History-taking
CPSA · Focused history · Renal & urology
Lower urinary tract symptoms
Separate storage (frequency, urgency, nocturia) from voiding (hesitancy, poor stream, dribbling) symptoms, and screen the red flags — haematuria, retention and infection.
Focused questions
Storage symptoms
- Frequency, urgency, nocturia, urge incontinence
Voiding symptoms
- Hesitancy, poor/intermittent stream, straining, incomplete emptying, terminal dribbling
Red-flag & context screen
- Visible haematuria (bladder cancer), dysuria/fever (UTI/pyelonephritis), acute retention (can’t pass urine, suprapubic pain)
- Weight loss, bone pain (metastatic prostate); fluid intake, caffeine; medications
Differentials to screen
Benign prostatic hyperplasiaOlder man, voiding symptoms, enlarged smooth prostate
UTIDysuria, frequency, urgency, cloudy urine ± fever
Bladder / prostate cancerVisible haematuria, weight loss, irregular hard prostate
Overactive bladderUrgency, frequency, urge incontinence, no obstruction
Acute urinary retentionSudden inability to void, painful palpable bladder
Red flags — exclude these
- Visible (painless) haematuria — 2-week-wait for bladder cancer
- Acute urinary retention (painful, palpable bladder)
- Fever with loin pain (pyelonephritis / urosepsis)
- Weight loss / bone pain (metastatic prostate cancer)
OSCE tips
- Split symptoms into storage vs voiding — it points to the cause.
- Painless visible haematuria is a 2-week-wait referral (bladder cancer) until proven otherwise.
- Always ask about acute retention — a can’t-miss emergency.