Dysuria Alison C.

Agner MD Basics Description Painful urination Pain, tingling, or burning during or after urination Age-Related Factors Incidence of cystitis is steady throughout a o!an"s life. Cer#icitis is !ost co!!on during adolescence and early adulthood. $pide!iology % in & o!en ill e'perience acute dysuria each year. ()*+), of o!en ill ha#e cystitis once in their life.

-.. !illion cases of chla!ydia per year /)),))) cases of gonorrhea per year % out of ( adults ha#e genital herpes.

Ris0 Factors 1istory of urinary tract infection or pyelonephritis 1istory of se'ually trans!itted infections

1igh-ris0 se'ual beha#ior

Pathophysiology Infla!!ation2 o 3rethra or bladder trigone

o

4ul#a

Referred pain

Diagnosis 5igns and 5y!pto!s 1istory 6i!ing of sy!pto!s2 o 7nset, duration

Associated sy!pto!s2
o

5ee 8Re#ie of 5yste!s9

Alle#iating:Aggra#ating factors 5e'ual history

Re#ie of 5yste!s Constitutional2 o Fe#er, chills, fatigue

;I2
o

<ausea, e!esis, diarrhea

;32
o o o

3rinary fre=uency, he!aturia, flan0 pain 3rinary incontinence Abnor!al #aginal discharge, pel#ic pain

<eurologic2
o

3rinary or fecal incontinence

Physical $'a! ;eneral2 o Fe#er

Pel#ic e'a!2
o o o o

6hrough #ul#ar e'a! for lesions Bladder or urethral tenderness Cer#ical !otion tenderness Abnor!al #aginal discharge

Abdo!inal e'a!2
o o

5uprapubic pain Assess for costo#ertebral angle tenderness

6ests >abs

3A and urine culture2 o ?%)),))) organis!s on a clean catch

o

?%),))) organis!s on a cath speci!en

@et prep if indicated2

o

6o e#aluate for yeast infect, bacterial #aginosis, or tricho!oniasis

Cer#ical cultures if indicated2

o

6o e#aluate for gonorrhea or Chla!ydia

I!aging 3ltrasound is not routinely needed Cystoscopy

o o

6o e#aluate for nephrolithiasis or hydronephrosis 6o e#aluate for tu!or or interstitial cystitis

Differential Diagnosis Infection 36I2 o Cystitis

o

Pyelonephritis

Cer#icitis2
o o o

;onorrhea Chla!ydia 1erpes

6u!or:Malignancy Bladder cancer2 Presents ith painless gross he!aturia Irritati#e #oiding sy!pto!s !ay also be present.

Ath !ost co!!on cancer in fe!ales

6rau!a 5traddle inBury Masturbation

Rape:Abuse

7ther:Miscellaneous 4ul#ar disorders2 4ul#itis Ce'ternal dysuriaD Contact der!atitis

>ichen si!ple' >ichen sclerosus

P.&E Manage!ent Medication CDrugsD Pyridiu!2 o For sy!pto!atic treat!ent only

o

5tains urine orange

Antibiotic to treat 36I2

6MP-5MF is first line therapy2

E days for unco!plicated 36I / days for co!plicated 36I

o o

Ciproflo'acin is second-line <itrofurantoin is used in pregnancy

5urgery 1ydrodistention !ay be used to treat interstitial cystitis and for diagnosis Csee topicD. Follo up Disposition Issues for Referral Consider urology referral for2 <ephrolithiasis Red flag sy!pto!s.
o

Painless he!aturia

Bibliography @renn G. Dysuria, fre=uency, and urgency. In2 Clinical Methods2 6he 1istory, Physical, and >aboratory $'a!inations, Erd ed. Butter orths. A#ailable at2 http2:: .ncbi.nl!.nih.go#:boo0s:b#.fcgiHinde'edIgoogleJridIc!.chapter.(-&E Miscellaneous Clinical Pearls Asy!pto!atic bacteruria is !ore co!!on in pregnancy2 * 3A at e#ery #isit to e#aluate for 36I Abbre#iations 36IK3rinary tract infection 6MP-5MFK6ri!ethopri!:5ulfa!etho'aLole Codes ICDA-CM M )A..%( ;onorrhea cer#icitis M )AA.(E Chla!ydia cer#icitis M (A(.) Cystitis M (A(.% Interstitial cystitis M (A).. Pyelonephritis Patient 6eaching Pre#ention M A#oid bubble baths, soaps ith fragrance, etc. M 4oid i!!ediately after intercourse M AC7;KPatient $ducation Pa!phletK3rinary 6ract Infection