Modern Review

MODERN REVIEW

INTRODUCTION:-

Human body is mainly composed of three tubes e.g. Respiratory, Alimentary

and Genitourinary. The urinary tract, like the respiratory and digestive tracts, ends on
the body surface and therefore there is maximum chance of infection. The urinary
tract is considered in two distinct divisions- upper and lower. The upper part includes
kidneys and ureters and the lower part includes bladder and urethra. The urinary tract
is an important system for excretion of waste products.

In urinary tract diseases, abnormality in emptying the bladder, obstruction in

the tract and pain during micturition appears as common complaints, which have been
singularly attributed to the term dysuria.

Now-a-days it seems that, several patients are reporting to the hospitals

regularly with affected from different disorders of Urinary tract diseases. Dysuria is a
very common manifestation of urinary tract disorders. Dysuria is typically described
to be a burning or stinging sensation.

According to modern medical science, dysuria is a symptom. In modern,

specifically urology, Dysuria refers to painful urination. Dysuria is painful or burning
sensation during or immediately after urination caused by irritation of the
uroepithelium and its innervation. This is very common clinical problem of urology
department. More than 60% of women are suffering from this clinical problem and
50% of them are occurs due to Urinary Tract Infection. Dysuria is uncommon in men
except after 60 years of age. There are also other causes of dysuria like STD, bladder
stones, virtually any condition of the prostate and allergies, instrumentation, applied
chemicals. It can also occur as a side effect of anticholinergic medication used for
Parkinson’s disease. But the most common cause of dysuria is urinary tract infection
which is divided in to lower and upper urinary tract infection. The symptoms of lower
urinary tract infection or cystitis are suprapubic pain, scanty and frequent micturition,
burning micturition, painful micturition, cloudy urine which are similar to the
symptoms of mutrakrichhra.

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To study and manage the cases of dysuria, consideration of urinary structure

and application of diagnostic methods to find out the exact location and nature of
infection become necessary.

HISTORICAL GLIMPSES:-

Attentions of workers have been drawn to urinary tract and its diseases in the
past. To identify urinary diseases by inspecting patient’s urine was a common
practice. Hippocrates (460 B.C.) systematized different means of urine inspection,
expounded urinary diseases and identified renal stones with their formation. He was
able to inspect vesicular calculi, urinary tuberculosis and carcinoma of urinary tract by
uroscopy. Shakespeare was considered as an expert in diagnosing urinary diseases by
special physical examination of urine. Although Bellini – Professor of Anatomy – pisa
knew the morphology of tubular structure of the kidney. He also portrayed a distinct
picture of glomeruli, the capsule of which has designated according to his name as
Bowman’s capsule.

PHYSIOLOGICAL ANATOMY THE URINARY TRACT:-

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The urinary tract involves kidney, ureter, urinary bladder and urethra.

(1) KIDNEY:-
The two kidneys, each weighing 150 gms in adults are located
retroperitoneally in the upper dorsal region of the abdominal cavity, on either side of
the vertebral column. The kidneys are bean-shaped organs, approx. 10 cm long, 5 cm
wide and 2.5 cm thick. Vertical section of the kidney shows-
(i) Cortex – The renal cortex is granular due to the presence of nephrons.
(ii) Medulla – The medulla consists of multiple pyramidal tissue masses, called
the renal pyramids.
(iii) Hilum
The following structures are seen in the hilum – Renal vein, renal artery and
renal pelvis.
- The ureters exit from the hilus of the kidney and pass to the bladder. The blood
vessels, lymphatic and nerves enter in to or exit from the kidney via the hilus.
- The basic functional unit of the kidney is ‘nephron’. The different parts of the
nephrons are Bowman’s capsule, Glomerulus, Proximal convoluted tubule, the
Loop of Henle, Distal convoluted tubule and the collecting tubules.
- The glomerulus acts to filter the blood free of cells and large proteins, producing
an ultra-filtrate composed of the other smaller circulating elements. The ultra-
filtrate enters the tubule, which is highly specialized at various segments, to
produce the final urine by removing substances from the tubular fluid like water
and solutes and transported in to the blood (reabsorption) or adding substances to
the tubular fluid like toxic of the body (secretion).
(2) URETER:-
Each ureter is about 25 cm long of which begins with in the renal sinus as a
funnel shaped dilation, called the renal pelvis. The ureters convey urine from the renal
pelvis to bladder.
(3) BLADDER:-
The urinary bladder is mainly a smooth muscle hollow vesicle. It composed of
Body, Trigone, and Internal sphincter.
The physiological capacity of the bladder is 600 ml and the anatomical
capacity is 1 L.

