"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today to discuss some urinary symptoms you've been experiencing. Is that right?"
"Before we go any further, what are your thoughts about what might be causing these symptoms, or what they might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please tell me more about your urinary symptoms? When did they first start, and did they come on suddenly or gradually? How long have they been going on?"
"Let's talk about the specific problems you're having. Are you needing to pass urine much more often than usual, both during the day and at night? How many times a day, and how many times do you wake up at night to go?"
"Do you ever get a sudden, strong urge to go to the toilet that's hard to defer?"
"Have you experienced any leakage of urine? If so, does it happen when you cough, sneeze, laugh, or exercise (stress incontinence)? Or does it happen when you get a sudden urge to go but can't make it to the toilet in time (urge incontinence)? Is it a continuous leak? How do you manage this – do you use pads, or change your clothing frequently?"
"When you go to the toilet, do you have any difficulty starting to pass urine (hesitancy)? Is your stream weak or stop-start? Do you feel like your bladder isn't completely empty after you've finished?"
"Do you experience any 'post-micturition dribble' – meaning you leak urine shortly after you think you've finished urinating?"
"Have you ever had difficulty passing urine at all, leading to your bladder feeling very full (urinary retention)? This can sometimes cause constant dribbling."
"Do you ever feel pain when you pass urine (dysuria)? What about pain in your lower tummy (suprapubic), perineum, testicles, flanks, groin, or lower back?"
"Have you noticed any blood in your urine (haematuria)? Is it visible, or has it been picked up on a test? Have you had any other symptoms like fever, chills, night sweats, weight loss, bloating, or erectile dysfunction? What about excessive thirst, any new weakness or numbness, constipation, or vomiting?"
"How have your urinary symptoms changed over time? Are they constant, or do they come and go? Are there any specific triggers for your symptoms, or anything that makes them better or worse, like cold weather or certain drinks?"
"How have these symptoms impacted your daily life, your sleep, your social activities, or your work?"
"I also need to ask about some important 'red flag' symptoms. Have you noticed any painless blood in your urine, especially if you're over 45? Have you had recurrent urine infections? Any unexplained weight loss, or new onset back pain that wasn't there before, especially with your urinary symptoms? What about any new weakness or numbness in your legs?"
"Do you have any existing medical conditions, such as benign prostatic hyperplasia (BPH) or prostate cancer? What about recurrent urine infections, kidney stones, diabetes, or neurological conditions like Parkinson's disease, multiple sclerosis, or a spinal cord injury? Have you ever had any urethral strictures, or sexually transmitted infections?"
"Have you ever had any operations or procedures, especially any prostate surgery, hernia repair, or rectal surgery? Have you ever needed a catheter?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? Some medications, like water tablets (diuretics), or certain cold remedies that contain alpha-agonists, or even some antidepressants and sedatives, can sometimes affect bladder function. Have you ever used recreational drugs, particularly ketamine?"
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you had?"
"Does anyone in your close family – like your father or brother – have a history of prostate cancer, or other urological cancers? What about other urological problems like BPH or kidney stones, or neurological conditions?"
"Could you tell me a little about your living situation and who you live with? Do you have a good support network around you? Are you able to manage all your daily activities independently?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week?"
"What's your typical diet like, especially your fluid intake and consumption of caffeine, fizzy drinks, or artificial sweeteners?"
"What kind of work do you do, and have you been exposed to any chemicals, dyes, or rubber in your occupation, as these can sometimes be risk factors for bladder cancer?"
"Thank you very much for sharing all of that information with me. Just to summarise, you've been experiencing [recap key symptoms], which started [onset] and are often [character/timing]. This has been impacting your [daily life areas]. You've also mentioned [recap relevant PMH/DH/FH/SH]."
"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"
"Based on what you've told me, the next steps would be for me to perform a physical examination, including an abdominal and a digital rectal examination (DRE) to assess your prostate. We would also likely arrange for some investigations, such as a urine dipstick and culture, blood tests (like U&Es and PSA if appropriate), imaging (like an ultrasound), a uroflowmetry test to measure urine flow, and possibly a bladder diary. We may also refer you to a urologist for further assessment."
"Do you have any questions for me at this stage?"
"Thank you for your time."