Dysuria resident survival guide: Difference between revisions

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__NOTOC__
__NOTOC__


{{CMG}}; {{AE}} {{IQ}} {{RAB}}
{{CMG}}; {{AE}} {{RAB}}
==Overview==
==Overview==
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
[[Dysuria]] is typically described to be a burning, [[tingling]], or [[stinging]] sensation of the [[urethra]] and [[meatus]] associated with [[voiding]]. [[Dysuria]] refers to [[painful]] [[urination]]. It is most often a result of an [[infection]] of the [[urinary tract]]. Noninfectious [[inflammatory]] [[causes]] include a foreign body in the [[urinary]] tract and [[Dermatologic disorders|dermatologic]] [[conditions]] such as [[Herpes simplex|herpes]], [[Dermatitis|irritant dermatitis]], erosive, [[lichen planus]], [[Contact dermatitis|contact dermatitis]]. It may also be due to an [[sexually transmitted diseases]], [[bladder]] [[stones]], [[bladder tumors]] and any [[condition]] of the [[prostate]]. It can also occur as a [[side effect]] of [[medications]]. It is one of the constellations of irritative bladder [[symptoms]], which includes the frequency of urination and [[haematuria]].  


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening [[causes]] of dysuria include:
* [[Life threatening cause 1]]
*[[Stevens-Johnson syndrome overview|Stevens–Johnson syndrome]]
* [[Life threatening cause 2]]
*[[Toxic epidermal necrolysis]]
* [[Life threatening cause 3]]
The aforementioned [[conditions]] may result in death or permanent disability within 24 hours if left untreated.
 
===Common Causes===
===Common Causes===
* [[Common cause 1|Acute cystitis]]
Common causes include: <ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref>
*Urethritis from sexually transmitted infections  
*[[Cystitis|Acute Cystitis]]
**Gonorrhea
*[[Urethritis]] from [[Sexually transmitted disease|sexually transmitted infections]]
**Chlamydia
**[[Gonorrhea]]
**Trichomoniasis
**[[Chlamydia infection|Chlamydia]]
*Female genital structure related
**[[Trichomoniasis]]
**Vulvo-Vaginitis
*Female genital structure related<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref>
***Trichomoniasis
**[[Vulvovaginitis|Vulvo-Vaginitis]]
***Bacterial vaginosis
***[[Trichomoniasis]]
***Candidal infections
***[[Bacterial vaginosis]]
***Atrophic vaginitis
***[[Candidiasis|Candidal infections]]
**Cervicitis
***[[Atrophic vaginitis]]
*Male genital Structire related
**[[Cervicitis]]
**Prostatitis
**[[Pelvic inflammatory disease|Pelvic Inflammatory Disease]]
**Epididymo-orchitis
*Male genital Structure related<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref>
**Urethral Stricture
**[[Balanitis]]
**Bening prostatic hyperplasia
**[[Prostatitis]]
* Foreign Body in urinary tract
**[[Epididymoorchitis|Epididymo-orchitis]]
**Indwelling Foley catheter
**[[Benign prostatic hyperplasia]]
* Foreign Body in urinary tract<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref>
**Indwelling [[Foley catheter]]
**Stone
**Stone
*Pyelonephritis
**Urethral or ureteral [[stent]]
*Dermatological
*[[Pyelonephritis]]
**Herpes
*[[Stricture|Urethral Stricture]]
**Irritant contact dermatitis
*Dermatological<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref>
**Erosive lichen planus
**[[Herpes simplex|Herpes]]
**Contact Dermatitis
**[[Dermatitis|Irritant dermatitis]]
**Erosive [[lichen planus]]
**[[Contact dermatitis|Contact Dermatitis]]
*Local trauma
*Local trauma
*Medication use
*Medication use
**Cyclophosphamide
**[[Cyclophosphamide]]
*Neoplasia
*Neoplasia
**Bladder Carcinoma
**[[Bladder cancer|Bladder Carcinoma]]
**Renal Cell Carcinoma
**[[Renal cell carcinoma|Renal Cell Carcinoma]]
 
==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
*Shown below are two algorithms summarizing the diagnosis of [[Dysuria]]
{{familytree/start |summary=PE diagnosis Algorithm.}}
=====Diagnostic Approach in Women=====
{{familytree | | | | A01 | | | A01= }}
Algorithm showing the [[diagnosis]] of dysuria in woman: <ref name="urlDysuria, Frequency, and Urgency - Clinical Methods - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK291/ |title=Dysuria, Frequency, and Urgency - Clinical Methods - NCBI Bookshelf |format= |work= |accessdate=}}</ref> <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref>
{{familytree | | | | |!| | | | }}
 