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(4) URETHRA:-
In male, the urethra extends from the internal urethral orifice at the neck of the
urinary bladder to the external urethral orifice at the tip of the penis. It is 18- 20 cm
long. In female it begins at the internal urethral orifice at the neck of the urinary
bladder and ends at the external urethral orifice in the vestibule. It is 4 cm long.
Through urethra urine excreted out.
ACT OF MICTURITION:-
The urine formation occurs in the kidney and it reach to bladder through ureter.
As the urinary bladder fills with urine, the wall stretches, impulses are initiated by
stretch receptors in the bladder wall causing sensory signals through sympathetic
nerve and back again to the urinary bladder through parasympathetic nerve to cause
contraction of the urinary bladder wall and relaxation of trigone and internal
sphincter. Finally results in emptying of bladder.

DEFINATION:-
Dysuria is defined as painful or burning sensation during or immediately after
urination caused by irritation of urothelium and its innervation.

The term dysuria is used to describe painful urination, which often signifies an
infection of the lower urinary tract. The discomfort is usually described by the patient
as burning, stinging or itching. Pain occurring at the beginning of or during urination
suggests a urethral and bladder site of disease, whereas pain after voiding implies
pathology within the bladder or prostate area. Sometimes a patient will relate a history
of pain in the supra pubic area.

CAUSES:-
1. Drugs and irritants:-
 Chemical irritants – soap, tampons, toilet papers.
 Drugs – Anticholinergic, NSAIDs
2. Genital:-
 BPH (male)
 Prostatitis (male)
 Vaginitis (Female)

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3. Urinary tract:-
 Cystitis
 Hemorrhagic cystitis
 Kidney stones
 Malignancy- Bladder cancer, Prostate cancer, urethral cancer
 Prostatic enlargement
 Chlamydia
 Trichomoniasis
 Gonorrhea
 Urethral stricture
 UTI caused by bacterial infection

The non-infectious causes include urethral trauma during sexual intercourse,

sensitivity to scented creams, sprays, soap or toilets paper, spermicidal jellies, sanitary
napkins and in case of postmenopausal case. In postmenopausal women, the marked
reduction in endogenous estrogen can lead to lower urinary tract dysfunction.
Atrophy, dryness and occasionally inflammation of the vaginal epithelium contribute
to urinary symptoms such as dysuria, frequency and urgency.
Physical activities such as horseback riding or bicycling can lead to dysuria
with minimal urethral discharge. Dysuria may also be a feature of psychogenic
condition such as somatization disorder, chronic pain syndromes, major depression
and chemical dependency. Sexually abused and other emotionally distressed person
can have psychogenic urinary retention and dysuria.

Infections are one of the leading causes of painful urination and can occur in
any part of urinary tract. This includes the kidneys, ureter, bladder and urethra. Most
often these infections are the result of bacteria and called urinary tract infection.
However there exist inflammatory conditions that can cause dysuria, such as an
allergic reaction or a foreign body in the urinary tract.

URINARY TRACT INFECTION:-

Urinary tract infection commonly caused due to E.coli, Klebsiella,
Enterobactor, Pseudomonas and Proteus. But the most common infective organism is
E.coli. In 80% cases infection is occurs due to E.coli.

