Urinary symptoms are very common in general practice. Women are affected more often than men.

Haematuria

Whether the patient notices blood in their urine (macroscopic), or it is picked up on dipstick or microscopy testing (microscopic), haematuria usually needs prompt and full investigation to exclude serious causes (see Box 66.1). In primary care it is helpful to exclude transient causes first such as UTI, menstruation in women or exercise-induced haematuria. Further investigations will be guided by any associated history, but patients may be asymptomatic.

Infection

History

Patients typically give a short history of frequency and burning pain on passing urine and often suprapubic discomfort. It occurs commonly in females because of the shortness of urethra. Recurrent infection must be investigated. In otherwise healthy women presenting with symptoms of both dysuria and urinary frequency, the probability of UTI is >90%. Infection is unusual in men and if confirmed should always be investigated. With advancing age the prostate gland will enlarge and may well cause urgency and frequency. This may be accompanied by infection because the obstruction leads to incomplete emptying.

Investigations

The diagnosis is primarily based on symptoms and signs. Presence of white cells (leucocytes) with or without nitrites on urine dipstick suggests infection. In a mid stream urine sample (MSU), large numbers (>100,000 organisms/ml) of organisms are strong evidence of infection but (except in pregnancy) bacteriuria alone is rarely an indication for antibiotic treatment.

Treatment

Lower Urinary Tract Infection

A brief course of antibiotics (e.g. trimethoprim 200 mg b.d. for 3 days) is usually successful. Where the infections are frequent and an underlying cause has been excluded many authorities recommend an extended course. Although the common infecting organism is Escherichia coli

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