Dysuria resident survival guide: Difference between revisions
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Diagnosis|Diagnosis]] | ! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Diagnosis|Diagnosis]] | ||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Diagnostic Approach in Women|Women]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Diagnostic Approach in Men|Men]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Treatment|Treatment]] | ! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Treatment|Treatment]] | ||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Treatment in Women|Women]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Treatment in Men|Men]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Do's|Do's]] | ! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align=left | [[{{PAGENAME}}#Do's|Do's]] | ||
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE | {{CMG}}; {{AE}} {{RAB}} | ||
==Overview== | ==Overview== | ||
[[Dysuria]] is typically described to be a burning, tingling, or stinging sensation of the urethra and meatus associated with voiding.[[Dysuria]] refers to painful [[urination]]. It is most often a result of an [[infection]] of the [[urinary tract]].Noninfectious inflammatory causes include a foreign body in the urinary tract and dermatologic conditions such as [[Herpes simplex| | [[Dysuria]] is typically described to be a burning, [[tingling]], or [[stinging]] sensation of the [[urethra]] and [[meatus]] associated with [[voiding]]. [[Dysuria]] refers to [[painful]] [[urination]]. It is most often a result of an [[infection]] of the [[urinary tract]]. Noninfectious [[inflammatory]] [[causes]] include a foreign body in the [[urinary]] tract and [[Dermatologic disorders|dermatologic]] [[conditions]] such as [[Herpes simplex|herpes]], [[Dermatitis|irritant dermatitis]], erosive, [[lichen planus]], [[Contact dermatitis|contact dermatitis]]. It may also be due to an [[sexually transmitted diseases]], [[bladder]] [[stones]], [[bladder tumors]] and any [[condition]] of the [[prostate]]. It can also occur as a [[side effect]] of [[medications]]. It is one of the constellations of irritative bladder [[symptoms]], which includes the frequency of urination and [[haematuria]]. | ||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes of dysuria include | Life-threatening [[causes]] of dysuria include: | ||
*[[Stevens-Johnson syndrome overview|Stevens–Johnson syndrome]] | *[[Stevens-Johnson syndrome overview|Stevens–Johnson syndrome]] | ||
*[[Toxic epidermal necrolysis]] | *[[Toxic epidermal necrolysis]] | ||
The aforementioned [[conditions]] may result in death or permanent disability within 24 hours if left untreated. | |||
===Common Causes=== | ===Common Causes=== | ||
Common causes include: <ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref> | |||
*[[Cystitis|Acute Cystitis]] | *[[Cystitis|Acute Cystitis]] | ||
*[[Urethritis]] from [[Sexually transmitted disease|sexually transmitted infections]] | *[[Urethritis]] from [[Sexually transmitted disease|sexually transmitted infections]] | ||
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**[[Chlamydia infection|Chlamydia]] | **[[Chlamydia infection|Chlamydia]] | ||
**[[Trichomoniasis]] | **[[Trichomoniasis]] | ||
*Female genital structure related | *Female genital structure related<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref> | ||
**[[Vulvovaginitis|Vulvo-Vaginitis]] | **[[Vulvovaginitis|Vulvo-Vaginitis]] | ||
***[[Trichomoniasis]] | ***[[Trichomoniasis]] | ||
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**[[Cervicitis]] | **[[Cervicitis]] | ||
**[[Pelvic inflammatory disease|Pelvic Inflammatory Disease]] | **[[Pelvic inflammatory disease|Pelvic Inflammatory Disease]] | ||
*Male genital Structure related | *Male genital Structure related<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref> | ||
**[[Balanitis]] | **[[Balanitis]] | ||
**[[Prostatitis]] | **[[Prostatitis]] | ||
**[[Epididymoorchitis|Epididymo-orchitis]] | **[[Epididymoorchitis|Epididymo-orchitis]] | ||
**[[Benign prostatic hyperplasia]] | **[[Benign prostatic hyperplasia]] | ||
* Foreign Body in urinary tract | * Foreign Body in urinary tract<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref> | ||
**Indwelling [[Foley catheter]] | **Indwelling [[Foley catheter]] | ||
**Stone | **Stone | ||
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*[[Pyelonephritis]] | *[[Pyelonephritis]] | ||
*[[Stricture|Urethral Stricture]] | *[[Stricture|Urethral Stricture]] | ||
*Dermatological | *Dermatological<ref name="pmid26554471">{{cite journal |vauthors=Michels TC, Sands JE |title=Dysuria: Evaluation and Differential Diagnosis in Adults |journal=Am Fam Physician |volume=92 |issue=9 |pages=778–86 |date=November 2015 |pmid=26554471 |doi= |url=}}</ref> | ||
**[[Herpes simplex|Herpes]] | **[[Herpes simplex|Herpes]] | ||
**[[Dermatitis|Irritant dermatitis]] | **[[Dermatitis|Irritant dermatitis]] | ||
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==Diagnosis== | ==Diagnosis== | ||
*Shown below are two algorithms summarizing the diagnosis of [[Dysuria]] | *Shown below are two algorithms summarizing the diagnosis of [[Dysuria]] | ||
=====Diagnostic Approach in Women===== | |||