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The infection by these organisms can involve any of the urinary organs and
can spread from one place to another or may extent to the whole tract.

The incidence of urinary tract infection is higher in female then men due to
shorter urethra and absence of bactericidal prostatic secretions. It is higher in females
during adolescence and child bearing age.

In a normal individual, a series of specific and non-specific defence

mechanisms prevents adhesion and colonization of bacteria. The non- specific
mechanisms are the flushing effect of voiding, factors like pH, osmolality,
mucopolysacccharide layer in uroepithelium, prostatic secretion, and normal vaginal
flora. Urine flow and the act of micturition are important defence mechanisms which
help to eliminate the bacteria.

Source of infection:-
It is now generally considered that urinary tract infection is caused by
organism derived from patient’s own bowel. The infection developed by a series of
steps, which the organisms most successfully negotiate. The first of these steps are
colonization at anterior urethra. When host defences are weakened, urethral
colonization and mucosal adhesion of bacteria occur. The second step is transfer in
the bladder and third is growth within the bladder and fourth steps takes place in
severe case where transfer of the organism to kidney occurs.

Sexual intercourse, catheterization or instrumentation may also help transfer of

bacteria in to the bladder.

The other and rare source of infection may be cutaneous septic faci such as
carbuncles, furuncle and osteomyelitis.

The common infective organism from the gastro intestinal tract includes
E.coli, pseudomonas, staphylococcus, protest and enterococci.

Mode of Transmission:-
This has been discussed by many authors in great details. It still remains a
controversial issue because of uncritical evaluation of result and confusing
experimental data. The following root of infection has been suggested.

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(i) Ascending infection: - The possible movement of bacteria from the lower
urinary tract to the kidney via lumen of ureter.
(ii) Descending infection: - The infection may transmit from kidney to lower
urinary tract.
(iii) Haematogenous transmission: - Transmission through blood is uncommon
in case of urinary tract. During the course of infection elsewhere in body, bacteria
enter to blood stream. In blood they are usually destroyed if body immunity
against them is high. If their number and virulence are great and they find a
suitable nidus in presence of stone, obstruction and vitality they grow. In case of
pulmonary tuberculosis, cutaneous carbuncles, gonococcal urethritis, urinary tract
is often infected through blood born route.
(iv) Lymphatic Transmission: - Rarely urinary tract can be infected by
lymphatic route. In this pathway bacterial pathogens may travel through the rectal
and colonic lymphatic to the prostate, bladder and through the preurethral lymph
vessels.
(v) Direct Transmission:-This is also a rare source in which infections from
adjacent viscera in case of intraperitoneal abscess, appendicular absceess, and
diverticulitis of sigmoid colon can directly spread to bladder.
Predisposing factors:-
(i) Constipation
(ii) Stones in kidney and bladder
(iii) Indwelling catheter
(iv) Low body resistance power

Risk factors for UTI:-

1. Incomplete bladder emptying.
2. Foreign bodies (Urethral catheter or ureteric stent)
3. Loss of host defences
- Atrophic urethritis and vaginitis in post-menopausal women.
- Diabetes mellitus

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UTI is subdivided in to two general anatomic categories-

1. Lower urinary tract infection (Cystitis)
2. Upper urinary tract infection (Pyelonephritis)
The Lower urinary tract composed of urethra and bladder. LUTI occurs if
the infection confined up to the bladder. The upper urinary tract composed of ureter
and kidney and UUTI occurs if infection spread to the kidney. Infection of the urethra
and bladder are often considered superficial (mucosal) infection of kidney signifies
tissue invasion

(A) CYSTITIS:-
Cystitis means inflammation of the bladder. It is often used in medical to
indicate symptomatic lower urinary tract infection which is characterized by dysuria,
frequency, urgency, suprapubic pain, cloudy urine, occasionally with hematuria, in the
absence of fever and flank pain. Systematic symptoms like fever, rigors, usually
absent in cystitis. Cystitis in most cases due to infection of the bladder by pyogenic
organisms such as staphylococci, streptococci, coliform bacilli etc. and mostly due to
E. coli.

