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You receive a telephone call from a 32-year-old woman who complains of burning with urination over the past 12 hours. She also feels an intense need to urinate but reports difficulty voiding more than a small amount. She has experienced similar symptoms in the past and requests that you call in a prescription for antibiotics to her pharmacy.
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- What additional questions will you ask her?
- What aspects of the patient history will enable you most efficiently to differentiate between benign and serious diagnoses?
- Which questions, if any, can help you determine whether it is safe to treat her over the telephone?
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Dysuria is defined as pain, burning, or discomfort experienced during or immediately after urination. Although it has a broad differential diagnosis, dysuria usually results from infection or inflammation of the bladder and/or urethra.1 The patient's age, sex, and sexual history can help the clinician quickly delineate the most likely causes of dysuria. When infection seems less likely, the characteristics and duration of the pain, associated symptoms, and the patient's medical comorbidities can effectively narrow the differential diagnosis.
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Dysuria usually reflects irritation or inflammation of the external genitalia (urethral meatus, labia majora/minora) or the lower (urethra, bladder) or upper (ureters, kidneys) genitourinary tract. Less commonly, referred pain from other pelvic or abdominal organs can lead to dysuria. Infection of the urinary tract (including the urethra, bladder, ...