Presentation On Dysuria 1

Presentation on dysuria
Dysuria
 Definition: The sensation of pain, burning or discomfort on urination.
 Epidemiology -
• In adulthood, more common in women than men.
• Approximately 25% of women report one episode of acute dysuria per year.
• Most common in women 25-54 years of age and in those who are sexually active.
• In men, dysuria becomes more prevalent with increasing age.
 Etiology -
• Infectious: - Most common cause - Presents as; cystitis, urethritis,
pyelonephritis, vaginitis or prostatitis
• Non- infectious: - Hormonal conditions (hypoestrogenism), obstruction (BPH,
urethral strictures), neoplasms, allergic reactions, chemicals, foreign body and
trauma
Clinical features of dysuria
Symptoms-
Fever.
Foul or stronger-smelling urine.
Cloudy or bloody urine.
Increased urinary frequency or urge to urinate.
Flank pain.
Causes
Bladder stones
Chlamydia trachomatis
Cystitis (bladder inflammation)
Drugs, such as those used in cancer treatment, that have bladder irritation as a side effect
Genital herpes
Gonorrhea
Having a recent urinary tract procedure performed, including use of urologic instruments for testing or
treatment
Kidney infection (pyelonephritis)
Kidney stones
Prostatitis
Sexually transmitted diseases (STDs)
Soaps, perfumes and other personal care products
Urethral stricture (narrowing of the urethra)
Urethritis (infection of the urethra)
Urinary tract infection (UTI)
Vaginitis
Yeast infection (vaginal)
Differential Diagnosis of Dysuria
• UTI
• STD Chlamydia trachomatis , N. gonorrhea , and HSV all can cause
urethritis and symptoms of LUTI.
• Candidal infections
• Urethral or bladder irritation.
• Interstitial cystitis in young women.
• Bladder tumors
• Instrumentation
• Trauma
• BPH , prostatitis , epididymitis.
• Renal stones, renal infarction papillary necrosis
Urinary Tract Infections
 UTI is Any infection involving the urothelium, which
includes urethral, bladder, prostate and kidney
infections.
• The term UTI and uncomplicated UTI are often used
to refer to cystitis
Risk Factors
Sexual intercourse
Diaphragm contraceptive
 Vaginal spermicide
Pregnancy
Menopause
Instrumentation
 Urinary tract obstruction
DM
 Immunosuppression
Malformation
Classification
• Upper urinary tract Infections: - Pyelonephritis
• Lower urinary tract infections
 Cystitis (“traditional” UTI)
- Urethritis (often sexually-transmitted)
- Prostatitis
Presentation
• Frequency, urgency, dysuria, hematuria, supra- pubic
pain, grossly cloudy and malodorous urine - THINK
OF CYSTITIS
• High grade Fever, rigors (shaking chills), nausea,

vomiting, diarrhea, loin pain -THINK OF ACUTE
PYELONEPHRITIS
• Flu like symptoms low backache, few urinary

