Dysuria

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Dysuria Microchapters

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Patient Information

Overview

Classification

Causes

Differentiating Dysuria from other Diseases

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Associate Editor(s)-in-Chief: nabeel ahmed

Synonyms and Keywords: Micturition painful, pain passing urine, painful urination; painful micturition

Overview

Dysuria is define as pain or burning, stinging, or itching of the urethra or urethral meatus during or just after urination.
Dysuria happens due to bladder muscle contraction and peristalsis of the urethra, which cause the urine to come in contact with the inflamed mucosal lining, which in turn stimulates pain receptors and causes one to feel pain or burning.

Epidemiology

  • Dysuria can happen in both males and females. One of the most common causes of dysuria is urinary tract infection. Urinary tract infections are more common in females than males due to female anatomy, having a shorter and straight urethra compared to males who have longer and curved urethra due to male anatomy.
  • In females, bacteria can reach the bladder more easily due to shorter and straight urethra as they have less distance to travel.
  • females who use the wrong wiping technique from back to front instead of front to back can predispose themselves to more frequent urinary tract infections due to the opening of the urethra being closer to the rectum. Because of these reasons, females tend to experience dysuria more frequently compared to males.

Pathophysiology

  • Dysuria from inflammatory causes like urinary tract infection results from bladder muscle contraction and urethral peristalsis, causing urine to come in contact with inflamed mucosa.
  • This contact causes stimulation of sensory nerves and pain receptors and causes pain along with burning, stinging, or itching.
  • The sensitivity of these receptors can become enhanced during the inflammatory or neuropathic processes
  • Inflammation from the surrounding organs such as colon can also sometimes result in dysuria.[1]
  • Dysuria from non-inflammatory causes like stone, tumor, trauma, or foreign body can cause irritation of the urethral or bladder mucosa .[2]

Classification

Dysuria can be divided broadly into two categories

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning Arsenicals, baneberry poisoning, chemical irritants
Dermatologic Balanitis xerotica obliterans, Behçet syndrome, genital herpes, irritative dermatitis, lichen sclerosus, malakoplakia, periurethral herpes simplex, Stevens–Johnson syndrome, toxic epidermal necrolysis
Drug Side Effect Abciximab, BCG vaccine, benzatropine, bicalutamide, clofibrate, dexchlorpheniramine, diflunisal, flavoxate, foscarnet sodium, hexaminolevulinate, hydroxyurea, indinavir, leflunomide, melarsoprol, meropenem, methenamine, milnacipran, nabumetone, nitazoxanide, oxcarbazepine, oxaprozin, phendimetrazine, pramipexole, pyrazinamide, rifaximin, spermicidal gel, sertraline, sulindac, tiagabine, tiaprofenic acid, valrubicin, zonisamide
Ear Nose Throat Behcet syndrome
Endocrine Hypercalciuria
Environmental No underlying causes
Gastroenterologic Appendicitis, bilharziasis, diarrhea, rectovesical fistula
Genetic Acute intermittent porphyria, adenine phosphoribosyltransferase deficiency, xanthine oxydase deficiency, xanthinuria, X-linked alpha thalassemia mental retardation syndrome
Hematologic Acute intermittent porphyria
Iatrogenic Radiation therapy, postoperative septicaemia, urethral catheterization
Infectious Disease Acute cystitis, acute urethritis, bacterial vaginosis, bilharziasis, candidal vaginitis, cervicitis, chlamydia, cystitis, diarrhea, epididymitis, fungal infection, genital herpes, genital schistosomiasis, gonorrhea, granulomatous prostatitis, hemorrhagic cystitis, hydatid cyst, kidney infection, Neisseria gonorrhoeae, non-gonococcal urethritis, nonspecific (chemical) urethritis, pelvic inflammatory disease, periurethral herpes simplex, pinworms, prostatic tuberculosis, prostatitis, pyelonephritis, renal tuberculosis, schistosoma haematobium, sexually transmitted disease, trichomoniasis, urethritis, urinary tract infection, vaginitis, vancomycin resistant enterococcal bacteremia, varicella, vulvitis
Musculoskeletal / Ortho Reactive arthritis, Reiter's syndrome
Neurologic No underlying causes
Nutritional / Metabolic Acute intermittent porphyria, adenine phosphoribosyltransferase deficiency, idiopathic hyperuricosuria, xanthine oxydase deficiency, xanthinuria
Obstetric/Gynecologic Atrophic vaginitis, bacterial vaginosis, candidal vaginitis, cervical cancer, cervicitis, complication of pregnancy, contraceptive foam, contraceptive sponge, cystocele, ectopic pregnancy, endometriosis, fallopian tube conditions , granulosa cell tumor of the ovary, labial adhesion, menopause, pelvic inflammatory disease, perineal trauma, prolapsed uterus, trichomoniasis, vaginal douche, vaginal lubricant, vaginal ulcers, vaginitis, vesicovaginal fistula, vulvar cancer, vulvitis
Oncologic Bladder cancer, cervical cancer, granulosa cell tumor of the ovary, prostatic carcinoma, urethral cancer, urinary tract neoplasm, vulvar cancer
Opthalmologic Behcet syndrome, reactive arthritis, Reiter's syndrome
Overdose / Toxicity No underlying causes
Psychiatric Functional disorders, psychogenic disorder, sexual abuse
Pulmonary Goodpasture syndrome
Renal / Electrolyte Acute pyelonephritis, congenital giant megaureter, dehydration, Goodpasture syndrome, hypercalciuria, kidney infection, kidney stone, pyelonephritis, renal nutcracker syndrome, renal tuberculosis, urolithiasis
Rheum / Immune / Allergy Behçet syndrome, Goodpasture syndrome, reactive arthritis, Reiter's Syndrome, Stevens-Johnson syndrome
Sexual Masturbation
Trauma Local trauma, urethral trauma
Urologic Acute abacterial cystitis, acute cystitis, acute urethritis, autoimmune orchitis, balanitis xerotica obliterans, balanitis, balanoposthitis, benign prostatic hyperplasia, bladder cancer, bladder diverticulum, bladder stone, cystitis, cystocele, dysfunctional elimination, eosinophilic cystitis, epididymitis, granulomatous prostatitis, hemorrhagic cystitis, Hunner ulcer, interstitial cystitis, malakoplakia, meatal stenosis, non-gonococcal urethritis, nonspecific (chemical) urethritis, paraurethral gland inflammation, pelvic lipomatosis, prostatic carcinoma, prostatic disease, prostatic tuberculosis, prostatitis, pyelitis, rectovesical fistula urethral cancer, urethral caruncle, urethral catheterization, urethral stricture, urethral syndrome, urethral trauma, urethritis, urinary incontinence, urinary obstruction, urinary stone, urinary tract infection, urinary tract malformation, urinary tract neoplasm, urolithiasis, vesicoureteral reflux, vesicovaginal fistula
Dental No underlying causes
Miscellaneous Poor perineal hygiene

