"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today to discuss some problems with your urinary system. 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 main urinary symptom? When did it start, and did it come on suddenly or gradually? How would you describe it? Does it spread anywhere, are there any other symptoms associated with it, and how has it changed over time? What makes it better or worse, and how severe is it?" (SOCRATES)
"Let's talk about how you pass urine. Do you have any difficulty starting to urinate (hesitancy)? Is your stream of urine strong or weak? Does it stop and start (intermittent flow)? Do you find that you dribble urine after you've finished (terminal dribbling)? Do you feel like your bladder isn't completely empty after you've been to the toilet? Do you have to strain to pass urine?"
"How about irritation symptoms? Do you experience any pain or burning when you urinate (dysuria)? Do you get a sudden, compelling need to go to the toilet (urgency)? Are you passing urine more often than usual during the day, or waking up at night to go (nocturia)? If so, how many times a day and night?"
"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)? What about a mix of both (mixed incontinence)? Do you have constant leakage from an overfull bladder (overflow incontinence)? Or is it related to physical challenges, like not being able to get to the toilet in time because of mobility issues (functional incontinence)? Is the leakage continuous?"
"Are you passing a very large amount of urine in a 24-hour period (polyuria)? This is different from just going frequently. How much fluid do you typically drink in a day?"
"Have you noticed any blood in your urine (haematuria)? What color is it – pink, red, or brown? Have you seen any blood clots? Is it painful or painless? Does it happen constantly, or intermittently? Does the blood appear only at the beginning of urination, the end, or throughout?"
"Have you had any other general symptoms like fever, shaking chills (rigors), nausea, vomiting, unexplained weight loss, or muscle cramps?"
"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 persistent pain in your loin or flank area? What about any new weakness or numbness, or problems with your balance? If you're having obstructive symptoms, have you noticed your bladder feels very full or distended?"
"Are you experiencing any other symptoms anywhere else in your body? For example, any chest pain or shortness of breath? Any stomach or bowel problems? Any new weakness, numbness, or problems with your vision? What about changes in your energy levels or appetite? This helps us get a full picture."
"Do you have any existing medical conditions? I'm particularly interested if you've had recurrent urine infections, or if you have any known prostate disease (for men) or kidney stones. What about diabetes, neurological conditions like multiple sclerosis or a spinal cord injury, high blood pressure, heart failure, or any autoimmune conditions?"
"Have you ever had any operations or procedures, especially any urological surgery, or abdominal or pelvic surgery? For men, have you had prostatectomy? For women, have you had a hysterectomy?"
"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), certain antidepressants (anticholinergics), or medications for high blood pressure (alpha-blockers), can sometimes affect bladder function. An ACE inhibitor for blood pressure can sometimes cause a cough that might worsen incontinence. What about sedatives?"
"Have you ever used recreational drugs, particularly ketamine, which can cause bladder problems?"
"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 parents, siblings, or children – have a history of urological disease, such as prostate cancer, kidney stones, or bladder cancer? What about neurological conditions, or other cancers?"
"Could you tell me a little about your living situation and who you live with? What type of accommodation do you live in, and do you have easy access to a bathroom? Do you have a good support network around you? Are you able to manage all your daily activities independently? How are your symptoms affecting your social activities, work, and personal hygiene?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week? Do you use any recreational drugs?"
"What's your typical diet like? Do you drink enough fluids, or perhaps too much? What about particular types of fluids, like a lot of caffeine or sugary fizzy drinks? Do you exercise regularly?"
"What kind of work do you do now, and what about jobs you've had in the past? Have you ever had any potential exposure to industrial dyes, textiles, rubber, plastics, or leather, as these can be associated with 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 examination, and depending on your gender and symptoms, a digital rectal examination (DRE) or a vaginal examination. We would also likely arrange for some investigations, such as a urine dipstick and sending a urine sample for culture. For men, a PSA blood test might be considered. We might also do imaging, like an ultrasound or a CT scan of your kidneys, ureters, and bladder (CT KUB). Other tests could include uroflowmetry (to measure urine flow) or keeping a bladder diary. Depending on the findings, a cystoscopy (looking inside the bladder with a camera) or a referral to a urologist or gynaecologist might be necessary."
"Do you have any questions for me at this stage?"
"Thank you for your time."