{{familytree | | | | B01 | | | B01= }}
<span style="font-size:85%">'''Abbreviations:''' '''ER''':[[Emergency room]],'''KUB USS''' :Kidney and Bladder Ultrasound study,'''[[PVR]]''': Post-void residual urine,'''USG''' : [[Ultrasonography]]
{{familytree | | |,|-|^|-|.| | }}
 
{{familytree | | C01 | | C02 | C01= | C02= }}
 
{{Family tree/start}}
{{Family tree | | | | | | | A01 | | | |A01=Woman with dysuria}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B01 | | | |B01= Take complete history}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 27em; width: 19em; padding:1em;"> '''Presence of:'''<br>
----
❑ Comcomitant [[fever]] <br><br/>❑ [[Flank pain]] <br><br/>❑ Abnormal vital signs:
:❑ [[Tachycardia]] <br><br/>
:❑ [[Tachypnea]] <br><br/>
:❑ [[Hypotension]]<br><br/>
❑ [[Nausea]]<br><br/>
❑ [[Vomiting]] </div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | |,|-|-|-|^|-|-|-|.| }}
{{Family tree | | | |!| | | | | | | |!| }}
{{Family tree | | | C03 | | | | | | C04 |C03= Yes|C04=No}}
{{Family tree | | | |!| | | | | | | |!| }}
{{Family tree | | | D04 | | | | | | R08 |D04='''Refer the [[patient]] to ER'''|R08=[[Urine Dipstick]] for [[Nitrites]] and [[Leukocytes]]}}
{{Family tree | | | | | | | | | | | |!| }}
{{Family tree | | | | | | | | | | | |!| | | | | | | | | | | | |}}
{{Family tree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | |}}
{{Family tree | | | | |!| | | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |}}
{{Family tree | | | | |!| | | | | | |!| | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | R09 | | | | T09 | | | | | | | | | | | P09 | | | | | | | | | |R09='''[[Nitrite]] Postitive'''|T09='''[[Leukocytes]] positive''','''[[Nitrite]] negative'''|P09='''Both [[Nitrite]] and [[Leukocyte]] negative'''| }}
{{Family tree | | | | | |!| | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree | | | | | |!| | | | | y09 | | | | | | | | | | | |!| | | | | | | | | | | | |y09=[[Urine]] culture}}
{{Family tree | | | | | R09 | | |,|-|^|-|-|.| | | | | | | | | U09 | | | | |R09=Empirical [[Antibiotic]] Therapy|U09=Urine [[Culture]]}}
{{Family tree | | | | | | | | | P08 | | | O08 | | | | | | | | |!| |P08='''Positive'''|O08='''Negative'''}}
{{Family tree | | | | | | | | | |!| | | | |!| | | | | | | | | |!| | |}}
{{Family tree | | | | | | | | | |!| | | | |!| | | | | | | | | |!| | |}}
{{Family tree | | | | | | | | | R09 | | | |!| | | | | | | | | |!| |R09=Treat with Specific [[Antibiotic]]}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | |,|^|-|-|-|.| | |}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | o09 | | | p09 | | | |o09='''Postive'''|p09='''Negative'''}}
{{Family tree | | | | | | | | | |,|-|-|-|-|^|-|-|-|.| | | | |!| | | | |!| | }}
{{Family tree | | | | | | | | | P08 | | | | | | | O08 | | | p09 | | | |!| |P08= Presence of any [[Urethral discharge]]/[[Itching]]|O08=Acid urine pH/history of [[Tuberculosis]]|p09= Treat with Specific [[antibiotic]]}}
{{Family tree | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | |!|}}
{{Family tree | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | |!|}}
{{Family tree | | | | | | | | | R09 | | | | | | | P09 | | | | | | | | i09 |i09=Think of any other non-infectious [[urogenital]] [[disease]] or [[vulvo-vaginal disease]]|R09=Do [[Swab]] test|P09=Urine speicific test for [[tuberculosis]]}}
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| | |}}
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | p09| | |p09='''Refer the patient to [[urologist]]/[[gynaecologist]]'''}}
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | p09 | | | | | | | | | | | | | | | | | | | | | |p09=<div style="float: left; text-align: left; height:15em; width: 28em; padding:1em;">[[Urethritis]] due to:<br>❑ [[Chlamydia trachomatis]]<br><br/>❑ [[Neisseria gonorrhea]]<br><br/>❑ [[Herpes simplex virus]]}}
{{Family tree/end}}
 
