Urological diagnosis, history and investigation

Urological disease is highly prevalent and affects both males and females in all age groups. The disorders affecting the urinary tract are diverse encompassing neoplastic, inflammatory, neurogenic, infective as well functional disease. Urological emergencies represent a significant proportion of surgical admissions, therefore the ability to properly assess patients is essential. History-taking and clinical examination form the basis of the urological assessment, which is further aided by bedside tests such as urinalysis as well as basic laboratory investigations including urine microscopy/culture and blood tests. Thereafter imaging with radiography, ultrasound or computed tomography scanning is often undertaken in the acute situation to confirm the cause of haematuria or loin pain. MRI scanning is mainly used to image the pelvic organs and stage bladder or prostatic malignancy. Nuclear medicine is useful in detecting metastases from urological malignancy as well estimating the split renal function and assessing renal obstruction. Direct inspection of the urinary tract is possible through endoscopic techniques, essential for determining the cause of haematuria. Urodynamic studies are undertaken to assess the underlying pathophysiological abnormality causing urinary symptoms and to plan subsequent treatment. We review the basis of history-taking and examination in urology as well as describing the common investigations undertaken.