Algorithm showing the [[diagnosis]] of dysuria in woman: <ref name="urlDysuria, Frequency, and Urgency - Clinical Methods - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK291/ |title=Dysuria, Frequency, and Urgency - Clinical Methods - NCBI Bookshelf |format= |work= |accessdate=}}</ref> <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref> | |||
<span style="font-size:85%">'''Abbreviations:''' '''ER''':[[Emergency room]],'''KUB USS''' :Kidney and Bladder Ultrasound study,'''[[PVR]]''': Post-void residual urine,'''USG''' : [[Ultrasonography]] | |||
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{{Family tree | | | | | | | B01 | | | |B01= Take complete history}} | {{Family tree | | | | | | | B01 | | | |B01= Take complete history}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 27em; width: 19em; padding:1em;"> '''Presence of:'''<br> | ||
---- | ---- | ||
❑ Comcomitant [[fever]] <br> ❑ [[Flank pain]] <br> ❑ Abnormal vital signs: | ❑ Comcomitant [[fever]] <br><br/>❑ [[Flank pain]] <br><br/>❑ Abnormal vital signs: | ||
:❑ [[Tachycardia]] <br> | :❑ [[Tachycardia]] <br><br/> | ||
:❑ [[Tachypnea]] <br> | :❑ [[Tachypnea]] <br><br/> | ||
:❑ [[Hypotension]]<br> | :❑ [[Hypotension]]<br><br/> | ||
❑ [[Nausea]]<br> | ❑ [[Nausea]]<br><br/> | ||
❑ [[Vomiting]] </div>}} | ❑ [[Vomiting]] </div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
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{{Family tree | | | | | |!| | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | | | | |}} | {{Family tree | | | | | |!| | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | | | | |}} | ||
{{Family tree | | | | | |!| | | | | y09 | | | | | | | | | | | |!| | | | | | | | | | | | |y09=[[Urine]] culture}} | {{Family tree | | | | | |!| | | | | y09 | | | | | | | | | | | |!| | | | | | | | | | | | |y09=[[Urine]] culture}} | ||
{{Family tree | | | | | R09 | | |,|-|^|-|-|.| | | | | | | | | U09 | | | | |R09=Empirical [[Antibiotic]] Therapy|U09=Urine Culture}} | {{Family tree | | | | | R09 | | |,|-|^|-|-|.| | | | | | | | | U09 | | | | |R09=Empirical [[Antibiotic]] Therapy|U09=Urine [[Culture]]}} | ||
{{Family tree | | | | | | | | | P08 | | | O08 | | | | | | | | |!| |P08='''Positive'''|O08='''Negative'''}} | {{Family tree | | | | | | | | | P08 | | | O08 | | | | | | | | |!| |P08='''Positive'''|O08='''Negative'''}} | ||
{{Family tree | | | | | | | | | |!| | | | |!| | | | | | | | | |!| | |}} | {{Family tree | | | | | | | | | |!| | | | |!| | | | | | | | | |!| | |}} | ||
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{{Family tree | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | |!|}} | {{Family tree | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | |!|}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | |!|}} | {{Family tree | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | |!|}} | ||
{{Family tree | | | | | | | | | R09 | | | | | | | P09 | | | | | | | | i09 |i09=Think of any other non-infectious [[urogenital]] [[disease]] or [[vulvo-vaginal disease]]|R09=Do Swab test|P09=Urine speicific test for [[tuberculosis]]}} | {{Family tree | | | | | | | | | R09 | | | | | | | P09 | | | | | | | | i09 |i09=Think of any other non-infectious [[urogenital]] [[disease]] or [[vulvo-vaginal disease]]|R09=Do [[Swab]] test|P09=Urine speicific test for [[tuberculosis]]}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| | |}} | {{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| | |}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | p09| | |p09='''Refer the patient to urologist/gynaecologist'''}} | {{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | p09| | |p09='''Refer the patient to [[urologist]]/[[gynaecologist]]'''}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | {{Family tree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | p09 | | | | | | | | | | | | | | | | | | | | | |p09=<div style="float: left; text-align: left; height: | {{Family tree | | | | | | | | | p09 | | | | | | | | | | | | | | | | | | | | | |p09=<div style="float: left; text-align: left; height:15em; width: 28em; padding:1em;">[[Urethritis]] due to:<br>❑ [[Chlamydia trachomatis]]<br><br/>❑ [[Neisseria gonorrhea]]<br><br/>❑ [[Herpes simplex virus]]}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
If the female patient presents with slow urine stream without any pain or burning sensation, then the algorithm below can be used to treat the patient | If the female patient presents with a slow urine stream without any pain or [[burning]] sensation, then the algorithm below can be used to treat the patient<br> | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | | | A01 | | | |A01= Female patient with only voiding symptoms}} | {{Family tree | | | | | | A01 | | | |A01= Female patient with only [[voiding symptoms]]}} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | B01 | | | |B01= Take complete history<br/>Ask about voidal habits: | {{Family tree | | | | | | B01 | | | |B01= Take complete history<br/>Ask about voidal habits: <br>❑[[Urinary frequency]]<br> ❑Interval between two consecutive [[micturation]]<br/>}} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | A01 | | | |A01= ❑Physical examination <br/>Suprapubic palpation and Vaginal examination}} | {{Family tree | | | | | | A01 | | | |A01= ❑Physical examination <br/><br/>[[Suprapubic]] palpation and Vaginal examination}} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | B01 | | | |B01= ❑Urine culture <br/>❑ Kidney and Bladder Ultrasound study (KUB USS)}} | {{Family tree | | | | | | B01 | | | |B01= ❑Urine [[culture]] <br/><br/>❑ Kidney and Bladder [[Ultrasound]] study ([[KUB]] [[USS]])}} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | |,|-|-|-|+|-|-|-|v|-|-|-|-|-|.|}} | {{Family tree | | |,|-|-|-|+|-|-|-|v|-|-|-|-|-|.|}} | ||