If the female patient presents with a slow urine stream without any pain or [[burning]] sensation, then the algorithm below can be used to treat the patient<br>
 
{{Family tree/start}}
{{Family tree | | | | | | A01 | | | |A01= Female patient with only [[voiding symptoms]]}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | B01 | | | |B01= Take complete history<br/>Ask about voidal habits: <br>❑[[Urinary frequency]]<br> ❑Interval between two consecutive [[micturation]]<br/>}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | A01 | | | |A01= ❑Physical examination <br/><br/>[[Suprapubic]] palpation and Vaginal examination}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | B01 | | | |B01= ❑Urine [[culture]] <br/><br/>❑ Kidney and Bladder [[Ultrasound]] study ([[KUB]] [[USS]])}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | |,|-|-|-|+|-|-|-|v|-|-|-|-|-|.|}}
{{Family tree | | |!| | | |!| | | |!| | | | | |!|}}
{{Family tree | | p09 | | o09 | | u09 | | | | s09 | |p09=Increased [[Detrusor]] wall thickness|o09=Bladder [[diverticula]]|u09=Increased [[post void residual]](>100)|s09=[[Hydronephrosis]] }}
{{Family tree | | |!| | | |!| | | |!| | | | | |!| |}}
{{Family tree | | |`|-|-|-|+|-|-|-|^|-|-|-|-|-|'}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | o09 | | | | |o09='''Refer to [[urologist]]''' }}
{{Family tree/end}}
 
=====Diagnostic Approach in Men=====
 
Algorithm showing the diagnosis of [[dysuria]] in Male patients: <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref>
 
<span style="font-size:85%">'''Abbreviations:''' '''ER''':[[Emergency room]], '''KUB USS''' :Kidney and Bladder Ultrasound study, '''[[PVR]]''': Post-void residual urine, '''USG''' : [[Ultrasonography]], '''NAAT''': Nucleic Acid Amplification Test, '''PCR''': Polymerase chain reaction, '''ESR''':Erythrocyte sedimentation rate, '''CRP''': C-reactive protein , '''HLA''':Human leukocyte antigen


