Dysuria

Dysuria is a painful or burning sensation during or immediately after urination. This is a common symptom in primary care; nearly 20% of women aged 20–55 will have one episode of dysuria per year. Women have episodes of acute dysuria much more frequently than men. The most common cause of dysuria in adult women is lower urinary tract infection.

Differential Diagnosis

Workup and Diagnosis

• History and physical examination
• Male genital exam with gonorrhea/chlamydia test, culture, Gram stain
  –Tender, boggy, swollen prostate suggests prostatitis (avoid prostatic massage, because of risk of bacteremia)
  –Tender epididymitis and testicles suggest infection
  –Generally enlarged prostate associated with nocturia and increasing frequency suggests BPH
• Female genital exam with KOH prep, wet mount, Gram stain, and DNA tests/culture as indicated
  –Thin, papery vaginal tissue suggests atrophic vaginitis
  –Candida discharge is thick, cheesy, and white; pruritic
  –Chlamydia discharge is scant, watery and gradual onset
  –Gonorrhea discharge is profuse, yellow-green with abrupt onset, intracellular gram-negative diplococci
  –Bacterial vaginosis discharge is pruritic, with clue cells on wet mount and a fishy odor with KOH (whiff test)
  –Trichomonas discharge is frothy, grey-green, with pruritis and mobile organisms on wet mount
  • Urinalysis should be done in all patients
    –Hematuria suggests urolithiasis, pyelonephritis, or cystitis; painless hematuria suggests bladder cancer
    –Positive nitrites, leukocyte esterase, or WBCs with suprapubic tenderness suggests uncomplicated cystitis
  • Urine culture is indicated if positive urinalysis and in pregnant women, diabetic or immunocompromised patients, or males with urethral discharge

  Treatment

  • Cystitis/prostatitis: Appropriate antibiotics
    –Begin with empiric therapy and adjust to sensitivities
    –Noninfectious cystitis: Remove offending medications
    or allergens if possible
• Pyelonephritis: Outpatient antibiotic treatment in patients who tolerate liquids and have no significant co-morbidities; otherwise, admit for IV hydration and antibiotics
• Urolithiasis: Hydration, pain control while attempting to pass stones; urology referral if stones will not pass
• Atrophic vaginitis: Consider estrogen creams or systemic replacement if other symptoms
• BPH: Symptomatic relief with α-blockers, 5α-reductase-inhibitors, or saw palmetto extract
• Sexually transmitted diseases
  –Treat specific etiology and screen for coexistent STDs (e.g., HIV, hepatitis B)

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Lack of urine

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Lack of urine

• Back to symptom: Lack of urine: Introduction (review 186 causes)
• Next Book Extract About Lack of urine: Urinary Stream (Decreased) (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Lack of urine

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Urinary Stream (Decreased) (In a Page: Signs and Symptoms)

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• Bladder distention (Handbook of Signs & Symptoms (Third Edition))

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