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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 infection (e.g., vaginitis, urethritis, sexually transmitted infection [STI]) (see Chap. 86). 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 Chap. 86). 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.

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 ealier 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

TREATMENT Dysuria

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

URINARY TRACT INFECTIONS

DEFINITIONS

  • The term urinary tract infection encompasses a variety of clinical entities.

    • Cystitis: symptomatic disease of the bladder

    • Pyelonephritis: symptomatic disease of the kidney

    • Prostatitis: symptomatic disease of the prostate

    • Asymptomatic bacteriuria (ASB): asymptomatic infection identified by a screening urine culture unrelated to the genitourinary tract

  • Uncomplicated UTI refers to acute disease in nonpregnant outpatient women without anatomic abnormalities or instrumentation of the urinary tract; complicated UTI refers to all other types of UTI.

EPIDEMIOLOGY

UTI occurs far more commonly in females than in males, although obstruction from prostatic hypertrophy causes men >50 years old to have an incidence of UTI comparable to that among women of the same age.

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