{{Family tree/start}}
{{Family tree | | | | | | | | A01 | | | |A01= Male patient with [[dysuria]]}}
{{Family tree | | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | | B01 | | | |B01= Take complete history}}
{{Family tree | | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | | B02 | | | |B02= Presence of [[urethral discharge]]}}
{{Family tree | | | | | | | | |!| | | | | }}
{{Family tree | | | |,|-|-|-|-|^|-|-|-|.| }}
{{Family tree | | | |!| | | | | | | | |!| }}
{{Family tree | | | C03 | | | | | | | C04 |C03= Yes|C04=No| }}
{{Family tree | | | |!| | | | | | | | |!| }}
{{Family tree | | | D04 | | | | | | | R08 | |D04=Ask about the discharge|R08=Presence Of Genital Lesion| }}
{{Family tree | | | |!| | | | | | | | |!| }}
{{Family tree | | |,|^|-|-|.| | |,|-|-|^|-|-|-|-|-|-|-|-|-|-|.| }}
{{Family tree | | |!| | | |!| | H08 | | | | | | | | | | | | H09 |H08=Yes|H09=NO }}
{{Family tree | | E05 | | E06 | |!| | | | | | | | | | | | | |!||E05=Profuse,purulent discharge <br/>
Yellowish green colour|E06=Thin,mucoid/[[mucopurulent]] discharge| }}
{{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!| |}}
{{Family tree | | F05 | | F06 | |!| | | | | | | | | | | | | |!|F05=[[Swab]] test |F06=Swab test }}
{{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!|}}
{{Family tree | | G07 | | G08 | |!| | | | | | | | | | | | | |!|G07=Gram negative Diplococci|G08=[[NAAT]]/[[PCR]] test }}
{{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!|}}
{{Family tree | | H08 | | H09 | |!| | | | | | | | | | | | | |!|H08=[[Gonorrhoea]]|H09=[[Chlamydia]]}}
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | |!|}}
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | |!|}}
{{Family tree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | | | |!| | | | |}}
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | |}}
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | |}}
{{Family tree | | R09 | | | | | T09 | | | | | | P09 | | | | |!| | | | | |R09=Inflammation of the [[glans penis]]|T09=[[Ulcer]]|P09=Painful [[Vesicles]]| }}
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | | | | |}}
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!|| | | | | | | | | | | |}}
{{Family tree | | R09 | | | |,|-|^|-|-|.| | | | U09 | | | | |!|R09=[[Balanitis]]|U09=[[Herpes]]| | | | | | | | | |}}
{{Family tree | | | | | | | P08 | | | O08 | | | | | | | | | |!|P08=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Presence of:'''<br>
----
❑ Firm, painless, non-itchy skin [[ulceration]]<br/><br> ❑ Multiple [[sore]]s<br/><br/>❑ A diffuse rash  involving the palms of the hands and soles of the feet<br/><br/>❑ Presence of [[gumma]]s  <br><br/> </div>|O08=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Presence of:'''<br>
----
❑ Painless genital ulcer <br/><br> ❑ [[Anorectal pain]] <br><br/> ❑  [[Tenesmus]]<br/><br> ❑[[Rectal discharge]]  <br/><br> ❑ Rectal discharge,[[Inguinal lymphadenopathy]] </div>}}
{{Family tree | | | | | | | |!| | | | |!| | | | | | | | | | |!| |}}
{{Family tree | | | | | | | |!| | | | |!| | | | | | | | | | |!| | |}}
{{Family tree | | | | | | | R09 | | | P09 | | | | | | | | | |!|R09=[[Syphilis]]|P09=[[Lymphogranuloma venereum]] (LGV) }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | I09 | | | | | | | | |I09=Presence of any Localized Pain}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | y09 | | | | | | | | | | p09 | | | | | | |y09=Yes|p09=No}}
{{Family tree | | | | | | | | | | | | | | | | | |!| | | | | | | |}}
{{Family tree | | | | | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| | | | | | | |}}
{{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!|}}
{{Family tree | | | | | | | | | | W09 | | | | | A09 | | | | T09 | | | | | | |W09= ❑[[Suprapubic pain]]|A09= ❑[[Flank pain]]<br/><br/>❑[[Costovertebral angle]] [[tenderness]]<br/><br/>❑[[Fever|Fever]]|T09=Joint pain}}
{{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | u09 | | | | | t09 | | | | p09 | | | | | | | | | | | |u09=[[Urine Analysis]]|t09=USG|p09= ❑[[X-ray]]<br/> ❑[[ESR]]/[[CRP]]<br/> ❑[[HLA-B27]]}}
{{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!| | | | | | | | | |}}
{{Family tree | | | | | | | | | | y09 | | | | | i09 | | | | u09 | | | | | | | | | | | | |y09=[[Cystitis]]|u09=[[Spondyloarthropathy]]|i09=[[Pyelonephritis]]}}
{{familytree/end}}
{{familytree/end}}


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
=====Treatment in Women=====
Shown below is an algorithm summarizing the treatment of [[Dysuria]] in female patients: <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref>
 
