Dysuria

Pain, burning or discomfort on urination.

Background

  • More common in younger women
  • Most commonly, but not always, a sign of cystitis/urethritis secondary to a UTI
    • Furthermore, the diagnosis of UTI may be secondary to an underlying predisposition e.g. prostatic enlargement in men; anatomical abnormality in children etc

History

  • Ask about timing/onset (including when in relation to urination), frequency (how often does it happen), severity, location
    • e.g. Pain on initiation suggests urethritis whereas suprapubic pain after micturition is more suggestive of cystitis
  • Ask about associated symptoms
    • Haematuria
    • Urinary frequency, urgency, hesitancy (LUTS); volumes/flow
    • Appearance of the urine (e.g. bloody, cloudy; malodourous)
    • Discharge
    • Flank/abdominal pain/colic
    • Fever, rigors, malaise
  • Ask about past medical history (particularly any recent urological procedures/conditions; and if they have had this before) and drug history, sexual history (including unprotected sex), social history
    • ?possible pregnancy

Examination

  • Vital observations
    • Temperature; pulse rate
  • Abdominal examination
    • Looking particularly for any tenderness, specifically suprapubic or loin tenderness
  • Examination of the external genitalia
    • Any inflammation of the genitals, any discharge, any trauma
  • PR exam may be appropriate in men who give a history suggestive of prostatic conditions

Investigations

  • Urinalysis and mid-stream urine microscopy/culture & sensitivity are often useful first line tests.
    • This may provide enough information to diagnose UTI and warrant the prescription of antibiotics
  • First pass urine or high vaginal swabs/endocervical swabs may be useful if sexually transmitted infections are suspected
  • Imaging (CT KUB or Renal/Pelvic USS) could be performed if there is suspicion of bladder (or other urological) stones

Causes

  • UTI or other infections
    • Pyelonephritis
    • Cystitis
  • STIs: Chlamydia, gonorrhoea, non-gonococcal urethritis; genital herpes simplex;
    • Vaginitis
    • Prostatitis, epididymitis/epididymo-orchitis
  • Kidney/Bladder stones in the urethra
  • Obstruction (prostate enlargement)
  • Trauma
  • Drugs
    • Cyclophosphamide, allopurinol, danazol,
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