Terminology
of Diagnostic Tools
The
following review covers the diagnostic measures currently
used to evaluate and treat common urological problems. It
is accompanied by a brief review of these conditions and will
provide a solid resource for the primary care physician.
Urologists today have adopted a more specific terminology
than in the past. This has been done to prevent limiting diagnostic
considerations, which was previously a problem. For example,
there was a tendency to describe a patient as having benign
prostatic hyperplasia (BPH) before confirming this diagnosis
histologically. In essence, this limited consideration of
other diagnostic possibilities. All urinary tract symptoms
do not have a basis in obstruction. More precision in terminology
helps to facilitate diagnosis, rather than limit thinking
about urinary symptoms.
First,
consider the common questions in the patient history regarding
the urinary system. In the past, many urologists preferred
to classify the symptoms referred to in these questions as
“obstructive” or “irritative.” Recently,
the urologic community has sought to retire these terms and
replace them with the terms “storage” symptoms
and “voiding” symptoms.
| Obstructive
symptoms typically include: |
 |
Reduced
force of urinary stream |
|
Urinary
hesitancy |
|
Straining
to void |
|
Nocturia |
|
Sensation
of incomplete emptying |
Also
included in the category of “obstructive symptoms”
are the “irritative symptoms” of urinary urgency
and frequency, which result from changes in bladder ultrastructure
and the bladder outlet as a result of long-standing obstruction.
| The
term “Irritative voiding symptoms” has traditionally
been used to describe the symptoms of urinary tract infection.
These symptoms include: |
|
Dysuria
(urinary burning) |
|
Urinary
frequency |
|
Urinary
urgency |
These
symptoms may also arise in the female patient from a reduction
or loss of estrogen, pelvic mass, retroverted (tipped) uterus,
cystocele, or a urethral diverticulum. Neuromuscular diseases
may cause many of these symptoms in both male and female patients.
Because
these symptoms overlap in both men and women in a variety
of conditions, the term lower urinary tract symptoms (LUTS)
in patients has been suggested as a better descriptive term.
Thus, the obstructive process that is usually referred to
as BPH (a histological description) is better described as
bladder outlet obstruction (BOO). Although BOO may be one
etiology of LUTS, not all LUTS are explained by this entity
and may have far different origins. LUTS may be divided into
bladder storage symptoms, bladder sensation symptoms, urinary
voiding symptoms, postmicturition symptoms, and genital and
lower urinary tract pain.*
The
term “overactive bladder” has been used to describe
patients with urinary frequency, urgency and urge incontinence.
Overactive bladder patients may be male or female, and the
underlying etiology of the overactive bladder is varied in
both. Thus, you will need to obtain a thorough patient history
that provides an appropriate overview of the various entities
potentially responsible for these conditions (differential
diagnosis) and then use the available tools to sort out the
problem.
This
review of current terminology should help the Primary Care
Physician approach the patient history with a more focused
view of the patient’s complaint. This will allow the
physician to evaluate the patient more efficiently and develop
an initial treatment plan.
