Many clues to the pathogenesis of upper urinary tract obstruction can be obtained from the initial patient encounter. It is important to take a complete history and do a physical examination when urgently evaluating a patient with upper urinary tract obstruction (Fig. 10.1). In addition to the duration and type of symptoms experienced, the patient's past medical and surgical history, current medications, and allergies should be thoroughly reviewed. Particular emphasis should be placed on the patient's prior urologic history including prior episodes and treatments of urinary calculi, current voiding patterns, prior urologic surgeries, prior history with urinary tract infections, and the presence of gross hematuria. The patient's prior history of urothelial carcinoma should be well documented as well as a history of other urologic and nonurologic malignancies. Pregnant females and patients with urinary diversion, renal transplantation, or history of urethral/ ureteral strictures can pose additional diagnostic and therapeutic challenges. A patient's smoking history should also be noted as well as familial factors that could be contributing to the underlying etiology (e.g., familial stone disease, hereditary nonpolyposis colo-rectal cancer syndrome associated with urothelial carcinoma).
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