorders
8. Procedures: imaging, cystoscopy, catheterization, surgery, and urology referral

1. When to refer to a urologist
   • Hematuria, recurrent UTI, stones, urinary obstruction, urinary retention, suspected malignancy, infertility, genital trauma, congenital anomalies.
2. When to investigate
   • Urinalysis/culture, renal function tests, ultrasound, CT, cystoscopy, uroflowmetry, urodynamics, PSA, biopsy, and tumor staging tests.
3. When to insert a urinary catheter or suprapubic catheter
   • Acute retention, monitoring selected critically ill patients, perioperative need, neurogenic bladder, urethral injury considerations.
4. When to operate or perform an endoscopic procedure
   • Stones, BPH and obstruction, urethral stricture, tumors, reflux/obstruction, trauma, undescended testis, varicocele, incontinence.
5. Emergency indications
   • Testicular torsion, obstructed infected kidney, Fournier gangrene, priapism, major urinary trauma, clot retention, anuria due to obstruction.
6. Disease-specific indications
   • Prostate, kidney, ureter, bladder, urethra, penis, testis/scrotum, pediatric urology, female urology, and urologic cancers.

History taking in urology

1. Opening

• Introduce yourself, confirm identity, explain the consultation, obtain consent.
• Ask the patient to describe the problem in their own words.
• Establish:
  • Onset, duration, and progression
  • Intermittent or continuous symptoms
  • Severity and effect on sleep, work, sexual life, and quality of life
  • Previous evaluation or treatment

2. Presenting complaint and history of presenting illness

A. Lower urinary tract symptoms (LUTS)

• “How often do you pass urine in the day and at night?”
• “Do you have to rush to the toilet?”
• “Has the stream become weak?”
• “Do you need to strain or wait before urine starts?”
• “Do you feel the bladder empties completely?”
• “Have you ever been unable to pass urine at all?”

B. Dysuria and suspected urinary tract infection

• Burning or pain during micturition
• Frequency, urgency, suprapubic pain
• Fever, chills/rigors, nausea or vomiting
• Flank pain, suggesting upper tract involvement
• Cloudy or foul-smelling urine
• Urethral discharge, genital ulcers, recent unprotected intercourse, or new sexual partner
• Previous UTIs, urine cultures, antibiotic use, hospital admission, or catheterization
• Pregnancy possibility in women

C. Hematuria

• Visible/gross or only found on testing
• Initial, terminal, or total hematuria
• Painless or painful
• Associated with clots. Worm-like clots suggest upper tract bleeding; amorphous clots more often occur with bladder bleeding.

• Onset, duration, recurrence
• Dysuria, frequency, fever, flank pain, renal colic
• Recent vigorous exercise, trauma, instrumentation, or infection
• Anticoagulants/antiplatelet drugs
• Smoking history including pack-years
• Occupational exposure to dyes, rubber, leather, petroleum, or aromatic amines
• Previous pelvic radiation, cyclophosphamide, urinary stones, or malignancy
• Family history of renal disease, stones, bleeding disorders, or urological cancer

D. Loin/flank pain and suspected urinary stone

• Site: flank, loin, abdomen, groin, testis, labium
• Onset: sudden or gradual
• Character: severe colicky pain or constant ache
• Radiation: loin-to-groin radiation suggests ureteric colic
• Associated symptoms: hematuria, nausea/vomiting, dysuria, frequency, fever
• Relieving/aggravating factors
• Previous similar episodes or passed stones

• Fever or rigors with obstruction, because this can indicate an infected obstructed kidney
• Reduced urine output, solitary kidney, or known chronic kidney disease
• Stone history, prior procedures, stone analysis
• Fluid intake, high salt/animal-protein diet, bowel disease/resection, gout, hyperparathyroidism
• Family history of recurrent stones

E. Urinary incontinence

• Number of pads used per day
• Daytime and nighttime frequency
• Fluid, caffeine, alcohol intake
• Childbirth, pelvic surgery, radiation
• Neurological disease, diabetes, spinal injury
• Constipation
• Medication history, especially diuretics, sedatives, anticholinergics, alpha-blockers