The route of invasion of the bladder is diverse.

1. Ascending infection: - The organisms especially E.coli contaminate the vulva

and reach the bladder, because of shortness and wide urethra in women. Hence
cystitis is frequently associated with vulvitis and is seen after labour.
2. Descending infection: - From kidney the infection may reach bladder by
descending from above in case of suppurative lesion in kidney or pelvis.
3. Lymphatic: - Bacteria can invade the bladder from surrounding organs, being
transmitted by lymphatic dissemination.
4. Haematogenous:- Bacteria from distant sources i.e. skin infections or
osteomyelitis in rare conditions may reach by circulation.
Predisposing factors:-
1. Constitutional causes: - Lowered state of general resistance to bacterial infection
due to fatigue, under nourishment, avitaminosis etc.
2. Injury: - It is possible in presence of calculus, foreign body etc. Sometimes
associated with Vesico- Ureteric reflux causing pyelonephritis in children.
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3. Incomplete emptying of bladder:- Certain causes like enlarged prostate, urethral

stricture, pregnancy, puerperium, external urethral meatus stenosis and
diverticulum of bladder, developed bacteria. The urine is decomposed rendering it
ammonical odour.
4. Presence of irritants: - Catheterization and certain drugs.
5. Loss of nervous control: - In case of spinal injury.
6. Instrumentation:- The passage of urethral instruments may cause cystitis in
either sex, more specially when bladder contains residual urine.
Clinical features:-
1. Frequency both during day and night. The desire to urinate occurs from every
hour to every few minutes and often it is so urgent that incontinence results if
bladder not emptied quickly.
2. Scalding pain in urethra during micturition (Dysuria).
3. Supra pubic pain varies from mild to agonizing when inflammation is situated in
the dome of bladder.
4. Intense desire to pass more urine after micturition, due to spasm of inflamed
bladder wall (Strangury).
5. Hematuria: - Occasionally
6. Cloudy urine:- Due to pus cells urine may appear cloudy and have an unpleasant
odour.
Treatment:-
Treatment should commence forthwith and modified if necessary when the
bacteriological report becomes available. Patient is asked to drink plenty water and as
long as sensitivity report is awaited one should prescribe either a Sulphonamide or
Nitrofurantoin with Potassium citrate hyocyamus. Nitrofurantoin is given 100 mg
twice in a day and Potassium Hyoscyamus in mixture form – 10 ml thrice daily to act
as a bladder sedative. In failure in response or early recurrence of infection,
investigation should be done to find out the predisposing factors which should be
eliminated in due course.

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(B) PYELONEPHRITIS:-
Definition: -
Pyelo (Greek word) means pelvis. Pyelonephritis means inflammation of the
renal pelvis. Here both renal pelvis and parenchyma affected and it occurs mostly due
to urinary tract infection.
Pyelonephritis divided in to :- 1. Acute pyelonephritis
2. Chronic pyelonephritis
Acute Pyelonephritis:-
This is characterized by an acute inflammation of the parenchyma and pelvis
of the kidney. It may be unilateral or bilateral. Acute pyelonephritis present as a
classic triad of loin pain, fever and tenderness over the kidney. Systemic symptoms
like fever, rigors, nausea, vomiting is more prominent.
Etiology:-
1. It is commonly associated with some obstruction in the urinary tract. In men it is
often due to prostatic enlargement. In pregnant women due to obstruction by
uterus and atonia of uterus by the action of progesterone and in infants and
children due to congenital malformation of the urinary tract or vesico- ureteric
reflux.
2. Calculi, cervical prolapse, cystocele, foreign bodies and tumors may also be
responsible.
Clinical features:-
1) Pain- Sudden onset of loin pain, that may radiate anteriorly and towards the groin.
Loin pain is absent in children, they may complain of abdominal discomfort.
2) Loin tenderness.
3) Pyrexia
4) Various lower urinary tract symptoms such as frequency, urgency, and dysuria are
often present. They usually develop later than general or renal symptoms.
5) Passage of cloudy urine.
6) Children and Infants- In young infants pyrexia is often absent and newborn babies
have abnormal weight loss and characteristic gray coloration of skin. Children
seem particularly liable to develop pyelonephritis associated with pyrexia.
7) Hematuria

