What questions should be asked when evaluating a new patient in urology?

Essential Questions for Evaluating a New Urology Patient

A detailed history is the most important aspect of a patient's assessment when evaluating a new urology patient. 1 The following structured approach will ensure comprehensive evaluation while prioritizing questions that impact morbidity, mortality, and quality of life.

Chief Complaint and Symptom Assessment

• Ask the patient to describe their primary urological problem in their own words 1
• Use validated symptom questionnaires such as the International Prostate Symptom Score (IPSS) or AUA Symptom Score to quantify lower urinary tract symptoms (LUTS) and assess symptom severity and bother 1
• Inquire about specific urinary symptoms:
  • Storage symptoms: frequency, urgency, nocturia, and urgency incontinence 1
  • Voiding symptoms: hesitancy, intermittency, weak stream, straining to void, and sensation of incomplete emptying 1
  • Post-micturition symptoms: post-void dribbling, feeling of incomplete emptying 1
• Ask about the onset, duration, and progression of symptoms (sudden vs. gradual onset may help differentiate psychogenic from organic causes) 1

Medical History

• Inquire about previous urological conditions, procedures, or surgeries 1
• Document relevant medical conditions that may affect urinary function:
  • Cardiovascular disease (may affect treatment options) 1
  • Neurological conditions (may cause neurogenic bladder) 1
  • Endocrine disorders (diabetes can cause polyuria) 1
• Review current medications, particularly those known to affect urinary function 1
• Ask about smoking history, alcohol consumption, and use of recreational drugs (important risk factors for urological malignancies) 1

Specific Symptom Evaluation

• For patients with LUTS:
  • Determine if symptoms are predominantly storage or voiding 1
  • Ask about impact on quality of life using the Disease Specific Quality of Life Question: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?" 1
• For patients with nocturia:
  • Ask about number of nighttime voids 1
  • Inquire about fluid intake patterns, especially in the evening 1
  • Consider using a frequency-volume chart to document patterns 1
• For patients with pain:
  • Characterize the location, radiation, intensity, timing, and factors that worsen or improve the pain 1
  • Ask about associated symptoms such as fever, hematuria, or dysuria 1, 2

Sexual Health Assessment

• Inquire about sexual function, as many urological conditions affect sexual health 1, 3
• For men, ask about erectile function, ejaculatory problems, or changes in libido 1
• Document any relationship problems or psychological issues that may contribute to sexual dysfunction 1

Risk Factor Assessment for Urological Malignancies

• Ask about family history of urological cancers 1
• Document occupational exposures to chemicals or dyes (bladder cancer risk) 1
• For patients with hematuria, assess risk factors using the AUA/SUFU Microhematuria Risk Stratification System 1
• Inquire about smoking history with specific pack-years (>30 pack-years is high risk for urothelial cancer) 1

Specific Questions for Common Urological Conditions

• For suspected benign prostatic hyperplasia (BPH):
  • Ask about response to previous treatments if any 1
  • Inquire about complications such as urinary retention or recurrent UTIs 1
  • Document impact on quality of life 1
• For erectile dysfunction:
  • Ask about quality of erections (including nocturnal and morning erections) 1
  • Determine if the onset was sudden (suggesting psychogenic cause) or gradual (suggesting organic cause) 1
  • Inquire about risk factors such as cardiovascular disease, diabetes, or medications 1
• For suspected urinary tract infection:
  • Ask about dysuria, frequency, urgency, and suprapubic pain 1, 2
  • Inquire about fever, flank pain, or systemic symptoms 1, 2
  • Document previous UTIs and antibiotic treatments 1, 2

Practical Considerations

• Use clear, non-technical language when asking questions 4
• Consider using standardized questionnaires to ensure comprehensive assessment 1
• Document responses systematically to facilitate follow-up and treatment planning 5, 6
• Be sensitive when discussing intimate issues related to urinary and sexual function 3

Common Pitfalls to Avoid

• Failing to quantify symptom severity using validated tools 1
• Not asking about impact on quality of life, which is crucial for treatment decisions 1
• Overlooking medication history that could explain urological symptoms 1
• Neglecting to ask about sexual function, which is often affected by urological conditions 1, 3
• Missing red flag symptoms that require urgent evaluation (gross hematuria, acute pain, urinary retention) 1, 6