Causes of Urinary stones
List of causes of Urinary stones
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Urinary stones)
that could possibly cause Urinary stones includes:
Urinary stones Causes: Book Excerpts
Urinary stones as a complication of other conditions:
Other conditions that might have
Urinary stones as a complication may,
potentially, be an underlying cause of Urinary stones.
Our database lists the following as having
Urinary stones as a complication of that condition:
Urinary stones as a symptom:
Conditions listing Urinary stones
as a symptom may also be potential underlying causes of Urinary stones.
Our database lists the following as having
Urinary stones as a symptom of that condition:
Related information on causes of Urinary stones:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Urinary stones may be found in:
Causes of Urinary stones: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Urinary stones.
Dysuria:
Differential Diagnosis
(In a Page: Signs and Symptoms)
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)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Urinary Stream (Decreased):
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Benign prostatic hyperplasia
-
–Most common cause of decreased urinary stream in men >40
Urethral stricture
–May be congenital or acquired
-
Chronic urethritis
–May be secondary to stricture or chronic infection
Prostate cancer
–More frequent in men >40
-
Neuropathic bladder
–Spinal cord trauma
–Herniated disc
–Multiple sclerosis
–Spina bifida
–CVA
–Parkinson's disease
–Nerve injury secondary to pelvic surgery
-
(e.g., prostatectomy)
-
Bladder neck contracture
–May be congenital or acquired
(e.g., post-prostatectomy)
Urethral or bladder foreign body
Bladder stones
Bladder neck cancer
Urethral cancer
Urethral polyp
Posterior urethral valves
–Frequently presents with recurrent UTIs
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Dysuria:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Urinary tract infection (UTI)
–Common cause of dysuria in children
–Common pathogens: bacteria including
E. coli (85%), Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa
and other gram negatives
-
Sexually transmitted disease (STD)
–Gonorrhea, Chlamydia, Trichomonas
–Very common in sexually active patients
–More common in girls
-
Bacterial vaginosis
–Gardnerella or Mobiluncus spp, may be sexually or nonsexually transmitted
-
Candidal vaginitis
–Common after antibiotic treatment
-
Local urethral irritation
–Pinworms
–Irritative dermatitis (e.g., bubble bath)
–Diarrhea
-
Hemorrhagic cystitis
–Typically viral in origin
–Sudden in onset
-
Macroscopic blood in the urine from any cause, causing urethral irritation
-
Periurethral herpes simplex
-
Periurethral varicella
-
Hypercalciuria
–Dysuria and urinary frequency
-
Kidney stone (within the urethra)
-
Renal tuberculosis (rare)
–Typically asymptomatic
–Sterile pyuria
-
Prostatitis (uncommon)
–Can affect adolescent boys
–Gonorrhea is the most common cause
-
Trauma to the perineum
–Sexual abuse
–Masturbation
-
Meatal ulceration
–In boys, may occur from contact with diapers
-
Pelvic abscess, including appendicitis
-
Drugs
–Amitriptyline hydrochloride (antidepressant)
-
Reiter disease
–Uncommon in children
–Triad of arthritis, urethritis, and
conjunctivitis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Bladder distention:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Benign prostatic hyperplasia (BPH). With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
❑ Bladder calculi. Bladder calculi may produce bladder distention, but more commonly produce pain as the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
❑ Bladder cancer. By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
CULTURAL CLUE: Bladder cancer is twice as common in Whites as in Blacks. It's relatively uncommon among Asians, Hispanics, and Native Americans.
❑ Multiple sclerosis. With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from the interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte's sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski's sign, and ataxia.
❑ Prostate cancer. Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
CULTURAL CLUE: Prostate cancer is more common in blacks than in other ethnic groups.
❑ Prostatitis. With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; a tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare. However, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and a dull pain radiating to the lower back, buttocks, penis, or perineum.
❑ Spinal neoplasms. Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
❑ Urethral calculi. With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
❑ Urethral stricture. Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
❑ Catheterization. Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
❑ Drugs. Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Urinary hesitancy:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Benign prostatic hyperplasia (BPH)
Signs and symptoms of BPH depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostatic cancer
In patients with advanced cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
Urinary tract infection
Urinary hesitancy may be associated with urinary tract infection. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy may also occur in those recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bladder distention:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia (BPH)
In BPH, bladder distention develops gradually as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but pain is usually the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It’s usually most severe when micturition ceases. The pain may be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Cultural Cue: Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
In this neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. In some patients, urine retention and bladder distention are the only signs.
Cultural Cue: Prostate cancer is more common in Blacks than in other ethnic groups.
Prostatitis
In acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and a sensation of suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Bladder distention is rare in chronic prostatitis, which may be accompanied by perineal discomfort, a sensation of suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that often mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
In urethral calculi, urethral obstruction leads to interrupted urine flow and bladder distention. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation due to catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Appendicitis
Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer
In this predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
Cultural Cue: Bladder cancer is twice as common in White males as in Blacks. It’s relatively uncommon in Asians, Hispanics, and Native Americans.
Cystitis
Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, a low-grade fever. In chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. In viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.
