Dysuria

Question 1

Common causes of dysuria

Answer 1

• Cystitis
• Urethritis, gonococcal and non-gonococaal (chlamydia, trichomonas, HSV)
• Pyelonephritis
• Acute and chronic prostatitis
• Epididymitis
• Vaginitis (yeast, bacterial vaginosis, trichomonas, atrophic, irritant)
• Interstitial cystitis

Question 2

Aspects of pathogenesis that affect UTI

Answer 2

• Gender
• Sexual activity
• DM
• Anatomic anomalies
• Instrumentation
• Use of indwelling catheter

Question 3

Hx items for dysuria

Answer 3

• Timing, frequency, severity, location
• F/C, sweats
• Frequency, urgency, hesitancy, incomplete voiding
• Back, abdominal, groin pain
• Hx of nephrolithiasis
• Hematuria
• Vaginal or penile discharge
• Penile skin lesions
• Sexual activity
• Hx STIs
• Dyspareunia
• Scrotal, testicular, perineal pain
• Use of topical hygiene products

Question 4

PE items for dysuria

Answer 4

• Percussion and palpation of bladder to accurately recognize distension and tenderness
• Palpation over kidneys to elicit flank tenderness
• Palpation of abdomen for elicit tenderness
• Palpation and massage of prostate to obtain discharge
• Accurate recognition of perineal or vaginal atrophy and inflammation
• Techniques of pelvic exam to assess for causes of vaginitis

Question 5

Potential labs in dysuria

Answer 5

• UA, cells, casts, urine dipstick and gram stain when appropriate
• UCx
• Gram stain and culture of urethral or cervical discharge
• KOH stain and normal saline wet prep of vaginal discharge
• Urinary or cervical PCR test for gonorrhea and chlamydia
• KUB radiograph

Question 6

Counseling in dysuria

Answer 6

• Dx, Tx, f/u
• Elicit input and questions about management plan
• Counsel on safe sex
• Explain risk of recurrent UTI and counsel on preventative measures