F. Male genital and sexual symptoms

• Erectile dysfunction: onset, rigidity, morning/nocturnal erections, libido, relationship factors
• Ejaculatory dysfunction: premature, delayed, painful, retrograde ejaculation
• Blood in semen
• Penile curvature or painful erection
• Penile lesions, ulcers, discharge, itching
• Testicular pain, swelling, lump, trauma, infertility
• Sexual orientation, partners, contraception, condom use, previous STIs, and HIV risk where relevant

G. Scrotal or testicular symptoms

• Pain: sudden versus gradual, severity, duration, radiation
• Swelling, redness, fever
• Trauma, strenuous exercise, recent infection
• Dysuria, urethral discharge, STI exposure
• Testicular lump, heaviness, change in size
• History of undescended testis, infertility, or prior scrotal surgery

3. Past history

Past medical history

• Diabetes, hypertension, ischemic heart disease, stroke
• Chronic kidney disease
• Neurological disease: Parkinson disease, multiple sclerosis, spinal cord injury, stroke, diabetic neuropathy
• Bleeding disorders
• Tuberculosis, schistosomiasis where epidemiologically relevant
• Gout and metabolic disease
• Previous cancer and pelvic radiotherapy

Past urological history

• Recurrent UTI, stones, retention, hematuria
• BPH, stricture, reflux, neurogenic bladder
• Previous cystoscopy, catheterization, urethral dilatation, TURP, lithotripsy, ureteroscopy, PCNL, nephrectomy
• Previous renal/bladder/prostate/testicular cancer
• Catheter use and complications

Surgical history

• Pelvic, abdominal, spinal, colorectal, gynecological, or prostate surgery
• Procedures can alter urinary anatomy or cause nerve injury affecting bladder/sexual function.

4. Drug and allergy history

• Antibiotics and prior culture-directed treatment
• Anticoagulants and antiplatelets
• Diuretics
• Alpha-blockers, antimuscarinics, 5-alpha-reductase inhibitors
• Drugs that can cause retention: anticholinergics, opioids, antihistamines, tricyclic antidepressants
• Drugs associated with erectile dysfunction
• Chemotherapy such as cyclophosphamide
• Contrast allergy
• Herbal drugs and supplements

5. Family history

• Kidney stones
• Polycystic kidney disease
• Renal failure
• Prostate, bladder, kidney, or testicular cancer
• Bleeding disorders
• Inherited metabolic disorders causing stones

6. Social history

• Smoking: quantify pack-years and other tobacco exposure
• Occupation: chemical, dye, rubber, leather, petroleum, metal, or radiation exposure
• Alcohol, recreational drug use
• Fluid intake, caffeine intake, dietary salt/protein
• Mobility, cognition, activities of daily living
• Sexual history where relevant
• Travel and exposure history for tuberculosis, schistosomiasis, or endemic infections

7. Review of systems

• Fever, weight loss, fatigue, anorexia, night sweats
• Edema, breathlessness, reduced urine output
• Bone pain, especially with possible advanced prostate cancer
• Neurological symptoms: weakness, numbness, altered perineal sensation, bowel dysfunction
• Gastrointestinal symptoms: constipation, bowel disease, rectal bleeding
• Gynecological symptoms in women: vaginal bleeding, discharge, prolapse, pregnancy status

8. Urological red flags

• Acute urinary retention with pain/distension
• Fever or sepsis with flank pain and suspected obstruction
• Anuria or rapidly falling urine output
• Gross hematuria with clots and inability to void
• Painless visible hematuria, particularly in older adults or smokers
• Sudden severe testicular pain, possible torsion
• Priapism lasting more than 4 hours
• Genital/perineal pain with fever, skin discoloration, or crepitus, possible Fournier gangrene
• Trauma with blood at the urethral meatus, inability to void, or pelvic fracture
• Back pain with weakness, saddle anesthesia, and urinary retention, possible cauda equina syndrome

Short OSCE closing summary

“I would summarize the urinary symptoms by separating them into storage, voiding, and post-micturition symptoms. I would assess for hematuria, infection, stones, renal impairment, malignancy risk factors, sexual and genital symptoms, relevant neurological disease, medications, prior urological procedures, and red-flag features requiring urgent intervention.”