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Other symptoms may include-

 Malaise and lassitude often accompanied with headache, nausea or vomiting.
 Moist skin
 Mental confusion
 Hypotension

Predisposing factors:-

 Diabetes mellitus
 Chronic urinary obstruction
 Analgesic nephropathy
 Sickle-cell disease
Diagnosis:-
Leukocytosis, bacteria, blood and pus in the urine.
Prognosis:-
With adequate treatment the disease subsides rapidly in great majority cases.
In some cases although acute symptoms subsides a low grade infection may persist
and the disease may pass into chronic stage.

Chronic pyelonephritis:-
Repeated attacks of acute pyelonephritis can lead to chronic pyelonephritis,
which involves destruction and scarring of renal tissue due to repeated inflammation.
Causes of the chronic pyelonephritis are same as those for acute
pyelonephritis. Chronic pyelonephritis is more common in children than in adults.
Clinical features:-
In many cases no symptoms arise directly from the renal lesion and the patient
consults the doctor because of lassitude, vague ill health or symptoms of uremia or
hypertension. Discovery of hypertension or proteinuria on routine examination may
be first indication of disease. Symptoms arising from the urinary tract may also be
present and include frequency of micturition, dysuria and lumbar pain. Occasionally
weakness and fainting results from salt loss in the urine.

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Laboratory diagnosis:-
1. Urine tests:-
Diagnosis of the disease can be done by direct demonstration of organism
and also by indirect evidence from the sample of urine.
Indirect evidence:-
In early morning, freshly voided, clean-catch, mid-stream urine should be
collected in a sterile container after proper anogenital cleansing for routine
examination without much delay.
Physical Examination:-
Amount: - Usually less than normal.
Appearance: - Usually turbid or smoky.
Reaction: - Either highly acidic or alkaline
Specific gravity: - Slightly increased
Chemical examination:-
Albumin: - Present trace to moderate in amount.
Sugar: - Present only in diabetic case.
Blood: - Often present.
Microscopical examination of centrifuged deposit:-
Epithelial cells: - Found a few to higher in number.
Pus cell: - Found moderate to plenty
R.B.C.: - Often found a few.
Direct evidence: -
The direct approach is invasive and involves examination of urine obtained
from bladder and ureter directly.
This is the optimal method, involving no risk to the patient. Prior to collection
of urine, urethral meatus and external genitalia must be cleansed with mild antiseptic
before sample collection to avoid contamination of urine by normal flora present in
this region. In men, the prepuce is retracted and in women, the labia is spread apart
and then the first part of urine stream is discarded, the middle part of urine stream
aseptically collected in a sterile container and send to the laboratory without much
delay.

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Specimen obtained by catheterization:-

Each urethral catheter insertion carries 1-2% risk of introducing
microorganism in to bladder and thus initiating urinary tract infection. So
catheterization only for the purpose of collecting urine should be avoided. In
situations where the patient is already catheterized, the urine must not be collected
from the bag, instead it should be aspirated from the catheter tube using needle and
syringe.
Specimen obtained by suprapubic aspiration:-
While the bladder is distended the suprapubic skin is aseptically prepared and
a sterile needle is then introduced in to the bladder. This permits aspiration of bladder
urine free from urethral contamination. Since this is in invasive technique, it must be
performed only when absolutely necessary.
2. Imaging tests: - Ultrasound should be done to look for cysts, tumor or other
obstructions in the urinary tract. For people who don’t respond to treatment within
72 hours, a CT scan may also be suggested to detect obstruction with in the
urinary tract.
3. Radioactive imaging: - A dimercaptosuccinic acid (DMSA) test may be
suggested if there is a suspect of scarring as a result of pyelonephritis. This is an
imaging technique that tracks an injection of radioactive material.
Treatment:-
 In people who do not require hospitalization, a fluroquinolone orally such as
ciprofloxacin or levofloxacin is an appropriate initial choice for therapy.
 People with acute pyelonephritis that is accompanied by high fever and
leukocytosis are typically admitted to hospital for IV hydration and IV antibiotic
treatment.
 Blood pressure should be controlled to slow the progression of CKD.
Complications:-
 Progressive renal scarring with CKD.
 Secondary hypertension.
 Focal glomerulosclerosis

