Abnormalities in micturition

Micturation Abnormalities Microchapters
Overview
Causes
Differential Diagnosis

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

Classification

• There is no established system for the classification of abnormalities in micturition.

Causes

• The causes of abnormalities in micturition includes causes of dysuria and incontinence:

Abnormalities of Micturition Differential Diagnosis

Differentiating the diseases that can cause abnormality in micturition:

Abbreviations: N= Normal, UTI= Urinary tract infection, CBC= Complete blood count, CT= Computed tomography, IBS= Irritable bowel syndrome, DRE= Digital rectal examination, HSV= Herpes simplex virus,

Diseases			Clinical manifestations									Para-clinical findings					Gold standard	Additional findings
			Symptoms						Physical examination
												Lab Findings			Imaging
			Fever	Urinary symptoms					Supra-pubic tenderness	Skin lesions	Other	CBC	Electrolytes	Urinalysis	Ultrasonography	CT scan
				Dysuria	Frequency	Dribbling	Hesitancy	Nocturia
Inflammatory	Dermatological disorders	Lichen sclerosus	–	+	–	–	+	–	–	Lichenified plaques	–	N	N	often shows UTI in women	N	N	Biopsy	Constipation IBS
		Behcet's syndrome	–	+	+	–	+	+	–	Erythema nodosum Papules Vesicles	aphthous ulcer in mouth	N	N	N	N	N	None	Neurogenic bladder Genital aphthous ulcers Recurrent cystitis Epididymitis Urethritis
	Infectious diseases	Cystitis	+	+	+	+	+	+	+	N	–	Leukopenia	N	WBC Leukocyte esterase Ntrite	Bladder wall thickening Intraluminal gas in emphysematous cystitis	hydronephrosis beaded necklace like in emphysematous cystitis	Urine culture to sensitivity	N
		Urethritis	+	+	+	–	+	–	+	Keratoderma blennorrhagica- in disseminated gonococcal infection Vesicles - HSV Painless ulcer- syphilis Warts- Condyloma acuminatum	–	Leukocytosis	N	N	N	N	Urethral swab for culture, NAAT	N
		Pyelonephritis	+	+	+	–	–	+	±	N	Urgency	Leukocytosis	Hyperkalemia	WBC Leukocyte esterase Ntrite	Hypoechoic when there is edema(swollen kidney) Gas buubles in emphysematous pyelonephritis
		Diseases	Fever	Dysuria	Frequency	Dribbling	Hesitancy	Nocturia	Suprapubic tenderness	Skin lesions	Other	CBC	Electrolytes	Urinalysis	Ultrasonography	CT scan	Gold standard	Additional findings
		Vulvovaginitis	±	+	+	+	+	–	–	Excoriations in vulva Genital ulceration Candida thrush	Thick white discharge	N	N	N	N	N	Microbiological diagnosis Wet mount PCR
		Cervicitis	+	±	+	±	–	–	+	Erythematous Friable	Thick yellow green pus	Leukocytosis	N	WBC	N or show PID like feature	N or show PID like feature	Culture of vaginal discharge	NAAT for gonocooccal cervicitis
		Prostatitis	+	+	+	+	+	+	±	–	Tender prostate	Leukocytosis	N	WBC Leukocyte esterase Ntrite	N	N	Urine culture	Prostate massage for chronic prostatits leads to raised leukocytes in urine
		Epididymoorchitis	±	+	+	+	–	–	–	–	Cremasteric reflexes present Prehn's sign	Leukocytosis	Dyselectrolytemia when vomiting is tehre	WBC	N	N	Urine culture	Ceftriaxone for STI Levofloxacin for coliform bacteria
Non-inflammatory	Anatomic	Urethral stricture	–	+	±	+	–	–	–	–	–	N	N	RBCs	Post void residual; volume is high	–	Retrograde urethrogrsm+cytsoscopy(urodynamic studies)
		Benign prostatic hyperplasia (BPH)	–	+	+	+	+	+	–	–	Enlarged and smooth prostate on DRE	N	N	May have UTI like picture on some occassion	Enlarged prostate	–		TURP is gold standard treatment
		Diseases	Fever	Dysuria	Frequency	Dribbling	Hesitancy	Nocturia	Suprapubic tenderness	Skin lesions	Other	CBC	Electrolytes	Urinalysis	Ultrasonography	CT scan	Gold standard	Additional findings
	Gynecological	Atrophic vaginitis	–	+	+	±	±	+	–	Vaginal dryness Vaginal erythema Excoriation marks	Vaginal discharge	N	N	N	Thinning of endometrium	N	Clinical exam
		Endometriosis	–	+	–	–	–	–	–	–	Dyspareunia Dyschezia	N	N	N	Cystic masses attached to adnexa	Cysts	Laparoscopy	Dysmenorrhea Dyspareunia Dyschezia
	Malignancy	Bladder cancer	–	–						–
		Vulvovaginal cancer	±	–
	Iatrogenic	Genitourinary instrumentation	+	–
		Pelvic irradiation	–							–
		Trauma	±	±