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01= }}  
{{familytree | | | | | | | | A01 | | | | | | | |A01=[[Symptoms]] of lower urinary tract }}  
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
{{familytree | | | | B01 | | | | | | | B02 | | |B01=Non recurrent |B02=<div style="float: left; text-align: left; height: 8em; width: 20em; padding:1em;">Recurrent <br/>❑ At least 3 episodes of uncomplicated [[UTI]] in 12 months<br/><br/>❑ With at least one positive by urine culture}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | | |!| | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
{{familytree | | |,|-|^|-|.| | | | | | |!| }}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | | D01 | | D02 | | | | | p09 |p09=Modify Lifestyle to intervene modifiable riskfactors and take prophylaxis|D01=Uncomplicated<br/> Without any risk factors|D02=<div style="float: left; text-align: left; height:28em; width: 30em; padding:1em;">'''Complicated :Presence of any of the following [[risk factors]]:'''<br>
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
----
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
❑ Presence of indwelling catheter <br><br/> ❑ [[Vesico-ureteric reflux]] <br><br/> ❑ Increased [[post void residual]] urine<br/><br> ❑ Increased post void residual urine<br/> <br> ❑ Presence of diseases:<br/>
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
:❑ [[Renal insufficiency]]<br/><br/>
{{familytree | | | | | | | | | | |!| | | | |!| }}
:❑ [[Diabetes mellitus]]<br/><br/>
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
:❑ [[Immunodeficiency]]<br/><br/>
❑ [[Obstructive Uropathy]] </div>}}
{{familytree | | |!| | | |!| | | | | | |!| | | }}
{{familytree | | E01 | | u09 | | | | | p09 | | |E01=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> Treatment with short term antibiotic therapy<br/> '''First line includes'''<br/> ❑ 3g oral dose of [[Fosfomycin]] trometamol<br/><br/> ❑ [[Pivmecillinam]] 400 mg twice a day for 3 days<br/><br/>❑ [[Nitrofurantoin]] 100mg twice a day for 5-7days <br/><br/> '''In case of <20% resistance rates for [[E.coli]]'''<br/>
❑ [[Cotrimoxazole]] 160/800 mg twice a day for 3 days<br/><br/> ❑[[Trimethoprim]] 200 mg twice a day for 5 days|u09=<div style="float: left; text-align: left; height: 24em; width: 30em; padding:1em;">❑ Specific antibiotic depending on urine culture <br/><br/>❑ Long Empeirical long term antibiotic([[Fluoroquinolone]]s,Third generation [[Cephalosporins]],[[Aminoglycoside]]s) for 10-14 days |p09=<div style="float: left; text-align: left; height: 24em; width: 30em; padding:1em;">'''Measurements to prevent recurrent UTI'''<br/><br/>❑ Low dose Antimicrobial [[prophylaxis]] continuously or after sexual intercourse <br/><br/>❑ Interventions on modifiable [[risk factors]]:<br/><br/>1.Avoid using [[spermicide]]<br/><br/>2.Maintain [[blood glucose]] level <br/><br/>3.Improving the treatment of [[urinary incontinence]] <br/><br/>4.Unspecific prophylaxis with [[cranberry]] extracts <br/><br/>5.Local hormonal therapy in case of post menopausal women|}}
{{familytree | | |!| | | |!| | | | | | |!| }}
{{familytree | | F01 | | F02 | | | | | |!|F01= Repeat urine [[culture]] in nonresponsive cases and pregnant women |F02= Repeat urine culture after treatment,[[KUB]] [[ultrasound]] with [[PVR]] measurement}}
{{familytree | | | | | | |!| | | | | | |!|}}
{{familytree | | | | | | o09 | | | | | 009 |o09='''Refer the patient to [[urologist]]'''|009=If all of the above fails }}
{{familytree | | | | | | | | | | | | | |!|}}
{{familytree | | | | | | | | | | | | | p09 |p09='''Refer to [[urologist]]'''}}
{{familytree/end}}
{{familytree/end}}
=====Treatment in Men=====
Treatment of dysuria in male patient: <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref>
{{Family tree/start}}
{{Family tree | | | | A01 | | | |A01=Male patient with dysuria}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01= Look for infection}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02 |C01= Presence of infection| C02=No infection}}
{{Familytree  | |!| | | | | | |!| | | | | }}
{{Familytree  | |o09| | | | |p09| | | | |p09=Further investigate to exclude [[Bladder cancinoma]] if <br/>❑ Patient is smoker<br/> or<br/>❑  H/o exposure to [[carcinogen]]<br/>or<br/>❑ Presence of [[Storage symptoms]] |o09=❑ Treatment with specific [[antibiotic]] for 7 days<br/>❑ If sensitivity tests are not available empirical treatment with  [[Quinolone]] }}
{{Familytree  | |!| | | | | | |!| | | | }}
{{Familytree  | |p09| | | | |l09| | | | |p09=Recurrent [[UTI]] or [[prostatitis]]|l09=Look for other non infective causes }}
{{Familytree  | |!| | | | | | | | |!| | | | }}
{{Familytree  | |p09| | | | |,|-|^|.| | | |p09='''Refer to [[Urologist]]'''| }}
{{Familytree  | | | | | | | | |!| | |!| | | }}
{{Familytree  | | | | | | | |k09| |u09| | |k09=Treat according to the specific cause|u09=No specific cause found, Suspect [[chronic pelvic pain syndrome]] ([[CPPS]]) }}
{{Familytree  | | | | | | | | | | | |!| | | }}
{{Familytree  | | | | | | | | | |,|-|^|-|-|-|-|.| }}
{{Familytree  | | | | | | | | | |!| | | | | | |!| }}
{{Familytree  | | | | | | | | | |p09| | |o09| | |p09=[[Quinolone]]-naive treatment|o09=Previously had treatment with [[Quinolones]] }}
{{Familytree  | | | | | | | | | |!| | | | | |!| }}
{{Familytree  | | | | | | | | |,|^|-|-|.| | |!| }}
{{Familytree  | | | | | | | |p09| |l09| |r09| | | |p09=No response for 4 weeks|l09=Response|r09=Apply UPOINT classification }}
{{Familytree  | | | | | | | | | |!| | | | | |!| }}
{{Familytree  | | | | | | | | | |p09| | | |)|j09|p09=Apply UPOINT classification|j09=Response }}
{{Familytree  | | | | | | | | | |!| | | | | |!| }}
{{Familytree  | | | | | | | | | |)|o09| | |`|h09|-|g09|o09=Response|h09=No response|g09=Refer to specialized pain clinic in Hospital }}
{{Familytree  | | | | | | | | | |!| | | | | | }}
{{Familytree  | | | | | | | | | |`|o09|-|p09| | |o09=No response|p09=Refer to specialized pain clinic in Hospital }}
{{Family tree/end}}
'''<big>UPOINT CLASSIFICATION</big>'''
{| style="border: 2px solid #4479BA; align="left"
! style="width: Phenotype Domains; background: #4479BA;" | {{fontcolor|#FFF|Phenotype Domains}}
! style="width: Clinical Features; background: #4479BA;" | {{fontcolor|#FFF|Clinical Features}}
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Urinary</big>'''
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Lower urinary tract [[symptoms]] that creates discomfort or High post-micturation residual volume
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Psychological</big>'''
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Patient]] with [[depression]] or severe [[anxiety]] thinking the worst will happen to them
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Organ-specific</big>'''
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Tenderness]]  in [[Prostate]], Presence of [[blood]] in [[ejaculation]],[[Leukocytes]] in [[prostatic]] fluid or post-massage urine
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Infectious</big>'''
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Infection]] with [[gram negative]] bacilli or [[Enterococcus|Enterococci]] localized to [[prostate]] or presence of [[Ureaplasma]] in urine
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Systemic</big>'''
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Pain]] anywhere else in the body except [[abdomen]] or [[pelvis]] or having a [[diagnosis]] of [[fibromyalgia]], chronic [[fatigue]] or i[[Irritable bowel syndrome|rritable bowel syndrome]]
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Tenderness</big>'''
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Presence of palpable [[muscle]] spams in [[abdomen]] or [[pelvic floor]]
|-
|-
|}
{{clear}}


