Critical thinking and diagnostic reasoning when assessing problems with the genitourinary system

With the prevalence of urological symptoms increasing within the ageing population and people self-managing symptoms until they become bothersome, nurses play a pivotal role in ensuring that patients follow the most appropriate pathway of care. To demonstrate excellence in patient safety, the advanced clinical practitioner must have a clear understanding of common conditions affecting the lower urinary tract, in order to undertake a comprehensive assessment of the presenting symptoms and associated comorbidities, interpret examinations and diagnostic investigations relevant to urological disorders, identify the relationships and provide a differential diagnosis based on the information gathered. Table 1 shows the differential diagnoses for a patient presenting with symptoms suggesting a urinary tract infection (UTI).

Source: adapted from Potter, 2021

Lower urinary tract symptoms in men are classed as follows:

The incidence of kidney stone disease (urolithiasis) is rising, with a lifetime risk of 10–15%, and a recurrence rate of 50% within 10 years (Wilcox et al, 2020). Renal colic is more prevalent in males (ratio 3:1 female) between the ages of 20 and 40 years. It is more common in industrialised countries that have high dietary sodium and protein levels. Medications such as diuretics, antacids, steroids, antivirals and vitamins C and D can promote the formation of calcium stones when taken at levels above the daily recommendation. Those at risk of stone formation are younger people with ureteric reflux, older females with history of recurrent UTI (struvite calculi) or people with neuropathic bladder dysfunction. Struvite (staghorn) calculi account for 10-15% of all urinary calculi (Flannigan et al, 2014).