Dysuria Flashcards
1
Q
Differential diagnoses of Dysuria
A
- UTI - Dysuria Young Female
- UTI - Dysuria Middle - Old Male
- UTI - Dysuria Young Male
- BPH +/- Dysuria Middle - Old Male
Probability diagnosis UTI (esp. cystitis) Urethritis Urethral syndrome—abacterial cystitis (female) Vaginitis
Serious disorders not to be missed Neoplasia: •bladder •prostate •urethra
Infection: •gonorrhoea •chlamydia/others •genital herpes •prostatitis
Reactive arthritis Calculi (e.g. bladder) Pitfalls (often missed) Menopause syndrome Adenovirus urethritis Prostatitis Foreign bodies in lower urinary tract Acidic urine Acute fever Interstitial cystitis Urethral caruncle/diverticuli Vaginal prolapse
Obstruction: •benign prostatic hyperplasia •urethral stricture •phimosis •meatal stenosis
Masquerades checklist Depression Diabetes Drugs UTI
Is the patient trying to tell me something?
Consider psychosexual problems, anxiety and hypochondriasis.
2
Q
Dysuria - Key History
A
Key history
It is important to determine whether dysuria is really genitourinary in origin and not attributable to functional disorders, such as psychosexual problems. Disturbances of micturition are uncommon in the young male and if present suggest sexually transmitted infection (STIs).
3
Q
Dysuria - Key questions
A
Key questions: •Could you describe the discomfort? •What colour is your urine? •Does it have a particular odour? •Have you noticed a discharge? •If so, could it be sexually acquired? •Do you find intercourse painful or uncomfortable (women)? •Have you any fever, sweats or chills?
4
Q
Dysuria - Key Examination
A
Key examination
- General inspection looking for evidence of kidney disease and vital signs
- Abdominal palpation to focus on the loins and suprapubic areas
- The possibility of STIs should be considered and this includes vaginal examination in the female and rectal and genital examination in the male
- In the menopausal female the cause may be evident from a dry atrophic urethral opening, a urethral caruncle or urethral prolapse
5
Q
Dysuria - Key Investigations
A
Key investigations
- Dipstick testing of the urine
- Microscopy or culture (midstream specimen of urine or suprapubic puncture in children)
- Urethral swabs or first pass urine for STIs
- Further investigations depend on findings
6
Q
Dysuria - Diagnostic Tips
A
Diagnostic tips
- Urethritis causes pain at the onset of micturition and cystitis at the end.
- Suprapubic discomfort is a feature of bladder infection (cystitis).
- Unexplained dysuria could be a pointer to chlamydia urethritis.