FREQUENCY AND URGENCY OF URINATION

Frequency of urination may be due to polyuria (increased output of urine), obstruction to the output of urine (requiring frequent voiding to get the urine out) because the net capacity of the bladder is reduced, or irritative lesions in or near the urinary tract.

1. Polyuria. Increased output of urine is discussed on page 429, but, in summary, it may be caused by pituitary diabetes insipidus, nephritis, diabetes mellitus, hyperthyroidism, hyperparathyroidism, and nephrogenic diabetes insipidus.
2. Obstruction of the bladder. This may be mechanical, as occurs in bladder neck obstruction due to prostatic hypertrophy, prostatitis, median bar hypertrophy, urethral stricture, and bladder calculi; or it may be due to a neurogenic bladder, as occurs in poliomyelitis, parasympatholytic drugs, tabes dorsalis, multiple sclerosis other spinal cord lesions, and diabetic neuropathy.
3. Irritative lesions of the urinary tract. Infection, calculus, or neoplasm of the bladder, kidney, ureters, or urethra may do this. Chronic or acute prostatitis is sometimes the culprit. Inflammation anywhere in the pelvis (vaginitis, hemorrhoids, diverticulitis, appendicitis, or salpingitis) may also cause this.

FREQUENCY AND URGENCY OF URINATION

Approach to the Diagnosis

This is no problem. Examine a drop of unspun urine under the microscope. More than 1 or 2 motile bacteria per high-power field (HPF) is diagnostic of UTI. Then culture the urine, catheterize for residual urine, and do an intravenous pyelogram (IVP) and voiding cystogram. A cystoscopy may be necessary. If these are negative for abnormal findings, it is a good idea to collect a 24-hour specimen and if the amount of urine exceeds 5 L, check the response to pitressin. Special cultures for Chlamydia should be done if all else fails. The workup of polyuria (see page 429) can be proceed further, if necessary.

Other Useful Tests

1. Prostatic massage and examination of exudate (prostatitis)
2. Fishberg concentration test (chronic nephritis)
3. CT scan of the brain (pituitary tumor)
4. Serum antidiuretic hormone (ADH) (diabetes insipidus)
5. Hickey–Hare test (diabetes insipidus)
6. Cystometric studies (neurogenic bladder)
7. Circulation time (CHF)

Book Source Details

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

Other Book Chapters Related to Urinary symptoms

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Urinary symptoms

• Back to symptom: Urinary symptoms: Introduction (review 1071 causes)
• Next Book Extract About Urinary symptoms: URINE COLOR CHANGES (Differential Diagnosis in Primary Care)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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