Causes in Alphabetical Order

Treatment

Treatment of dysuria depends on its cause the most common cause of dysuria is urinary tract infection for which empiric antibiotic are used.[4]
If the cause of dysuria is renal stones, then various treatment options can be considered depending on the size and location of stones. Stones smaller than 5 mm typically pass on their own, and patients should be asked to hydrate themselves and strain the urine to document the evidence of a passed stone. The stones that are bigger than 5 mm are treatable through various modalities, including extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) or open surgery.

When dysuria is occurring due to chronic prostatitis in males, oral antibiotics merit consideration after obtaining urine culture.[5]

References


  1. Wagenlehner FM, Brockmeyer NH, Discher T, Friese K, Wichelhaus TA (January 2016). "The Presentation, Diagnosis, and Treatment of Sexually Transmitted Infections". Dtsch Arztebl Int. 113 (1–02): 11–22. doi:10.3238/arztebl.2016.0011. PMC 4746407. PMID 26931526.
  2. Yaxley JP (2016). "Urinary tract cancers: An overview for general practice". J Family Med Prim Care. 5 (3): 533–538. doi:10.4103/2249-4863.197258. PMC 5290755. PMID 28217578.
  3. Bellazreg F, Abid M, Lasfar NB, Hattab Z, Hachfi W, Letaief A (2019). "Diagnostic value of dipstick test in adult symptomatic urinary tract infections: results of a cross-sectional Tunisian study". Pan Afr Med J. 33: 131. doi:10.11604/pamj.2019.33.131.17190. PMC 6754830 Check |pmc= value (help). PMID 31558930.
  4. Coker TJ, Dierfeldt DM (January 2016). "Acute Bacterial Prostatitis: Diagnosis and Management". Am Fam Physician. 93 (2): 114–20. PMID 26926407.
  5. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I (2016). "Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial". Ger Med Sci. 14: Doc01. doi:10.3205/000228. PMC 4749724. PMID 26909012.