Urinary red flags

Question 1

What if I see retention of urine?

Answer 1

Acute retention of Urine

If faced with an unwell, elderly male patient complaining of inability to pass any urine, most practitioners immediately consider prostatic disease.

The following points should be considered, however:

Is the problem retention or anuria? In retention, a distended bladder can be felt rising out of the pelvis on abdominal examination.
Does past history actually suggest the possibility of prostatic disease?
Is there any history of previous surgery or neurological disorder that might affect the mechanism of urination?
It is generally agreed that any case of suspected acute retention should be referred urgently for hospital management.

Question 2

What if I see painless haematuria?

Answer 2

Painless haematuria

Painless haematuria should raise the suspicion of urinary tract malignancy, and patients with it should be referred for further investigation.

Acute loin pain coming in waves, with vomiting or collapse:

Suggests an obstructed kidney stone. The pain may radiate around to the suprapubic region, particularly if the stone moves some way down the ureter.

Question 3

What if I see recurrent or persistent urinary tract infections?

Answer 3

Recurrent or persistent urinary tract infections

Recurrent episodes of symptoms including cloudy urine, burning on urination, abdominal discomfort, blood in urine and fever may suggest an underlying disorder of the urinary tract

Question 4

What if I see a urinary tract infection in ceratin patient groups including those with diabetes?

Answer 4

Urinary tract infection in certain patient groups, including:

Those with a pre-existing disorder of the urinary system (including kidney disease, kidney stones, bladder cancer, or enlarged prostate gland)
Those with diabetes
Those with paraplegia
Pregnant women

Question 5

What if I see a combination of fever, malaise, loin pain and cloudy urine?

Answer 5

A combination of fever, malaise, loin pain and cloudy urine

May suggest an infection of the kidneys (acute pyelonephritis)

Question 6

What should I watch out for in children?

Answer 6

Recurrent episodes of urinary tract infection (cloudy urine or burning on urination) in children

May be caused by vesicoureteric reflux disease (VUR)