==Do's==
==Do's==
* The content in this section is in bullet points.
Instruct the female [[patients]] to:<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref>
* Lose weight (if they are overweight or obese).
* Always stay hydrated.
* Urinate after sexual [[intercourse]].
* Always wipe front to back.
* Wear cotton/comfortable underwear.
* Use [[menstrual cup]]<nowiki/>s, sanitary pads, or clean period-proof underwear.
* Maintain personal [[hygiene]].


==Don'ts==
==Don'ts==
* The content in this section is in bullet points.
* Instruct the female [[patients]] not to delay in urinating.<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref>
* Avoid Smoking<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref>
* Avoid drinking the following items a lot:<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref>
** Caffeinated sodas
** Alcohol
** Spicy foods
** Acidic fruits


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 11:26, 7 March 2021

Dysuria
Resident Survival Guide
Overview
Causes
Diagnosis
Women
Men
Treatment
Women
Men
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Overview

Dysuria is typically described to be a burning, tingling, or stinging sensation of the urethra and meatus associated with voiding. Dysuria refers to painful urination. It is most often a result of an infection of the urinary tract. Noninfectious inflammatory causes include a foreign body in the urinary tract and dermatologic conditions such as herpes, irritant dermatitis, erosive, lichen planus, contact dermatitis. It may also be due to an sexually transmitted diseases, bladder stones, bladder tumors and any condition of the prostate. It can also occur as a side effect of medications. It is one of the constellations of irritative bladder symptoms, which includes the frequency of urination and haematuria.

