Definitions
Dysuria is defined as a pain that arises from an irritation of the urethra and is felt during micturition. Frequency indicates increased passage of urine during the daytime; nocturia indicates increased passage of urine during the night. Urgency is an uncontrollable desire to micturate and may be associated with incontinence, which is the involuntary loss of urine. Pneumaturia is the passage of gas (air) mixed with urine and may be described by patients as passing bubbles in the urine.
- UTI is the most common cause of dysuria in adults.
- Features of systemic sepsis and loin pain suggest an ascending UTI (pyelonephritis).
- Elderly men with recurrent UTIs often have an underlying problem of bladder emptying due to prostate disease.
- Recurrent infections require investigation to exclude an underlying cause.
- Pneumaturia, ‘bits/debris’ in the urine and coliform infections suggest a colovesical fistula.
Important Diagnostic Features
Urinary Tract Infection
Acute Pyelonephritis
Cause:
Upper tract infection.
Predisposing Causes:
- Outflow tract obstruction.
- Vesicoureteric reflux (in children).
- Renal or bladder calculi.
- Diabetes mellitus.
- Neuropathic bladder dysfunction.
Features:
Pyrexia, rigors, flank pain, dysuria, malaise, anorexia, leucocytosis, pyuria (>10 WBC/mm3 urine), bacteriuria, microscopic haematuria, C&S >100 000 organisms/ml. Sterile pyuria may be caused by perinephric abscess, urethral syndrome, chronic prostatitis, renal TB and fungal infections.
Acute Cystitis
Causes:
- Lower tract infection.
- Usually coliform bacteria.
- Because of short urethra more common in females.
- Proteus infections may indicate stone disease.
Features:
Dysuria, frequency, urgency, suprapubic pain, low back pain, incontinence and microscopic haematuria.
Urethritis
Causes:
- Sexually transmitted diseases.
- May be gonococcal, chlamydial or mycoplasmal.
Features:
Dysuria and meatal pruritus, occurs 3–10 days after sexual contact, yellowish purulent urethral discharge suggests Gonococcus, thin mucoid discharge suggests Chlamydia.
Other Causes of Dysuria
Urethral Syndrome
A condition characterized by frequency, urgency and dysuria in women with urine cultures showing no growth or low bacterial counts.
Vaginitis
A condition characterized by dysuria, pruritus and vaginal discharge. Urine cultures are negative, but vaginal cultures often reveal Trichomonas vaginalis, Candida albicans or Haemophilus vaginalis.
Bladder Problems
- Bladder tumours are an uncommon cause of dysuria (10%), they usually present with haematuria.
- Interstitial cystitis: a chronic inflammatory condition of the bladder that causes frequent, urgent and painful urination with or without pelvic discomfort.
- Colovesical fistula: usually caused by diverticular disease, rarely by Crohn’s disease, carcinoma of the colon or bladder and very rarely by gas-producing bacterial infection of the urinary tract.
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