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SEXUALLY TRANSMITTED INFECTIONS (STI):-

A wide range of infections may be sexually transmitted, but the symptom of
dysuria is mainly seen in following STIs.

Chlamydia:-
It is a common sexually transmitted disease caused by Chlamydia
trachomatis.

Sign and Symptoms:-

In male: - Discharge from the penis.
- Burning sensation when urinating.
- Burning and itching around the opening of penis.
- Pain and swelling in one or both testicles.

In Female:
- Abnormal vaginal discharge with strong smell.
- Burning micturition.
- Dysuria
- Pain during intercourse
- Intermenstrual or post coital bleeding

If the infection spread, there may be lower abdominal pain, nausea or fever.

Trichomoniasis:-

It is caused by Trichomonas vaginalis. The sign and symptoms are as follows-

Male:-
- Discharge from the urethra.
- Burning during urination or after ejaculation.
- Frequency and urgency in micturition.

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Female:-
- Vaginal discharge of white, gray, yellow or green with unpleasant smell.
- Irritation and itching in genital area.
- Genital redness and swelling.
- Pain during urination or sexual intercourse.
- Vaginal spotting or bleeding.

Gonorrhoea:-

It is caused by Neisseria gonorrhoea. Transmission is usually the result of

vaginal, anal or oral sex. Untreated mothers may infect their babies during delivery.

The sign and symptoms are as follows-

Male: -
- Discharge from the tip of the penis that may white, yellow or green in color.
- Swelling or redness at the opening of the penis.
- Swelling or pain in the testicles.
- Dysuria.
- Frequency and urgency in urination.

Female: -
- Unusual discharge from vagina that is thick and green or yellow in color.
- Pain and burning micturition.
- Pain during intercourse.
- Lower abdominal pain.
- Bleeding between periods and or heavy periods.

Investigation:- Diagnosis is confirmed by culture or NAAT.

Treatment:-

Chlamydia and Gonorrhea are bacterial STDs/STIs that can be treated with
antibiotics given either orally or by injection. The antibiotics for Gonorrhoea are
cefixime, ciprofloxacin, amoxylin and for Chlamydial infection Azythromycin,
ofloxacin. Trichomoniasis can be treated with a single dose of an antibiotic, usually
either metronidazole or tinidazole taken orally. Often, a Trichomonas infection
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reoccurs, so it is important to make sure that both sexual partners are treated if
diagnosed with this infection.

Here a few symptoms that are more commonly associated with STDs
and not UTI:-

 Vaginal blisters or blisters in the genital area

 Vaginal rash
 Vaginal or urethral discharge
 Pain during intercourse
 Bleeding or spotting between menstrual cycles
 Sore throat

BPH (Benign Prostatic Hyperplasia):-

BPH is nonmalignant (noncancerous) enlargement of the prostate gland. From

40 years of age the prostate increase in volume by 2.4 cm3 per year on average.
Associated symptoms are very common from 60 years of age. It is also seen in men
older than 50 years also.

Clinical features:-
- Frequent and urgency in urination.
- hesitancy
- Incontinence or leakage of urine.
- Painful urination.
- Blood in urine.
- A weak urinary stream.
- A sensation of incomplete emptying of bladder.
- Terminal dribbling or post-micturition dribbling.