Causes

Life Threatening Causes

Life-threatening causes of dysuria include:

The aforementioned conditions may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Common causes include: [1]

Diagnosis

  • Shown below are two algorithms summarizing the diagnosis of Dysuria
Diagnostic Approach in Women

Algorithm showing the diagnosis of dysuria in woman: [2] [3]

Abbreviations: ER:Emergency room,KUB USS :Kidney and Bladder Ultrasound study,PVR: Post-void residual urine,USG : Ultrasonography


 
 
 
 
 
 
Woman with dysuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of:

❑ Comcomitant fever

Flank pain

❑ Abnormal vital signs:

Tachycardia

Tachypnea

Hypotension

Nausea

Vomiting
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Refer the patient to ER
 
 
 
 
 
Urine Dipstick for Nitrites and Leukocytes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nitrite Postitive
 
 
 
Leukocytes positive,Nitrite negative
 
 
 
 
 
 
 
 
 
 
Both Nitrite and Leukocyte negative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine culture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Empirical Antibiotic Therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Culture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
 
Negative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat with Specific Antibiotic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Postive
 
 
Negative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of any Urethral discharge/Itching
 
 
 
 
 
 
Acid urine pH/history of Tuberculosis
 
 
Treat with Specific antibiotic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do Swab test
 
 
 
 
 
 
Urine speicific test for tuberculosis
 
 
 
 
 
 
 
Think of any other non-infectious urogenital disease or vulvo-vaginal disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Refer the patient to urologist/gynaecologist
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

If the female patient presents with a slow urine stream without any pain or burning sensation, then the algorithm below can be used to treat the patient

 
 
 
 
 
Female patient with only voiding symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
Ask about voidal habits:
Urinary frequency
❑Interval between two consecutive micturation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Physical examination

Suprapubic palpation and Vaginal examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Urine culture

❑ Kidney and Bladder Ultrasound study (KUB USS)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased Detrusor wall thickness
 
Bladder diverticula
 
Increased post void residual(>100)
 
 
 
Hydronephrosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Refer to urologist
 
 
 
 
Diagnostic Approach in Men

Algorithm showing the diagnosis of dysuria in Male patients: [3]

Abbreviations: ER:Emergency room, KUB USS :Kidney and Bladder Ultrasound study, PVR: Post-void residual urine, USG : Ultrasonography, NAAT: Nucleic Acid Amplification Test, PCR: Polymerase chain reaction, ESR:Erythrocyte sedimentation rate, CRP: C-reactive protein , HLA:Human leukocyte antigen

 
 
 
 
 
 
 
Male patient with dysuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of urethral discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about the discharge
 
 
 
 
 
 
Presence Of Genital Lesion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
NO
 
Profuse,purulent discharge
Yellowish green colour
 
Thin,mucoid/mucopurulent discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Swab test
 
Swab test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gram negative Diplococci
 
NAAT/PCR test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gonorrhoea
 
Chlamydia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Inflammation of the glans penis
 
 
 
 
Ulcer
 
 
 
 
 
Painful Vesicles
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Balanitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Herpes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of:

❑ Firm, painless, non-itchy skin ulceration

❑ Multiple sores

❑ A diffuse rash involving the palms of the hands and soles of the feet

❑ Presence of gummas

 
 
Presence of:

❑ Painless genital ulcer

Anorectal pain

Tenesmus

Rectal discharge

❑ Rectal discharge,Inguinal lymphadenopathy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Syphilis
 
 
Lymphogranuloma venereum (LGV)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of any Localized Pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Suprapubic pain
 
 
 
 
Flank pain

Costovertebral angle tenderness

Fever
 
 
 
Joint pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Analysis
 
 
 
 
USG
 
 
 
X-ray
ESR/CRP
HLA-B27
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cystitis
 
 
 
 
Pyelonephritis
 
 
 
Spondyloarthropathy
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Treatment in Women

Shown below is an algorithm summarizing the treatment of Dysuria in female patients: [3]

 
 
 
 
 
 
 
Symptoms of lower urinary tract
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non recurrent
 
 
 
 
 
 
Recurrent
❑ At least 3 episodes of uncomplicated UTI in 12 months

❑ With at least one positive by urine culture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Uncomplicated
Without any risk factors
 
Complicated :Presence of any of the following risk factors:

❑ Presence of indwelling catheter

Vesico-ureteric reflux

❑ Increased post void residual urine

❑ Increased post void residual urine

❑ Presence of diseases:

Renal insufficiency

Diabetes mellitus

Immunodeficiency

Obstructive Uropathy
 
 
 
 
Modify Lifestyle to intervene modifiable riskfactors and take prophylaxis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment with short term antibiotic therapy
First line includes
❑ 3g oral dose of Fosfomycin trometamol

