Testing the water!

Kidney stones, LUTS, UTIs, cancer, incontinence, investigations

LEARNING OUTCOMES

• Describe how to investigate haematuria

• Identify red flags associated with renal stones

• outline management options for LUTS/ incontinence

Prior reading for extra CPD hours:

The presence of haematuria may be a singular symptom signalling underlying urological pathology, either benign or malignant. However, a large proportion of patients with haematuria will have no identifiable cause found. Appropriate early investigation and management of haematuria in the primary care setting is important for timely referral of patients suspected of having serious underlying pathology while avoiding over-investigation in those patients prone to transient and benign causes.

The aim of this article is to provide a summary of the aetiology, investigation and management of haematuria in the primary care setting, with a focus on urological assessment and outcomes.

The approach to the diagnosis and investigation of haematuria differs depending on whether the haematuria is macro- or microscopic. In both cases, clinicians should begin by obtaining a careful patient history to include specific risk factors for urological malignancy, as often the decision for further work-up requires a risk-stratified approach. https://www1.racgp.org.au/ajgp/2021/july/haematuria-in-the-general-practice-setting

Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a patient with renal tract pain can aid immensely in formulating an accurate diagnosis and providing optimal care.

The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management.

Renal tract pain is mediated by a surge in prostaglandin release, leading to arterial vasodilatation, increased vascular permeability, and subsequently ureteric oedema and spasms. Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Diagnosis requires a stepwise approach with history-taking, assessment, blood tests and imaging. Successful management of renal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required. https://www1.racgp.org.au/ajgp/2021/july/an-update-on-management-of-renal-colic

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