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In the workup of any patient, the history is of paramount importance; this is particularly true in urology. It is necessary to discuss here only those urologic symptoms that are apt to be brought to the physician’s attention by the patient. It is important to know not only whether the disease is acute or chronic but also whether it is recurrent, since recurring symptoms may represent acute exacerbations of chronic disease.
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Obtaining the history is an art that depends on the skill and methods used to elicit information. The history is only as accurate as the patient’s ability to describe the symptoms. This subjective information is important in establishing an accurate diagnosis.
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SYSTEMIC MANIFESTATIONS
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Symptoms of fever and weight loss should be sought. The presence of fever associated with other symptoms of urinary tract infection may be helpful in evaluating the site of the infection. Simple acute cystitis is essentially an afebrile disease. Acute pyelonephritis or prostatitis is apt to cause high temperatures (≤40°C [104°F]), often accompanied by violent chills. Infants and children who have acute pyelonephritis may have high temperatures without other localizing symptoms or signs. Such a clinical picture, therefore, invariably requires bacteriologic study of the urine.
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A history of unexplained attacks of fever occurring even years before may otherwise represent asymptomatic pyelonephritis. Renal carcinoma sometimes causes fever that may reach 39°C (102.2°F) or more. The absence of fever does not by any means rule out renal infection, for it is the rule that chronic pyelonephritis does not cause fever.
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Weight loss is to be expected in the advanced stages of cancer, but it may also be noticed when renal insufficiency due to obstruction or infection supervenes. In children who have “failure to thrive” (low weight and less than average height for their age), chronic obstruction, urinary tract infection, or both should be suspected.
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General malaise may be noted with tumors, chronic pyelonephritis, or renal failure. The presence of many of these symptoms may be compatible with human immunodeficiency virus (HIV; see Chapter 17).
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LOCAL AND REFERRED PAIN
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Two types of pain have their origins in the genitourinary organs: local and referred. The latter is especially common.
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Local pain is felt in or near the involved organ. Thus, the pain from a diseased kidney (T10–T12, L1) is felt in the costovertebral angle and in the flank in the region of and below the 12th rib. Pain from an inflamed testicle is felt in the gonad itself.
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Referred pain originates in a diseased organ but is felt at some distance from that organ. The ureteral colic (Figure 3–1) caused by a stone in the upper ureter may be associated with severe pain in the ipsilateral testicle; this is explained by the common innervation ...