Pivmecillinam 400 mg twice a day for 3 days

Nitrofurantoin 100mg twice a day for 5-7days

In case of <20% resistance rates for E.coli
Cotrimoxazole 160/800 mg twice a day for 3 days

Trimethoprim 200 mg twice a day for 5 days
 
❑ Specific antibiotic depending on urine culture

❑ Long Empeirical long term antibiotic(Fluoroquinolones,Third generation Cephalosporins,Aminoglycosides) for 10-14 days
 
 
 
 
Measurements to prevent recurrent UTI

❑ Low dose Antimicrobial prophylaxis continuously or after sexual intercourse

❑ Interventions on modifiable risk factors:

1.Avoid using spermicide

2.Maintain blood glucose level

3.Improving the treatment of urinary incontinence

4.Unspecific prophylaxis with cranberry extracts

5.Local hormonal therapy in case of post menopausal women
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat urine culture in nonresponsive cases and pregnant women
 
Repeat urine culture after treatment,KUB ultrasound with PVR measurement
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Refer the patient to urologist
 
 
 
 
If all of the above fails
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Refer to urologist
Treatment in Men

Treatment of dysuria in male patient: [3]

 
 
 
Male patient with dysuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look for infection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of infection
 
 
 
No infection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Treatment with specific antibiotic for 7 days
❑ If sensitivity tests are not available empirical treatment with Quinolone
 
 
 
 
Further investigate to exclude Bladder cancinoma if
❑ Patient is smoker
or
❑ H/o exposure to carcinogen
or
❑ Presence of Storage symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Recurrent UTI or prostatitis
 
 
 
 
Look for other non infective causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Refer to Urologist
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat according to the specific cause
 
No specific cause found, Suspect chronic pelvic pain syndrome (CPPS)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Quinolone-naive treatment
 
 
Previously had treatment with Quinolones
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No response for 4 weeks
 
Response
 
Apply UPOINT classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Apply UPOINT classification
 
 
 
 
 
Response
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Response
 
 
 
 
No response
 
Refer to specialized pain clinic in Hospital
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No response
 
Refer to specialized pain clinic in Hospital
 
 
 
 



UPOINT CLASSIFICATION


Phenotype Domains Clinical Features
Urinary Lower urinary tract symptoms that creates discomfort or High post-micturation residual volume
Psychological Patient with depression or severe anxiety thinking the worst will happen to them
Organ-specific Tenderness in Prostate, Presence of blood in ejaculation,Leukocytes in prostatic fluid or post-massage urine
Infectious Infection with gram negative bacilli or Enterococci localized to prostate or presence of Ureaplasma in urine
Systemic Pain anywhere else in the body except abdomen or pelvis or having a diagnosis of fibromyalgia, chronic fatigue or irritable bowel syndrome
Tenderness Presence of palpable muscle spams in abdomen or pelvic floor

Do's

Instruct the female patients to:[4]

  • Lose weight (if they are overweight or obese).
  • Always stay hydrated.
  • Urinate after sexual intercourse.
  • Always wipe front to back.
  • Wear cotton/comfortable underwear.
  • Use menstrual cups, sanitary pads, or clean period-proof underwear.
  • Maintain personal hygiene.

Don'ts

  • Instruct the female patients not to delay in urinating.[4]
  • Avoid Smoking[4]
  • Avoid drinking the following items a lot:[4]
    • Caffeinated sodas
    • Alcohol
    • Spicy foods
    • Acidic fruits

References

  1. 1.0 1.1 1.2 1.3 1.4 Michels TC, Sands JE (November 2015). "Dysuria: Evaluation and Differential Diagnosis in Adults". Am Fam Physician. 92 (9): 778–86. PMID 26554471.
  2. "Dysuria, Frequency, and Urgency - Clinical Methods - NCBI Bookshelf".
  3. 3.0 3.1 3.2 3.3 Gontero, Paolo; Kirby, Roger S.; Carson III, Culley C. (2013). doi:10.1007/978-1-4471-4634-6. Missing or empty |title= (help)
  4. 4.0 4.1 4.2 4.3 Gungor, Ilkay; Beji, Nezihe Kizilkaya (2011). "Lifestyle changes for the prevention and management of lower urinary tract symptoms in women". International Journal of Urological Nursing. 5 (1): 3–13. doi:10.1111/j.1749-771X.2011.01112.x. ISSN 1749-7701.