DYSURIA

DYSURIA: Excerpt from Differential Diagnosis in Primary Care

Dysuria is difficult or painful micturition. One could cover most of the causes simply by considering the inflammatory lesions of the genitourinary tract in ascending order. Thus, there may be a urethritis or urethral carbuncle, a trigonitis or prostatitis, a cystitis, or a pyelonephritis with associated cystitis. This would not, however, cover the disorders that frequently cause associated inflammation of the urinary tract or are associated with difficulty in voiding. To recall these, it is necessary to apply the mnemonic MINT. M—Malformations would bring to mind meatal stricture, bladder neck obstruction by prostatic hypertrophy, median bar, and urethral strictures. Bladder and ureteral calculi should also be considered here. I—Inflammatory conditions have already been considered. N—Neoplasms of the prostate and bladder may cause difficulty in voiding or painful urination when secondary infection sets in. T—Trauma suggests cystitis and trigonitis (honeymoon cystitis) caused by frequent or traumatic intercourse or by introduction of foreign bodies into the bladder, such as catheters. The N may also stand for neurologic conditions; one must not forget multiple sclerosis, poliomyelitis, diabetic neuropathy, and tumors of the spinal cord in the differential diagnosis of dysuria. These are also discussed in the section on incontinence on page 269.

Approach to the Diagnosis

The approach to the diagnosis includes a urinalysis, urine cultures, smear and culture of any discharge, an IVP, voiding cystogram and cystoscopy, and cystometric examination. In women with “negative” cultures, Chlamydia urethritis must be considered and treated. In men with negative cultures, prostatic examination, massage, and evaluation of discharge are done. Massage of the prostate should be avoided in acute prostatitis.

Other Useful Tests

1. Cultures for gonorrhea and Chlamydia
2. Anaerobic cultures
3. Cultures for acid-fast bacilli
4. Urology consult
5. Gynecology consult
6. Four cup test (proatatitis)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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