top of page

Lower Urinary Tract Infection (LUTI)

Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓

 

Doctor Instruction:


You are a doctor working in the emergency department. Your next patient is Roc Johnson – a 51-year-old man who complains of pain during urination. Please take a history and perform a relevant examination.



 

Patient History:


Roc Johnson - a 51-year-old male - retired teacher.


You started experiencing pain when you urinated three days ago. This started quite suddenly, and the pain has been getting worse. You rate the pain 6/10. You describe the pain as burning. You do feel quite uncomfortable in the area below your belly button. You do not have any groin/loin pain.


You have noticed feeling quite feverish – today recorded 37.6 C. You have also been going to the toilet to empty your bladder more frequently than usual. You also sometimes have a sudden urge to urinate. Therefore, you always ensure a toilet nearby when you go outside. You also sometimes find it difficult to start urine, and the flow also seems to be slower compared to 1 year ago.


No discharge/haematuria/hesitancy/weight loss/nocturia. Not sexually active/ no pain in testicles.


Ideas, Concerns, Expectations:

  • You recently have been with a new partner and have been sexually active. You have always used barrier contraceptives. You think you have received AIDs from your new partner. You are very concerned about this as you heard many people have died of AIDS in the past. You are thinking of ending the relationship because of this. You hope to find out what is going on and seek treatment as soon as possible.


Past Medical History:

  • Type 2 Diabetes


Drug History:

  • Metformin, allergic to penicillin > rash


Family History:

  • Father has prostate cancer.


Social History:

  • Smoker – non-smoker

  • Alcohol – 3-4 pints of lager per week.

  • Occupation – retired teacher

  • Live alone.


 

Examination Findings:

  • Abdominal discomfort/ tenderness in the suprapubic region

  • Warm + sweats on palpation

  • No costovertebral angle tenderness

  • Enlarged prostate with central sulcus during PR if done (no tenderness / abnormal lumps)


 

Differentials:

  1. Urinary tract infection (Lower)

  2. STI

  3. Things to rule out BPH/ Stones/ Prostate, Bladder or Renal Cancer/ stricture / Prostatitis


 

Investigations:


Bedside:

  • Observation

  • PR examination / testicular exam

  • Mid-stream Sample with Urine dipstick - White cells, Haematuria, Nitrites

  • Urinalysis - microscopy, culture if needed

  • STI screen


Bloods:

  • FBC – infection

  • CRP – infection

  • U&E & Creatinine – assess renal function

  • LFT – baseline

  • PSA

  • Consider blood culture – infection/ suspect sepsis


Imaging:

  • Consider CT KUB (non-contrast) – rule out stones if any features of nephrolithiasis or suspected complications

  • Consider US KUB - as with CT, also useful for assessing urodynamics, especially if recurrent


 

Management:

      Want to read more?

      Subscribe to oscefinals.com to keep reading this exclusive post.

      bottom of page