{{Family tree | | |!| | | |!| | | |!| | | | | |!|}} | {{Family tree | | |!| | | |!| | | |!| | | | | |!|}} | ||
{{Family tree | | p09 | | o09 | | u09 | | | | s09 | |p09=Increased Detrusor wall thickness|o09=Bladder diverticula|u09=Increased post void residual(>100)|s09=Hydronephrosis }} | {{Family tree | | p09 | | o09 | | u09 | | | | s09 | |p09=Increased [[Detrusor]] wall thickness|o09=Bladder [[diverticula]]|u09=Increased [[post void residual]](>100)|s09=[[Hydronephrosis]] }} | ||
{{Family tree | | |!| | | |!| | | |!| | | | | |!| |}} | {{Family tree | | |!| | | |!| | | |!| | | | | |!| |}} | ||
{{Family tree | | |`|-|-|-|+|-|-|-|^|-|-|-|-|-|'}} | {{Family tree | | |`|-|-|-|+|-|-|-|^|-|-|-|-|-|'}} | ||
{{Family tree | | | | | | |!| | | | | }} | {{Family tree | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | o09 | | | | |o09='''Refer to urologist''' }} | {{Family tree | | | | | | o09 | | | | |o09='''Refer to [[urologist]]''' }} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
=====Diagnostic Approach in Men===== | |||
Algorithm showing the diagnosis of [[dysuria]] in Male patients: <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref> | |||
<span style="font-size:85%">'''Abbreviations:''' '''ER''':[[Emergency room]], '''KUB USS''' :Kidney and Bladder Ultrasound study, '''[[PVR]]''': Post-void residual urine, '''USG''' : [[Ultrasonography]], '''NAAT''': Nucleic Acid Amplification Test, '''PCR''': Polymerase chain reaction, '''ESR''':Erythrocyte sedimentation rate, '''CRP''': C-reactive protein , '''HLA''':Human leukocyte antigen | |||
{{Family tree/start}} | {{Family tree/start}} | ||
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{{Family tree | | | | | | | | B01 | | | |B01= Take complete history}} | {{Family tree | | | | | | | | B01 | | | |B01= Take complete history}} | ||
{{Family tree | | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | | | B02 | | | |B02= Presence of urethral discharge}} | {{Family tree | | | | | | | | B02 | | | |B02= Presence of [[urethral discharge]]}} | ||
{{Family tree | | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | | |!| | | | | }} | ||
{{Family tree | | | |,|-|-|-|-|^|-|-|-|.| }} | {{Family tree | | | |,|-|-|-|-|^|-|-|-|.| }} | ||
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{{Family tree | | |!| | | |!| | H08 | | | | | | | | | | | | H09 |H08=Yes|H09=NO }} | {{Family tree | | |!| | | |!| | H08 | | | | | | | | | | | | H09 |H08=Yes|H09=NO }} | ||
{{Family tree | | E05 | | E06 | |!| | | | | | | | | | | | | |!||E05=Profuse,purulent discharge <br/> | {{Family tree | | E05 | | E06 | |!| | | | | | | | | | | | | |!||E05=Profuse,purulent discharge <br/> | ||
Yellowish green colour|E06=Thin,mucoid/mucopurulent discharge| }} | Yellowish green colour|E06=Thin,mucoid/[[mucopurulent]] discharge| }} | ||
{{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!| |}} | {{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!| |}} | ||
{{Family tree | | F05 | | F06 | |!| | | | | | | | | | | | | |!|F05=Swab test |F06=Swab test }} | {{Family tree | | F05 | | F06 | |!| | | | | | | | | | | | | |!|F05=[[Swab]] test |F06=Swab test }} | ||
{{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!|}} | {{Family tree | | |!| | | |!| | |!| | | | | | | | | | | | | |!|}} | ||
{{Family tree | | G07 | | G08 | |!| | | | | | | | | | | | | |!|G07=Gram negative Diplococci|G08=[[NAAT]]/[[PCR]] test }} | {{Family tree | | G07 | | G08 | |!| | | | | | | | | | | | | |!|G07=Gram negative Diplococci|G08=[[NAAT]]/[[PCR]] test }} | ||
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{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | |}} | {{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | |}} | ||
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | |}} | {{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | |}} | ||
{{Family tree | | R09 | | | | | T09 | | | | | | P09 | | | | |!| | | | | |R09=Inflammation of the glans penis|T09=Ulcer|P09=Painful Vesicles| }} | {{Family tree | | R09 | | | | | T09 | | | | | | P09 | | | | |!| | | | | |R09=Inflammation of the [[glans penis]]|T09=[[Ulcer]]|P09=Painful [[Vesicles]]| }} | ||
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | | | | |}} | {{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | | | | |}} | ||
{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!|| | | | | | | | | | | |}} | {{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | | |!|| | | | | | | | | | | |}} | ||
{{Family tree | | R09 | | | |,|-|^|-|-|.| | | | U09 | | | | |!|R09=[[Balanitis]]|U09=[[Herpes]]| | | | | | | | | |}} | {{Family tree | | R09 | | | |,|-|^|-|-|.| | | | U09 | | | | |!|R09=[[Balanitis]]|U09=[[Herpes]]| | | | | | | | | |}} | ||
{{Family tree | | | | | | | P08 | | | O08 | | | | | | | | | |!|P08=<div style="float: left; text-align: left; height: | {{Family tree | | | | | | | P08 | | | O08 | | | | | | | | | |!|P08=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Presence of:'''<br> | ||
---- | ---- | ||
