Clinical Assessment and Risk Stratification

History

A detailed history will point to a likely cause for the AUR. Most commonly, this will be the progression of benign prostatic hypertrophy (BPH). Careful enquiry may elucidate a history of gradual deterioration of lower urinary symptoms such as urge, hesitancy, frequency and post micturition dribbling.

A full drug history must be taken including recreational drugs.

Constipation, UTI and excess alcohol can precipitate AUR and should be specifically screened for. It is especially important to treat such precipitants. A detailed enquiry of associated urinary symptoms is essential, especially haematuria, which, if present, will influence further investigation and management.

Neurological symptoms must be screened for by direct questioning. This is particularly important in women.

Direct enquiry should also be made for urogenital conditions such as herpes that can cause AUR through discomfort.

Learning Bite:

Urinary tract sepsis and constipation should be treated before attempting trial without catheter.