Dysuria

01-2020
Maryam Fadah
01 02
Case Scenario GU Hx & Physical Examination

03 04 TABLE OF CONTENTS
Differential Diagnosis POCT & Reliability

05 06
Complicated Vs Antibiotics/ management of
Uncomplicated UTI dysuria
Etiology, pathophysiology and
treatment
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. The patient states that she had similar
symptoms 6 months ago, which were diagnosed as a urinary
tract infection. Her symptoms at that time resolved
completely with antibiotic treatment. She denies any current
vaginal irritation or discharge. She has had one male sexual
Case Scenario
partner for the past 2 years, does not use condoms, and has
not had any sexually transmitted diseases. She denies fever,
chills, nausea, vomiting, and back, pelvic, or abdominal pain.
She does not have diabetes and is not pregnant.
 Age: 32 year old
Gender: Female
Social status: married

PATIENT
MEDICAL
• burning with urination HISTORY
• over the past 12 hours. (acute)
• intense need to urinate, difficulty
• similar symptoms 6 months ago
• No vaginal irritation or discharge.
• One male sexual partner for the past 2 years does not have STD’s.
• No fever, chills, nausea, vomiting, and back, pelvic, or abdominal
pain.
• Not Diabetic and is not pregnant.
 Physical Examination
Findings

“Male Sex”

Alerting signs 1 2 3 4

Herpes Irritant contact dermatitis Syphilitic chancre Erosive lichen planus

Skin rash

Gonorrhea Chlamydia Trichomoniasis

Signs indicative of STDs:

Signs of urosepsis fever chills Altered Mental status

Flank pain or tenderness Recent instrumentation Immunocompromised patient Recurrent episodes

Others urinary tract
abnormality
Women Others:
• Fever (e.g. Pyelonephritis)
• Hematuria (e.g. Hemorrhagic cystitis,
Bladder cell cancer, Nephrolithiasis,
Renal cell cancer.
• Vaginal discharge • frequency, urgency, incontinence,
• Pregnancy/ type of contraception 
• Menstrual cycle
• Sexual partners
History and physical
Men examination

Physical Examination
- Abdominal, GU and
Rectal
• Prostate? - Derma (be selective)
• Bacterial epididymitis?
Differential Diagnosis
MERCURY
It’s the
closest
It’s the
planet to Clinical Decision Rule
smallest for UTI in Women
the
one Sun
in our Without Signs of
It’s only a Complicated Disease
Solar
bit larger
It was
System
than
named ourafter
Moon
the Roman
messenger
god

U/S
BPH; secondary study in
recurrent UTIs, complicated
pyelonephritis, or hematuria urolithiasis
iodinated contrast media
allergy or pregnancy
most useful test in a
patient with dysuria
(PV+ = 75-95%),
when combined with
dipstick = 95%
Investigations
& POCT
Plevic &
Cystoscop
AXR abdomina C T MRI
y
useful in Evaluation of hematuria, Voiding symptoms, complicated
known recurrent UTI (with risk urethral pyelonephritis;
factors or relapses), and diverticula, bladder
complicated pyelonephritis cancer, interstitial
cystitis/bladder not preferred, for stones
Without contrast; urolithiasis. pain syndrome and hematuria
In hematuria: If CT unavailable
consider Intravenous urography
Approach to
the Patient
Approach to
the Patient
 UTI; comlicated
Vs Uncomplicated
Treatment
 A
Treatment is directed at the cause.
Many clinicians do not treat dysuria in
B C
trimethoprim/sulfame Because they can cause tendinopathy,
women without red flag findings if no thoxazole or trimetho fluoroquinolones should not be used for
cause is apparent based on prim alone is uncomplicated urinary tract infections (UTIs)
examination and the results of a recommended
urinalysis
Recommended
App
• THOMAS C. MICHELS, MD, ARRET E. SANDS, DO. Dysuria: Evaluation
and Differential Diagnosis in Adults. AAFP [Internet]. 2015 Nov 1 
[cited at 26th January 2020];92(9):778-788. Available at:
https://www.aafp.org/afp/2015/1101/p778.html#sec-5
• JEFF A. SIMERVILLE, M.D., WILLIAM C. MAXTED, M.D., JOHN J.
PAHIRA, M.D. Urinalysis: A Comprehensive Review.  AAFP [Internet].
2005 Mar 15 [cited at 26th January 2020];71(6):1153-1162.
Available at: https://www.aafp.org/afp/2005/0315/p1153.html
• KENNETH W. LIN, MD, THEODORE R. BROWN, DO, MPH. Screening REFERENCES
for Asymptomatic Bacteriuria in Adults. AAFP [Internet]. 2010 Feb
15 [cited at 26th January 2020];81(4):508-509. Available at:
https://www.aafp.org/afp/2010/0215/p508.html
• Anuja P. Shah. Dysuria. MERCK MANUAL Professional Version
[Internet]. 2019 jun [cited at 26th January 2020]. Available at:
https://www.merckmanuals.com/professional/genitourinary-disord
ers/symptoms-of-genitourinary-disorders/dysuria
THANKS
Does anyone have any questions?