❑ | ❑ Firm, painless, non-itchy skin [[ulceration]]<br/><br> ❑ Multiple [[sore]]s<br/><br/>❑ A diffuse rash involving the palms of the hands and soles of the feet<br/><br/>❑ Presence of [[gumma]]s <br><br/> </div>|O08=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Presence of:'''<br> | ||
---- | ---- | ||
❑ Painless genital ulcer <br> ❑ [[Anorectal pain]] <br> ❑ [[Tenesmus]] | ❑ Painless genital ulcer <br/><br> ❑ [[Anorectal pain]] <br><br/> ❑ [[Tenesmus]]<br/><br> ❑[[Rectal discharge]] <br/><br> ❑ Rectal discharge,[[Inguinal lymphadenopathy]] </div>}} | ||
{{Family tree | | | | | | | |!| | | | |!| | | | | | | | | | |!| |}} | {{Family tree | | | | | | | |!| | | | |!| | | | | | | | | | |!| |}} | ||
{{Family tree | | | | | | | |!| | | | |!| | | | | | | | | | |!| | |}} | {{Family tree | | | | | | | |!| | | | |!| | | | | | | | | | |!| | |}} | ||
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{{Family tree | | | | | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| | | | | | | |}} | {{Family tree | | | | | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| | | | | | | |}} | ||
{{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!|}} | {{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!|}} | ||
{{Family tree | | | | | | | | | | W09 | | | | | A09 | | | | T09 | | | | | | |W09= ❑[[Suprapubic pain]]|A09= | {{Family tree | | | | | | | | | | W09 | | | | | A09 | | | | T09 | | | | | | |W09= ❑[[Suprapubic pain]]|A09= ❑[[Flank pain]]<br/><br/>❑[[Costovertebral angle]] [[tenderness]]<br/><br/>❑[[Fever|Fever]]|T09=Joint pain}} | ||
{{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!| | | | | | | | | |}} | {{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!| | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | | u09 | | | | | t09 | | | | p09 | | | | | | | | | | | |u09=Urine Analysis|t09=USG|p09= | {{Family tree | | | | | | | | | | u09 | | | | | t09 | | | | p09 | | | | | | | | | | | |u09=[[Urine Analysis]]|t09=USG|p09= ❑[[X-ray]]<br/> ❑[[ESR]]/[[CRP]]<br/> ❑[[HLA-B27]]}} | ||
{{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!| | | | | | | | | |}} | {{Family tree | | | | | | | | | | |!| | | | | | |!| | | | | |!| | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | | y09 | | | | | i09 | | | | u09 | | | | | | | | | | | | |y09=Cystitis|u09=[[Spondyloarthropathy]]|i09=[[Pyelonephritis]]}} | {{Family tree | | | | | | | | | | y09 | | | | | i09 | | | | u09 | | | | | | | | | | | | |y09=[[Cystitis]]|u09=[[Spondyloarthropathy]]|i09=[[Pyelonephritis]]}} | ||
{{familytree/end}} | {{familytree/end}} | ||
==Treatment== | ==Treatment== | ||
Shown below is an algorithm summarizing the treatment of [[Dysuria]] in female patients | =====Treatment in Women===== | ||
Shown below is an algorithm summarizing the treatment of [[Dysuria]] in female patients: <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref> | |||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | A01 | | | | | | | |A01=Symptoms of lower urinary tract }} | {{familytree | | | | | | | | A01 | | | | | | | |A01=[[Symptoms]] of lower urinary tract }} | ||
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }} | {{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }} | ||
{{familytree | | | | B01 | | | | | | | B02 | | |B01=Non recurrent |B02=<div style="float: left; text-align: left; height: 8em; width: 20em; padding:1em;">Recurrent <br/>❑ At least 3 episodes of uncomplicated UTI in 12 months<br/>❑ With at least one positive by urine culture}} | {{familytree | | | | B01 | | | | | | | B02 | | |B01=Non recurrent |B02=<div style="float: left; text-align: left; height: 8em; width: 20em; padding:1em;">Recurrent <br/>❑ At least 3 episodes of uncomplicated [[UTI]] in 12 months<br/><br/>❑ With at least one positive by urine culture}} | ||
{{familytree | | | | |!| | | | | | | | |!| }} | {{familytree | | | | |!| | | | | | | | |!| }} | ||
{{familytree | | |,|-|^|-|.| | | | | | |!| }} | {{familytree | | |,|-|^|-|.| | | | | | |!| }} | ||
{{familytree | | D01 | | D02 | | | | | p09 |p09=Modify Lifestyle to intervene modifiable riskfactors and take prophylaxis|D01=Uncomplicated<br/> Without any risk factors|D02=<div style="float: left; text-align: left; height: | {{familytree | | D01 | | D02 | | | | | p09 |p09=Modify Lifestyle to intervene modifiable riskfactors and take prophylaxis|D01=Uncomplicated<br/> Without any risk factors|D02=<div style="float: left; text-align: left; height:28em; width: 30em; padding:1em;">'''Complicated :Presence of any of the following [[risk factors]]:'''<br> | ||
---- | ---- | ||
❑ Presence of indwelling catheter <br> ❑ [[ | ❑ Presence of indwelling catheter <br><br/> ❑ [[Vesico-ureteric reflux]] <br><br/> ❑ Increased [[post void residual]] urine<br/><br> ❑ Increased post void residual urine<br/> <br> ❑ Presence of diseases:<br/> | ||
:❑ [[Renal insufficiency]]<br/><br/> | |||
:❑ [[Diabetes mellitus]]<br/><br/> | |||
:❑ [[Immunodeficiency]]<br/><br/> | |||
❑ [[Obstructive Uropathy]] </div>}} | |||
{{familytree | | |!| | | |!| | | | | | |!| | | }} | {{familytree | | |!| | | |!| | | | | | |!| | | }} | ||
{{familytree | | E01 | | u09 | | | | | p09 | | |E01=<div style="float: left; text-align: left; height: | {{familytree | | E01 | | u09 | | | | | p09 | | |E01=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> Treatment with short term antibiotic therapy<br/> '''First line includes'''<br/> ❑ 3g oral dose of [[Fosfomycin]] trometamol<br/><br/> ❑ [[Pivmecillinam]] 400 mg twice a day for 3 days<br/><br/>❑ [[Nitrofurantoin]] 100mg twice a day for 5-7days <br/><br/> '''In case of <20% resistance rates for [[E.coli]]'''<br/> | ||
