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Dysuria

Contents
  1. Read book excerpt
  2. Urinary disorders: Introduction
  3. News
  4. Urinary disorders Overview
  5. More book excerpts for Urinary disorders

Dysuria: Excerpt from In a Page: Signs and Symptoms

Dysuria is a painful or burning sensation during or immediately after urination. This is a common symptom in primary care; nearly 20% of women aged 20–55 will have one episode of dysuria per year. Women have episodes of acute dysuria much more frequently than men. The most common cause of dysuria in adult women is lower urinary tract infection.

Differential Diagnosis

  • Lower urinary tract etiologies (male)
    –Infectious cystitis: E. coli (#1 cause), Staphylococcus saprophyticus, Proteus, Klebsiella, Enterococcus
    –Acute prostatitis
    –Benign prostatic hypertrophy
    –Epididymitis/urethritis: Chlamydia, gonorrhea, E. coli, staphylococcus aureus
    –External infections (e.g., herpes)
    –Allergic reaction to contraceptives, soaps, lotions
    –Malignancy (urethral or bladder cancer)
    –Urethral strictures
  • Lower urinary tract etiologies (female)
    –Infectious cystitis: E. coli (#1 cause), Staphylococcus saprophyticus, Proteus, Klebsiella, Enterococcus
    –Acute urethritis: Chlamydia, gonorrhea
    –Vaginitis: Candida, herpes
    –Atrophic vaginitis
    –Allergic reaction to contraceptives, soaps, lotions
    –Malignancy: Urethral cancer, bladder cancer
    –Urethral strictures
    –Vaginitis (Trichomonas, bacterial vaginosis)
    • Upper urinary tract etiologies
      –Pyelonephritis: Fever, chills, nausea, vomiting, and CVA tenderness
      –Urolithiasis: Acute onset of dysuria with associated flank pain, with or without hematuria
  • Reiter's syndrome
    –Genital ulcers, conjunctivitis, and arthritis
  • Noninfectious cystitis (e.g., drugs, radiation, granulomatous, allergic)
  • Behçet syndrome
    –Oral and genital ulcers, arthritis, and uveitis
  • Trauma
  • Rectal fissure
  • Psychogenic (e.g., conversion disorder)

    • Workup and Diagnosis

    • History and physical examination
    • Male genital exam with gonorrhea/chlamydia test, culture, Gram stain
      –Tender, boggy, swollen prostate suggests prostatitis (avoid prostatic massage, because of risk of bacteremia)
      –Tender epididymitis and testicles suggest infection
      –Generally enlarged prostate associated with nocturia and increasing frequency suggests BPH
    • Female genital exam with KOH prep, wet mount, Gram stain, and DNA tests/culture as indicated
      –Thin, papery vaginal tissue suggests atrophic vaginitis
      –Candida discharge is thick, cheesy, and white; pruritic
      –Chlamydia discharge is scant, watery and gradual onset
      –Gonorrhea discharge is profuse, yellow-green with abrupt onset, intracellular gram-negative diplococci
      –Bacterial vaginosis discharge is pruritic, with clue cells on wet mount and a fishy odor with KOH (whiff test)
      –Trichomonas discharge is frothy, grey-green, with pruritis and mobile organisms on wet mount
      • Urinalysis should be done in all patients
        –Hematuria suggests urolithiasis, pyelonephritis, or cystitis; painless hematuria suggests bladder cancer
        –Positive nitrites, leukocyte esterase, or WBCs with suprapubic tenderness suggests uncomplicated cystitis
      • Urine culture is indicated if positive urinalysis and in pregnant women, diabetic or immunocompromised patients, or males with urethral discharge

      Treatment

      • Cystitis/prostatitis: Appropriate antibiotics
        –Begin with empiric therapy and adjust to sensitivities
        –Noninfectious cystitis: Remove offending medications
        or allergens if possible
    • Pyelonephritis: Outpatient antibiotic treatment in patients who tolerate liquids and have no significant co-morbidities; otherwise, admit for IV hydration and antibiotics
    • Urolithiasis: Hydration, pain control while attempting to pass stones; urology referral if stones will not pass
    • Atrophic vaginitis: Consider estrogen creams or systemic replacement if other symptoms
    • BPH: Symptomatic relief with α-blockers, 5α-reductase-inhibitors, or saw palmetto extract
    • Sexually transmitted diseases
      –Treat specific etiology and screen for coexistent STDs (e.g., HIV, hepatitis B)

    Book Source Details

    • Book Title: In a Page: Signs and Symptoms
    • Author(s): Scott Kahan, Ellen G. Smith
    • Year of Publication: 2004
    • Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

    More About Urinary disorders

    More Medical Textbooks Online about Urinary disorders

    Review other book chapters online related to Urinary disorders:

    Medical Books Excerpts
    • DYSURIA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • NOCTURIA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • POLYURIA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • PROTEINURIA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • Dysuria
    • "In a Page: Signs and Symptoms" (2004)
    • [ read ]
    • Dysuria
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • DYSURIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • NOCTURIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • POLYURIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • Nocturia
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Polyuria
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Polyuria
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Dysuria
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Nocturia
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Polyuria
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Dysuria
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Nocturia
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Proteinuria
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Urethral Discharge
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Urinary Incontinence
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Dysuria
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Polyuria
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Bladder distention
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Dysuria
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Nocturia
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Polyuria
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Dysuria
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Proteinuria
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Dysuria
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Nocturia
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Polyuria
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • DYSURIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • NOCTURIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • POLYURIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
     

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



    More About This Book:
    Title: In a Page: Signs and Symptoms
    Authors: Scott Kahan, Ellen G. Smith
    Publisher: Lippincott Williams & Wilkins
    Copyright: 2004
    ISBN: 1-4051-0368-X

     » Next page: Polyuria (In a Page: Signs and Symptoms)

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