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DYSURIA

Dysuria, or pain that occurs during urination, is commonly perceived as burning or stinging in the urethra and is a symptom of several syndromes that can be distinguished by the presence or absence of other symptoms.

Epidemiology

Approximately 50% of women experience dysuria at some time in their lives; ~20% report having had dysuria within the past year. Dysuria is less common among men.

Clinical manifestations

The underlying syndromes that cause dysuria differ somewhat between men and women.

  • In women, most dysuria syndromes can be categorized as either bacterial cystitis or lower genital tract infections (e.g., vaginitis, urethritis, sexually transmitted infections [STIs]) (see Chaps. 83 and 144). The presence of urinary frequency, urinary urgency, suprapubic pain, and/or hematuria is more typical of bacterial cystitis than of STIs.

  • In men, dysuria is often due to STIs or involvement of the prostate (e.g., acute or chronic bacterial prostatitis) (see Chaps. 83 and 144). In addition, dysuria and other symptoms of cystitis can occur in the setting of significant benign prostatic hyperplasia that leads to urinary stasis with an accompanying bacterial infection.

  • In both sexes, dysuria can result from noninfectious disorders. Noninfectious causes of acute dysuria include lower urinary tract stones, trauma, and urethral exposure to topical chemicals. Chronic dysuria may be attributable to lower urinary tract cancers, certain medications, Behçet’s syndrome, or interstitial cystitis/bladder pain syndrome (see Chap. 144).

Diagnosis

Among women presenting with dysuria, the probability of bacterial cystitis is ~50%. This figure rises to >90% if four criteria are fulfilled: (1) dysuria and (2) frequency without either (3) vaginal discharge or (4) irritation.

  • Healthy, nonpregnant women who meet the above criteria can be diagnosed with uncomplicated bacterial cystitis; other women with dysuria should be further evaluated by urine dipstick, urine culture, and a pelvic examination.

  • Men should be evaluated with urinalysis, urine culture, and prostate examination.

Treatment

Once the underlying cause of dysuria is identified, it should be treated appropriately, as outlined in other chapters.

BLADDER PAIN

Pts perceive pain as coming from the urinary bladder if it is suprapubic in location, alters with bladder filling or emptying, and/or is associated with urinary symptoms such as urgency and frequency.

  • Bladder pain occurring acutely (i.e., lasting ≤2 days) is helpful in distinguishing bacterial cystitis from lower genital tract infections.

Chronic or recurrent bladder pain may accompany lower urinary tract stones, pelvic cancers, urethral diverticulum, cystitis induced by radiation or certain medications, tuberculous cystitis, bladder neck obstruction, neurogenic bladder, urogenital prolapse, or benign prostatic hyperplasia. The diagnosis of interstitial cystitis/bladder pain syndrome should be considered in pts who do not have one of these conditions (see Chap. 144).

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