❑ [[Cotrimoxazole]] 160/800 mg twice a day for 3 days<br/><br/> ❑[[Trimethoprim]] 200 mg twice a day for 5 days|u09=<div style="float: left; text-align: left; height: 24em; width: 30em; padding:1em;">❑ Specific antibiotic depending on urine culture <br/><br/>❑ Long Empeirical long term antibiotic([[Fluoroquinolone]]s,Third generation [[Cephalosporins]],[[Aminoglycoside]]s) for 10-14 days |p09=<div style="float: left; text-align: left; height: 24em; width: 30em; padding:1em;">'''Measurements to prevent recurrent UTI'''<br/><br/>❑ Low dose Antimicrobial [[prophylaxis]] continuously or after sexual intercourse <br/><br/>❑ Interventions on modifiable [[risk factors]]:<br/><br/>1.Avoid using [[spermicide]]<br/><br/>2.Maintain [[blood glucose]] level <br/><br/>3.Improving the treatment of [[urinary incontinence]] <br/><br/>4.Unspecific prophylaxis with [[cranberry]] extracts <br/><br/>5.Local hormonal therapy in case of post menopausal women|}} | |||
❑ [[Cotrimoxazole]] 160/800 mg twice a day for 3 days<br/> ❑[[Trimethoprim]] 200 mg twice a day for 5 days|u09=<div style="float: left; text-align: left; height: | |||
{{familytree | | |!| | | |!| | | | | | |!| }} | {{familytree | | |!| | | |!| | | | | | |!| }} | ||
{{familytree | | F01 | | F02 | | | | | |!|F01= Repeat urine culture in nonresponsive cases and pregnant women |F02= Repeat urine culture after treatment,KUB ultrasound with PVR measurement}} | {{familytree | | F01 | | F02 | | | | | |!|F01= Repeat urine [[culture]] in nonresponsive cases and pregnant women |F02= Repeat urine culture after treatment,[[KUB]] [[ultrasound]] with [[PVR]] measurement}} | ||
{{familytree | | | | | | |!| | | | | | |!|}} | {{familytree | | | | | | |!| | | | | | |!|}} | ||
{{familytree | | | | | | o09 | | | | | 009 |o09='''Refer the patient to urologist'''|009=If all of the above fails }} | {{familytree | | | | | | o09 | | | | | 009 |o09='''Refer the patient to [[urologist]]'''|009=If all of the above fails }} | ||
{{familytree | | | | | | | | | | | | | |!|}} | {{familytree | | | | | | | | | | | | | |!|}} | ||
{{familytree | | | | | | | | | | | | | p09 |p09='''Refer to urologist'''}} | {{familytree | | | | | | | | | | | | | p09 |p09='''Refer to [[urologist]]'''}} | ||
{{familytree/end}} | {{familytree/end}} | ||
=====Treatment in Men===== | |||
Treatment of dysuria in male patient: <ref name="GonteroKirby2013">{{cite journal|last1=Gontero|first1=Paolo|last2=Kirby|first2=Roger S.|last3=Carson III|first3=Culley C.|year=2013|doi=10.1007/978-1-4471-4634-6}}</ref> | |||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | A01 | | | |A01=Male patient with dysuria}} | {{Family tree | | | | A01 | | | |A01=Male patient with dysuria}} | ||
Line 242: | Line 259: | ||
{{Family tree | C01 | | | | C02 |C01= Presence of infection| C02=No infection}} | {{Family tree | C01 | | | | C02 |C01= Presence of infection| C02=No infection}} | ||
{{Familytree | |!| | | | | | |!| | | | | }} | {{Familytree | |!| | | | | | |!| | | | | }} | ||
{{Familytree | |o09| | | | |p09| | | | |p09=Further investigate to exclude [[Bladder cancinoma]] if <br/>❑ Patient is smoker<br/> or<br/>❑ H/o exposure to [[carcinogen]]<br/>or<br/>❑ Presence of [[Storage symptoms]] |o09=❑ Treatment with specific [[antibiotic]] for 7 days<br/>❑ If sensitivity tests are not available empirical treatment with Quinolone }} | {{Familytree | |o09| | | | |p09| | | | |p09=Further investigate to exclude [[Bladder cancinoma]] if <br/>❑ Patient is smoker<br/> or<br/>❑ H/o exposure to [[carcinogen]]<br/>or<br/>❑ Presence of [[Storage symptoms]] |o09=❑ Treatment with specific [[antibiotic]] for 7 days<br/>❑ If sensitivity tests are not available empirical treatment with [[Quinolone]] }} | ||
{{Familytree | |!| | | | | | |!| | | | }} | {{Familytree | |!| | | | | | |!| | | | }} | ||
{{Familytree | |p09| | | | |l09| | | | |p09=Recurrent UTI or prostatitis|l09=Look for other non infective causes }} | {{Familytree | |p09| | | | |l09| | | | |p09=Recurrent [[UTI]] or [[prostatitis]]|l09=Look for other non infective causes }} | ||
{{Familytree | |!| | | | | | | | |!| | | | }} | {{Familytree | |!| | | | | | | | |!| | | | }} | ||
{{Familytree | |p09| | | | |,|-|^|.| | | |p09='''Refer to Urologist'''| }} | {{Familytree | |p09| | | | |,|-|^|.| | | |p09='''Refer to [[Urologist]]'''| }} | ||
{{Familytree | | | | | | | | |!| | |!| | | }} | {{Familytree | | | | | | | | |!| | |!| | | }} | ||
{{Familytree | | | | | | | |k09| |u09| | |k09=Treat according to the specific cause|u09=No specific cause found, Suspect chronic pelvic pain syndrome (CPPS) }} | {{Familytree | | | | | | | |k09| |u09| | |k09=Treat according to the specific cause|u09=No specific cause found, Suspect [[chronic pelvic pain syndrome]] ([[CPPS]]) }} | ||
{{Familytree | | | | | | | | | | | |!| | | }} | {{Familytree | | | | | | | | | | | |!| | | }} | ||
{{Familytree | | | | | | | | | |,|-|^|-|-|-|-|.| }} | {{Familytree | | | | | | | | | |,|-|^|-|-|-|-|.| }} | ||
Line 268: | Line 285: | ||
''' | '''<big>UPOINT CLASSIFICATION</big>''' | ||
