Clinical evaluation: History and physical examination

Introduction A thorough history and physical examination are the cornerstones of the initial evaluation of patients with neurologic diseases suffering from lower urinary tract symptoms. While more exact and specific means are often necessary to pinpoint the nature of bladder dysfunction in such patients, a directed, though thorough history and physical examination are essential to defining which patients require more costly and invasive testing, and which can be followed with alternative strategies. Advanced videourodynamic has allowed for a more precise characterization of bladder dysfunction in patients with neurologic disorders, but failing to know what questions to ask, and what signs to observe, can lead to erroneous diagnoses, and inappropriate testing. The focus of this chapter will be on obtaining as much information as possible on the initial visit by directed questioning and a focused examination, so as to be able to discern what testing, if any, is necessary on future visits.