Objective assess of obstruction is only possible by urodynamic (Normal

micturition cycle, Stress incontinence, Urge incontinence, Overflow incontinence,
Prostatic obstruction), obstructive neuropathy identified by ultrasound. Mild to
moderate symptoms can be treated by medications and severe case requires surgical
treatment.

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PROSTATITIS:-

It is the inflammation of the prostate gland that may be acute or chronic. It can
be caused by infection with the same bacteria that are associated with UTI or more
commonly may be non-bacterial.

Acute bacterial prostatitis:- Often caused by common strains of bacteria, this type of
prostatitis generally starts suddenly and cause flu-like sign & symptoms, such as
fever, chills, nausea and vomiting, frequency, pain or burning sensation when
urinating, perineal or groin pain, muscles and joints pain, weak urine stream .

Chronic bacterial prostatitis:- When antibiotics don’t eliminate the bacteria causing
prostatitis, the person can develop recurring or difficult to treat infections. Clinical
features are nocturnal urgency, painful urination, Low back pain, Blood in semen.

The treatment of choice is trimethoprim or erythromycin, which penetrate

prostatic secretion. A 4-6 weeks course is required.

BLADDER STONES:-
Bladder stones are caused by a buildup of minerals. They can occur if the
bladder is not completely emptied after voiding. Symptoms are severe lower
abdominal and back pain, pain in urination, nocturia, blood in the urine, fever.
Increase in fluid intake can facilitate the passage of small stones. However large
stones may require surgical procedure.
KIDNEY STONES:-
Kidney stones are hard masses made up of minerals and salt that form inside
the kidney. The symptoms are as below:-
- Sever pain in the side and back below the ribs and pain radiates to lower abdomen
and groin.
- Intermittent pain.
- Pain in urination.
- Hematuria.
- Scanty urination.

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- Nausea and vomiting.

An urine analysis, present of phosphate, crystallized minerals helps to rule out

bladder or kidney stone. X-ray, ultrasound can also be done to find out kidney or
bladder stone.

Most small kidney stones won’t require invasive treatment. The small stone
may be passes through urine by drinking plenty of water, pain relievers and medical
therapy (alpha blocker that relaxes the muscle of the ureter and help to pass the kidney
stone more quickly and with less pain. Large stone requires surgical treatment.

MANAGEMENT:-
The causes of dysuria will determine the type of treatment, which can involve
addressing a urinary tract infection, bladder, kidney or prostate problems or even a
sexually transmitted disease. The objectives of management are in three folds-
(i) Symptomatic relief, (ii) Prevention of recurrence and (iii) restoration of renal
function.
Antibiotics are commonly prescribed to treat bacterial infection. If an irritant
is causing the problem, then avoiding the trigger is best option. In order to reduce the
symptoms associated with dysuria, drink plenty of water.
Urethral syndrome:-
Some patients, usually females suggestive of urethritis and cystitis but no
bacteria are cultured from the urine. Possible explanation include allergy to toilet
preparation or disinfectants, urethral congestion related to sexual intercourse and post-
menopausal atrophic vaginitis, antibiotics are not indicated unless one of the unusual
organism is isolated.

Prophylactic measures:-
1. Adequate amount of fluid intake.
2. Regular emptying of bladder. Don’t hold in urine.
3. Emptying bladder before and after intercourse.
4. Maintain proper hygiene.
5. Always wear cotton underwear.
6. Administer the drug with normal dose and duration.

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7. Women should wipe front to back to avoid moving bacteria around.

8. Stay away from caffeine, spicy food and carbonated beverages to avoid worsening
the symptoms.
9. Increase intake of vitamin C.
10. Avoid alcohol, smoking.

Home remedies:-

1. Consume plain yogurt.

2. Drink coconut water, lemon water.
3. Drink diluted apple cider vinegar.
4. Drink baking soda in water.
5. Apply warm compresses to the lower abdomen.

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