History

Urologic emergencies, even if life-threatening (e.g., sepsis or hemodynamically relevant postoperative bleeding), should not hinder history taking of the acute event. Information to elicit includes concurrent illness or operation (e.g., previous nephrectomy in a patient with traumatic kidney rupture), medication (e.g., fever in neutropenic patients after chemotherapy requires a different therapeutic approach), and (crucially) allergy. Any minimal delay in therapy is offset by the avoidance of any potential iatrogenic complication, possibly adding a second emergency to the one already under evaluation. The AMPLE history (Allergies, Medications, Past medical history, time of Last meal, Events preceding the injury) used in trauma surgery can be used as a template in traumatic and even nontraumatic emergencies. Other elements of the urgent history include localization, time dimension, intensity and mitigating/ inducing factors of the current problem. Some patients may not be able to report their condition themselves. In young children, patients with dementia, and those who are severely ill (urosepsis or polytrauma) or whom we are asked to treat intraoperatively, the history may be obtained from family members, the rescue staff, or the operating team.

The importance of history taking in urologic emergency is illustrated by a prospective study (Eskelinen et al. 1998) addressing its accuracy in acute renal colic. The combination of gross hematuria, loin tenderness, pain lasting less than 12 h, and decreased appetite-all information easily available from history-detected renal colic with a sensitivity of 84% and a specificity of 98%.

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