Dysuria

Dysuria, which is one of the urological symptoms, is defined as painful urination, in other words,
it’s the pain felt in the urethra during urination.
Dysuria is a symptom that can be present in the history of many disease such as Urinary Tract
Infections, Bladder cancer …etc.
Approaching the patients with Dysuria differs according to gender.
 Bladder Cancer
Bladder cancer is the second most common cancer and is the most frequent malignant tumor of
the urinary tract. This tumor is usually formed from Transitional cells. This cancer is more seen
among males during their sixth and seventh decades of life.

Risk Factors
1. Smoking.
2. Diet rich in meet and fat.
3. Schistosomiasis; a parasitic infection.
4. Chronic treatment with cyclophosphamide.
5. Occupational exposure to aniline dye.
History
In the early stages of the disease, most of the patients are asymptomatic, later on they will develop
symptoms such as
1. Gross Hematuria; most common symptom.
2. Frequency, urgency, and dysuria

Diagnosis
1. Cystoscopy with biopsy is diagnostic and is recommended in the evaluation
of older adults to rule out malignancy.
2. UA often shows hematuria (macro- or microscopic).
3. Cytology may show dysplastic cells.
4. MRI, CT, and bone scan are important tools with which to define invasion
and metastases.
5. IVP can examine the upper urinary tract as well as defects in bladder filling.
Seldom used.

Gonorrhea
Gonorrhea, a Gram-negative intracellular diplococcus, is a sexually transmitted infection that can
infect almost any site in the female reproductive tract. Infection in men tends to be limited to the
urethra.

History
Female patients with gonorrhea present with a greenish-yellow discharge, pelvic or adnexal pain,
and swollen Bartholin’s glands. While male patients Presents with a purulent urethral discharge,
dysuria, and erythema of the urethral meatus. However, disseminated disease may present with
monoarticular septic arthritis, rash, and/or tenosynovitis.

Diagnosis
Gram stain and culture is the gold standard for any site (pharynx, cervix, urethra, or anus). Nucleic
acid amplification tests can be sent on penile/vaginal tissue or from urine.
 Urinary Tract Infections (UTIs)
Urinary Tract infection is an infection in any part of your urinary system —kidneys, ureters,
bladder and urethra. Most infections involve the lower urinary tract — the bladder and the
urethra. Females are more frequently affected than males and E coli cultures are obtained in 80%
of the cases.

Risk factors
1. Presence of catheters or other urologic instrumentation.
2. Anatomic abnormalities (eg, BPH, vesicoureteral reflux).
3. History of previous UTIs or pyelonephritis.
4. Diabetes Mellitus.
5. Recent antibiotic use.
6. Immunocompromised patients.
7. Pregnancy.

History
Patients usually present with
1. Dysuria, urgency, frequency, suprapubic pain, and hematuria.
2. Children may present with bedwetting, poor feeding, recurrent fevers, and foul-smelling
urine.
The differential includes vaginitis, STDs, urethritis or acute urethral syndrome, and prostatitis.

Diagnosis
1. Diagnosed by clinical symptoms. In the absence of symptoms, treatment is warranted only
for children, patients with anatomical GU tract anomalies, pregnant women, those with
instrumented urinary tracts, patients scheduled for GU surgery, and renal transplant
patients.
2. Urine dipstick/UA: ↑ leukocyte esterase (a marker of WBCs) is 75% sensitive and up to
95% specific. ↑ nitrites (a marker of bacteria), ↑ urine pH (Proteus infections), and
hematuria (seen with cystitis) are also commonly seen.
3. Microscopic analysis: Pyuria (> 5 WBCs/hpf) and bacteriuria (1 organism/hpf = 106
organisms/mL) are suggestive.
4. Urine culture: The gold standard is > 105 CFU/mL.

By: Azri S. Haji Sgery