Line 277: | Line 294: | ||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Urinary</big>''' | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Urinary</big>''' | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Lower urinary tract symptoms that creates discomfort or High post-micturation residual volume | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Lower urinary tract [[symptoms]] that creates discomfort or High post-micturation residual volume | ||
|- | |- | ||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Psychological</big>''' | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Psychological</big>''' | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Patient with depression or severe anxiety thinking the worst will happen to them | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Patient]] with [[depression]] or severe [[anxiety]] thinking the worst will happen to them | ||
|- | |- | ||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Organ-specific</big>''' | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Organ-specific</big>''' | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Tenderness in Prostate,Presence of blood in ejaculation,Leukocytes in prostatic fluid or post-massage urine | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Tenderness]] in [[Prostate]], Presence of [[blood]] in [[ejaculation]],[[Leukocytes]] in [[prostatic]] fluid or post-massage urine | ||
|- | |- | ||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Infectious</big>''' | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Infectious</big>''' | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Infection with gram negative bacilli or | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Infection]] with [[gram negative]] bacilli or [[Enterococcus|Enterococci]] localized to [[prostate]] or presence of [[Ureaplasma]] in urine | ||
|- | |- | ||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Systemic</big>''' | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Systemic</big>''' | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Pain anywhere else in the body except abdomen or pelvis or having a diagnosis of fibromyalgia,chronic fatigue or | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Pain]] anywhere else in the body except [[abdomen]] or [[pelvis]] or having a [[diagnosis]] of [[fibromyalgia]], chronic [[fatigue]] or i[[Irritable bowel syndrome|rritable bowel syndrome]] | ||
|- | |- | ||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Tenderness</big>''' | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''<big>Tenderness</big>''' | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Presence of palpable | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Presence of palpable [[muscle]] spams in [[abdomen]] or [[pelvic floor]] | ||
|- | |- | ||
|- | |- | ||
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==Do's== | ==Do's== | ||
Instruct the female [[patients]] to: | Instruct the female [[patients]] to:<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref> | ||
* Lose weight (if they are overweight or obese). | |||
* Always stay hydrated. | * Always stay hydrated. | ||
* Urinate after sexual intercourse. | * Urinate after sexual [[intercourse]]. | ||
* Always wipe front to back. | * Always wipe front to back. | ||
* Wear cotton/comfortable underwear. | * Wear cotton/comfortable underwear. | ||
* Use [[menstrual cup]]<nowiki/>s, sanitary pads, or clean period-proof underwear | * Use [[menstrual cup]]<nowiki/>s, sanitary pads, or clean period-proof underwear. | ||
* Maintain personal [[hygiene]]. | * Maintain personal [[hygiene]]. | ||
==Don'ts== | ==Don'ts== | ||
Instruct the female [[patients]] not to | * Instruct the female [[patients]] not to delay in urinating.<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref> | ||
* Avoid Smoking<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref> | |||
* | * Avoid drinking the following items a lot:<ref name="GungorBeji2011">{{cite journal|last1=Gungor|first1=Ilkay|last2=Beji|first2=Nezihe Kizilkaya|title=Lifestyle changes for the prevention and management of lower urinary tract symptoms in women|journal=International Journal of Urological Nursing|volume=5|issue=1|year=2011|pages=3–13|issn=17497701|doi=10.1111/j.1749-771X.2011.01112.x}}</ref> | ||
** Caffeinated sodas | ** Caffeinated sodas | ||
** Alcohol | ** Alcohol | ||
Line 323: | Line 341: | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
Latest revision as of 11:26, 7 March 2021
Dysuria Resident Survival Guide |
---|
Overview |
Causes |
Diagnosis |
Women |
Men |
Treatment |
Women |
Men |
Do's |
Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
Overview
Dysuria is typically described to be a burning, tingling, or stinging sensation of the urethra and meatus associated with voiding. Dysuria refers to painful urination. It is most often a result of an infection of the urinary tract. Noninfectious inflammatory causes include a foreign body in the urinary tract and dermatologic conditions such as herpes, irritant dermatitis, erosive, lichen planus, contact dermatitis. It may also be due to an sexually transmitted diseases, bladder stones, bladder tumors and any condition of the prostate. It can also occur as a side effect of medications. It is one of the constellations of irritative bladder symptoms, which includes the frequency of urination and haematuria.
