From the Guidelines
The initial workup for a patient presenting with urinary urgency should begin with a thorough medical history, physical examination, and urinalysis to exclude microhematuria and infection, as recommended by the most recent guidelines 1. The history should focus on the duration and severity of symptoms, associated symptoms like frequency, nocturia, or incontinence, and potential risk factors such as recent antibiotic use, sexual activity, or neurological conditions.
- Key aspects of the history include:
- Duration and severity of urinary urgency
- Associated symptoms such as frequency, nocturia, or incontinence
- Potential risk factors like recent antibiotic use, sexual activity, or neurological conditions Physical examination should include abdominal, genital, and for women, a pelvic exam, while men should have a digital rectal examination to assess prostate size.
- The physical examination should:
- Evaluate the abdomen for any masses or tenderness
- Assess the genital area for any signs of infection or abnormalities
- Include a pelvic exam for women and a digital rectal examination for men Laboratory testing should include a urinalysis to check for pyuria, hematuria, or glycosuria, and a urine culture if infection is suspected.
- Urinalysis should be performed to:
- Check for pyuria (presence of white blood cells in the urine)
- Check for hematuria (presence of blood in the urine)
- Check for glycosuria (presence of glucose in the urine) A post-void residual measurement using ultrasound or catheterization helps evaluate bladder emptying.
- Post-void residual measurement is important to:
- Assess the patient's ability to empty their bladder
- Identify any potential issues with bladder emptying Additional tests may include a bladder diary to document voiding patterns, frequency-volume charts, and assessment of fluid intake.
- These tests can help:
- Document the patient's voiding patterns and fluid intake
- Identify any patterns or abnormalities that may be contributing to the patient's symptoms For persistent symptoms without clear cause, more specialized testing such as urodynamic studies, cystoscopy, or imaging studies may be warranted, as suggested by other guidelines 1.
- Specialized testing may be necessary to:
- Further evaluate the patient's symptoms and bladder function
- Rule out other potential causes of the patient's symptoms Initial management typically includes behavioral modifications like fluid management, timed voiding, and pelvic floor exercises while awaiting diagnostic results, and is supported by previous guidelines 1.
- Behavioral modifications can help:
- Manage the patient's symptoms and improve their quality of life
- Reduce the frequency and severity of urinary urgency episodes
From the Research
Initial Workup for Urinary Urgency
The initial workup for a patient presenting with urinary urgency typically involves a combination of medical history, physical examination, and diagnostic tests.
- Medical history: to identify any underlying medical conditions that may be contributing to the urinary urgency, such as diabetes, neurological disorders, or urinary tract infections 2.
- Physical examination: to assess for any abnormalities in the urinary tract, such as bladder distension or tenderness 2.
- Diagnostic tests: such as urinalysis, urine culture, and urodynamic studies to evaluate bladder function and rule out any underlying conditions 3, 4, 5, 6.
Diagnostic Tests
- Urinalysis: to check for signs of infection, blood, or other abnormalities in the urine 2.
- Urine culture: to identify any bacterial infections that may be causing the urinary urgency 2.
- Urodynamic studies: to evaluate bladder function and assess for any abnormalities in bladder contractions or urine flow 3, 4, 5, 6.