Gender Cue: Women are more prone to develop cystitis than men because they have a shorter urethra. For men, age is a factor: Older men have a 15% higher risk of developing cystitis.
Diverticulitis
Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.
Paraurethral gland inflammation
Dysuria throughout voiding is accompanied by urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria in this disorder.
Prostatitis
Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. In chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute)
More common in females than in males, this disorder causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter’s syndrome
In this predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urethral syndrome
Occurring in sexually active women, this syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and low back and unilateral flank pain. In the absence of pyuria, symptoms will usually resolve without intervention.
Urethritis
Primarily found in sexually active males, this infection causes dysuria throughout voiding. It’s accompanied by a reddened meatus and a copious, yellow, purulent discharge (gonorrheal infection) or a white or clear mucoid discharge (nongonorrheal infection).
Urinary obstruction
Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (In a complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features are diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis
Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants
Dysuria may result from irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes as well as urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs
Monoamine oxidase inhibitors and metyrosine can cause dysuria.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary hesitancy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia
Signs and symptoms of this disorder depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of the urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream, and occasionally urine retention. As the obstruction increases, the patient may develop urinary frequency, nocturia, urinary overflow, incontinence, bladder distention and, possibly, hematuria.
Prostate cancer
In advanced cancer, urinary hesitancy may occur along with frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from urine retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI
Urinary hesitancy may be associated with UTIs. Characteristic urinary changes include frequency, dysuria, nocturia, cloudy urine and, possibly, hematuria. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy also may occur in patients recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Lower urinary tract infection
❑ Acute pyelonephritis
❑ Urethritis
❑ Vaginitis
❑ Acute prostatitis
❑ Urethral calculus
❑ Reiter syndrome
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Bladder distention:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
See Bladder distention: Causes and associated findings, pages 46 and 47.
Benign prostatic hyperplasia (BPH)
With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but more commonly it produces pain as its only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis (MS)
With MS, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, a boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare. However, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that usually mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bladder distention:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
With benign prostatic hyperplasia (BPH), bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
CULTURAL CUE:Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Appendicitis
Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer
In bladder cancer, a predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
CULTURAL CUE:Bladder cancer is twice as common in White males as in Black males. It’s relatively uncommon in Asians, Hispanics, and Native Americans.
Cystitis
Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.
Diverticulitis
Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.
Paraurethral gland inflammation
Dysuria throughout voiding occurs with urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis
Acute prostatitis commonly causes dysuria throughout or toward the end of voiding. Dysuria may be accompanied by a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation.
With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects include urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute)
More common in females, acute pyelonephritis causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter’s syndrome
With Reiter’s syndrome, a predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urethral syndrome
Occurring in sexually active women, urethral syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and lower back and unilateral flank pain. In the absence of pyuria, symptoms usually resolve without intervention.
Urethritis
Primarily found in sexually active males, urethritis causes dysuria throughout voiding. It’s accompanied by a reddened meatus and copious, yellow, purulent discharge (gonorrheal infection) or white or clear mucoid discharge (nongonorrheal infection).
Urinary obstruction
Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features include diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis
Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants
Dysuria may be caused by contact with irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs
Dysuria can result from monoamine oxidase inhibitor use. Metyrosine can also cause transient dysuria.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary hesitancy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
Characteristic early findings of benign prostatic hyperplasia (BPH) include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostate cancer
In patients with advanced prostate cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
Urinary tract infection
Urinary hesitancy may be associated UTI. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Urinary hesitancy also may occur in those recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Principal Causes of Dysuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Urinarytract infection
- Urethritis
- Cystitis
- Pyelonephritis
- Chemical irritation
- Diaper dermatitis
- Trauma
- Psychogenic
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Bladder distention:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi.Bladder calculi may produce bladder distention, but more commonly pain is the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer.By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis.With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from the interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte's sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski's sign, and ataxia.
Prostate cancer.Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis.With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; a tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare; however, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and a dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms.Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi.With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture.Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization.Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs.Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Dysuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Appendicitis.Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney's point, anorexia, nausea, vomiting, constipation, a slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer.Bladder cancer, a predominantly male disorder, causes dysuria throughout voiding—a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
Cystitis.Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, a low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and a fever.
Paraurethral gland inflammation.Dysuria throughout voiding occurs with urinary frequency and urgency, a diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis.Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, a fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; a diminished urine stream; perineal, back, and buttock pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute).Pyelonephritis causes dysuria throughout voiding. Other features include a persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter's syndrome.Reiter's syndrome is a disorder in which dysuria occurs 1 or 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and a low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urinary obstruction.Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features are a diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis.Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia with vaginitis. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants.Dysuria may result from irritating substances, such as bubble bath salts and feminine deodorants; it's usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs.Dysuria can result from monoamine oxidase inhibitors. Metyrosine can also cause transient dysuria.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary hesitancy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).Signs and symptoms of BPH depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostatic cancer.In patients with advanced prostate cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion.A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture.Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI.Urinary hesitancy may be associated with a UTI. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs.Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy may also occur in those recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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