Causes
Life Threatening Causes
Life-threatening causes of dysuria include:
The aforementioned conditions may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Common causes include: [1]
- Acute Cystitis
- Urethritis from sexually transmitted infections
- Female genital structure related[1]
- Male genital Structure related[1]
- Foreign Body in urinary tract[1]
- Indwelling Foley catheter
- Stone
- Urethral or ureteral stent
- Pyelonephritis
- Urethral Stricture
- Dermatological[1]
- Local trauma
- Medication use
- Neoplasia
Diagnosis
- Shown below are two algorithms summarizing the diagnosis of Dysuria
Diagnostic Approach in Women
Algorithm showing the diagnosis of dysuria in woman: [2] [3]
Abbreviations: ER:Emergency room,KUB USS :Kidney and Bladder Ultrasound study,PVR: Post-void residual urine,USG : Ultrasonography
Woman with dysuria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Take complete history | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of: ❑ Comcomitant fever
❑ Nausea | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Refer the patient to ER | Urine Dipstick for Nitrites and Leukocytes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Nitrite Postitive | Leukocytes positive,Nitrite negative | Both Nitrite and Leukocyte negative | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Urine culture | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Empirical Antibiotic Therapy | Urine Culture | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treat with Specific Antibiotic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Postive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of any Urethral discharge/Itching | Acid urine pH/history of Tuberculosis | Treat with Specific antibiotic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do Swab test | Urine speicific test for tuberculosis | Think of any other non-infectious urogenital disease or vulvo-vaginal disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Refer the patient to urologist/gynaecologist | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If the female patient presents with a slow urine stream without any pain or burning sensation, then the algorithm below can be used to treat the patient
Female patient with only voiding symptoms | |||||||||||||||||||||||||||||||||||||
Take complete history Ask about voidal habits: ❑Urinary frequency ❑Interval between two consecutive micturation | |||||||||||||||||||||||||||||||||||||
❑Physical examination Suprapubic palpation and Vaginal examination | |||||||||||||||||||||||||||||||||||||
❑Urine culture ❑ Kidney and Bladder Ultrasound study (KUB USS) | |||||||||||||||||||||||||||||||||||||
Increased Detrusor wall thickness | Bladder diverticula | Increased post void residual(>100) | Hydronephrosis | ||||||||||||||||||||||||||||||||||
Refer to urologist | |||||||||||||||||||||||||||||||||||||
Diagnostic Approach in Men
Algorithm showing the diagnosis of dysuria in Male patients: [3]
Abbreviations: ER:Emergency room, KUB USS :Kidney and Bladder Ultrasound study, PVR: Post-void residual urine, USG : Ultrasonography, NAAT: Nucleic Acid Amplification Test, PCR: Polymerase chain reaction, ESR:Erythrocyte sedimentation rate, CRP: C-reactive protein , HLA:Human leukocyte antigen
Male patient with dysuria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Take complete history | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of urethral discharge | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ask about the discharge | Presence Of Genital Lesion | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Profuse,purulent discharge Yellowish green colour | Thin,mucoid/mucopurulent discharge | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Swab test | Swab test | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gram negative Diplococci | NAAT/PCR test | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gonorrhoea | Chlamydia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inflammation of the glans penis | Ulcer | Painful Vesicles | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Balanitis | Herpes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of: ❑ Firm, painless, non-itchy skin ulceration ❑ Multiple sores ❑ A diffuse rash involving the palms of the hands and soles of the feet ❑ Presence of gummas | Presence of: ❑ Painless genital ulcer ❑ Anorectal pain ❑ Tenesmus ❑Rectal discharge ❑ Rectal discharge,Inguinal lymphadenopathy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Syphilis | Lymphogranuloma venereum (LGV) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of any Localized Pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑Suprapubic pain | ❑Flank pain ❑Costovertebral angle tenderness ❑Fever | Joint pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Urine Analysis | USG | ❑X-ray ❑ESR/CRP ❑HLA-B27 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cystitis | Pyelonephritis | Spondyloarthropathy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Treatment in Women
Shown below is an algorithm summarizing the treatment of Dysuria in female patients: [3]
Symptoms of lower urinary tract | |||||||||||||||||||||||||||||||||||
Non recurrent | Recurrent ❑ At least 3 episodes of uncomplicated UTI in 12 months ❑ With at least one positive by urine culture | ||||||||||||||||||||||||||||||||||
Uncomplicated Without any risk factors | Complicated :Presence of any of the following risk factors: ❑ Presence of indwelling catheter | Modify Lifestyle to intervene modifiable riskfactors and take prophylaxis | |||||||||||||||||||||||||||||||||
Treatment with short term antibiotic therapy First line includes ❑ 3g oral dose of Fosfomycin trometamol ❑ Pivmecillinam 400 mg twice a day for 3 days ❑ Nitrofurantoin 100mg twice a day for 5-7days In case of <20% resistance rates for E.coli ❑ Cotrimoxazole 160/800 mg twice a day for 3 days ❑Trimethoprim 200 mg twice a day for 5 days | ❑ Specific antibiotic depending on urine culture ❑ Long Empeirical long term antibiotic(Fluoroquinolones,Third generation Cephalosporins,Aminoglycosides) for 10-14 days | Measurements to prevent recurrent UTI ❑ Low dose Antimicrobial prophylaxis continuously or after sexual intercourse ❑ Interventions on modifiable risk factors: 1.Avoid using spermicide 2.Maintain blood glucose level 3.Improving the treatment of urinary incontinence 4.Unspecific prophylaxis with cranberry extracts 5.Local hormonal therapy in case of post menopausal women | |||||||||||||||||||||||||||||||||
Repeat urine culture in nonresponsive cases and pregnant women | Repeat urine culture after treatment,KUB ultrasound with PVR measurement | ||||||||||||||||||||||||||||||||||
Refer the patient to urologist | If all of the above fails | ||||||||||||||||||||||||||||||||||
Refer to urologist | |||||||||||||||||||||||||||||||||||
Treatment in Men
Treatment of dysuria in male patient: [3]
Male patient with dysuria | |||||||||||||||||||||||||||||||||||||||||||||
Look for infection | |||||||||||||||||||||||||||||||||||||||||||||
Presence of infection | No infection | ||||||||||||||||||||||||||||||||||||||||||||
❑ Treatment with specific antibiotic for 7 days ❑ If sensitivity tests are not available empirical treatment with Quinolone | Further investigate to exclude Bladder cancinoma if ❑ Patient is smoker or ❑ H/o exposure to carcinogen or ❑ Presence of Storage symptoms | ||||||||||||||||||||||||||||||||||||||||||||
Recurrent UTI or prostatitis | Look for other non infective causes | ||||||||||||||||||||||||||||||||||||||||||||
Refer to Urologist | |||||||||||||||||||||||||||||||||||||||||||||
Treat according to the specific cause | No specific cause found, Suspect chronic pelvic pain syndrome (CPPS) | ||||||||||||||||||||||||||||||||||||||||||||
Quinolone-naive treatment | Previously had treatment with Quinolones | ||||||||||||||||||||||||||||||||||||||||||||
No response for 4 weeks | Response | Apply UPOINT classification | |||||||||||||||||||||||||||||||||||||||||||
Apply UPOINT classification | Response | ||||||||||||||||||||||||||||||||||||||||||||
Response | No response | Refer to specialized pain clinic in Hospital | |||||||||||||||||||||||||||||||||||||||||||
No response | Refer to specialized pain clinic in Hospital | ||||||||||||||||||||||||||||||||||||||||||||
UPOINT CLASSIFICATION
Phenotype Domains | Clinical Features |
---|---|
Urinary | Lower urinary tract symptoms that creates discomfort or High post-micturation residual volume |
Psychological | Patient with depression or severe anxiety thinking the worst will happen to them |
Organ-specific | Tenderness in Prostate, Presence of blood in ejaculation,Leukocytes in prostatic fluid or post-massage urine |
Infectious | Infection with gram negative bacilli or Enterococci localized to prostate or presence of Ureaplasma in urine |
Systemic | Pain anywhere else in the body except abdomen or pelvis or having a diagnosis of fibromyalgia, chronic fatigue or irritable bowel syndrome |
Tenderness | Presence of palpable muscle spams in abdomen or pelvic floor |
Do's
Instruct the female patients to:[4]
- Lose weight (if they are overweight or obese).
- Always stay hydrated.
- Urinate after sexual intercourse.
- Always wipe front to back.
- Wear cotton/comfortable underwear.
- Use menstrual cups, sanitary pads, or clean period-proof underwear.
- Maintain personal hygiene.
Don'ts
- Instruct the female patients not to delay in urinating.[4]
- Avoid Smoking[4]
- Avoid drinking the following items a lot:[4]
- Caffeinated sodas
- Alcohol
- Spicy foods
- Acidic fruits
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Michels TC, Sands JE (November 2015). "Dysuria: Evaluation and Differential Diagnosis in Adults". Am Fam Physician. 92 (9): 778–86. PMID 26554471.
- ↑ "Dysuria, Frequency, and Urgency - Clinical Methods - NCBI Bookshelf".
- ↑ 3.0 3.1 3.2 3.3 Gontero, Paolo; Kirby, Roger S.; Carson III, Culley C. (2013). doi:10.1007/978-1-4471-4634-6. Missing or empty
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(help) - ↑ 4.0 4.1 4.2 4.3 Gungor, Ilkay; Beji, Nezihe Kizilkaya (2011). "Lifestyle changes for the prevention and management of lower urinary tract symptoms in women". International Journal of Urological Nursing. 5 (1): 3–13. doi:10.1111/j.1749-771X.2011.01112.x. ISSN 1749-7701.