symptoms - THINK OF PROSTATITIS
Causative Agents
• Escherichia coli and other ‘coliforms’ – 80%
• Proteus mirabilis
• Klebsiella aerogenes
• Enterococcus faecalis
• Staphylococcus saprophyticus or epidermidis – 5-15%
Lower Urinary Tract Infection
Cystitis
Uncomplicated (Simple) cystitis In healthy woman,
with no signs of systemic disease
Complicated cystitis In men, or woman with co-
morbid medical problems.
 Recurrent cystitis
Uncomplicated (simple) Cystitis
Definition Healthy adult woman (over age 12) Non-pregnant Rarely in men.
• Signs and symptoms Dysuria Frequency , urgency or both No fever, nausea, vomiting,
flank pain and no vaginal discharge
• Diagnosis Dipstick urinalysis positive for nitrites or leukocyte esterase. (no culture or
lab tests needed)
• Prognosis : Treatment is usually successful. Symptoms of a bladder infection usually
disappear within 24 - 48 hours after treatment
 Risk Factors and Treatment
 Major risk factor for uncomplicated simple cystitis is sexual activity. Treatment:
 • Sulfamethoxazole-trimethoprim
 • Amoxicillin
 • Nitrofurantoin
 • Ampicillin
 • Ciprofloxacin
 • Levofloxacin
Complicated Cystitis
• Females with comorbid medical conditions
• All male patients
• Indwelling foley catheters
• Urosepsis/hospitalization
--Diagnosis • CBC + blood culture . • Urine dipstick : pyuria on microscopic examination
urine WBC positive for nitrites or leukocyte esterase. • Middle stream urine culture:
bacterial account > 10^5/ml • The following tests may be done to help rule out problems
in the urinary system that might lead to infection or make a UTI harder to treat: - CT scan
of the abdomen - Intravenous pyelogram (IVP) Kidney scan - Kidney ultrasound -
Voiding cystourethrogram
 Risk Factors and Treatment : • Blockages in the urinary tract: Kidney stones or an
enlarged prostate can trap urine in the bladder and increase the risk of urinary tract
infection. • Urinary tract abnormalities: that don't allow urine to leave the body or cause
urine to back up in the urethra • Catheter to urinate: • Diabetes • Advanced age
Treatment • Fluoroquinolone (or other broad spectrum antibiotic) • 7-14 days of
treatment (depending on severity) • May treat even longer (2-4 weeks) in males with UTI
Recurrent Cystitis
• Recurrent cystitis is usually defined as three episodes of
urinary tract infection in previous 12 months or two
episodes in previous six months.
• It’s common in young, healthy women . One study
show that 27% of women developed a second infection
within six months of the first attack.
Evaluation and Treatment
• May consider urologic work-up to evaluate for anatomical
abnormality.
• Postcoital antibiotics (taken within two hours of
intercourse) reduce the rate of clinical recurrence of
cystitis as effectively as continuous treatment.
• Self-administered trimethoprim/sulfa-methoxazole or
continuous prophylaxis are effective in preventing
recurrence of cystitis in 95% of the cases
• Cranberry products (juice or capsules) seem to
significantly reduce the recurrence of symptomatic
cystitis.
Prostatitis
Diagnosis:
• Typical clinical history (fevers, chills, dysuria, malaise,
myalgias, pelvic/perineal pain,cloudy urine)
• The finding of an edematous and tender prostate on
physical examination
• Increased PSA
• Urinalysis, urine culture
Risk Factors and Treatment
• Being a young or middle-aged man
• Having a past episode of prostatitis
• Cystitis or urethritis
• Having a pelvic trauma, such as injury from cycling or horseback riding
• Not drinking enough fluids (dehydration)
• Using a urinary catheter
• Having unprotected sexual intercourse
• Having HIV/AIDS
• Being under psychological stress
Treatment:
• Trimethoprim/sulfamethoxazole, fluroquinolone or other broad spectrum
antibiotic
• 4-6 weeks of treatment
Urethritis
Urethritis is swelling and irritation (inflammation) of the
urethra. Urethritis may be caused by bacteria or a virus. The
same bacteria that cause urinary tract infections (E. coli) and
some sexually transmitted diseases (chlamydia, gonorrhea) can
lead to urethritis. Viral causes of urethritis include herpes
simplex virus and cytomegalovirus.
Other causes include: Injury Sensitivity to the chemicals used
in spermicides or contraceptive jellies,creams, or foams
Risks for urethritis include: • Being a female in the
reproductive years • Being male, ages 20 - 35 • Having many
sexual partners • High-risk sexual behavior (such as anal sex
without a condom) • History of sexually transmitted diseases
TREATMENT
Treatment (Chlamydia): Azithromycin – Doxycycline
– x 7 days (Neisseria gonorrhea):
• Ceftriaxone
• Levofloxacin
• Ofloxacin – • Spectinomycin
Pyelonephritis
Infection of the pelvis of kidney
• Symptoms of acute pyelonephritis : short duration; hours to days It can
cause high fever, pain on passing urine, and abdominal pain that radiates
along the flank towards the back. There is often associated vomiting.
• Physical examination may reveal fever and tenderness at the costovertebral
angle on the affected side.
• Most cases of "community-acquired" pyelonephritis are due to bowel
organisms that enter the urinary tract.
• Common organisms are E. coli (70–80%) and Enterococcus faecalis.
• Hospital-acquired infections may be due to coliform bacteria and
enterococci, as well as other organisms uncommon in the community (e.g.
Pseudomonas aeruginosa and various species of Klebsiella).
• Most cases of pyelonephritis start off as lower urinary tract infections, mainly
cystitis and prostatitis.
Diagnosis
• Symptoms + U/A (+ve Nitrite and WBCs) are sufficient to diagnose and are an
indication for empirical treatment,
• CBC shows neutrophilia
• Urine culture and antibiotic sensitivity are useful to establish a formal diagonsis
• KUB if suspected stone
• Where available, a noncontrast CT scan is the diagnostic modality of choice in
the radiographic evaluation of suspected nephrolithiasis
Treatment: 2-weeks of Trimethroprim/sulfamethoxazole or fluoroquinolone
Hospitalization and IV antibiotics if patient unable to take oral medication
Complications:
• Perinephric/Renal abscess: suspect in patient who is not improving on
antibiotic therapy.
• Renal failure
• Sepsis
Tactics of a general practitioner.
Conservative managementA positive urine culture in the absence of clinical
symptoms may indicate asymptomatic bacteriuria and does not warrant treatment
or further investigation. For all children, general measures that improve hygiene,
hydration and bowel habits are recommended.
Medical managementTreatment should be tailored to clinical severity and depends
on the child’s age. Broad spectrum oral antibiotics will treat most uncomplicated
UTIs. Comparatively, children with apparent sepsis, in shock and/or <3 months of
age should be treated aggressively with parenteral antibiotics and intravenous fluids.
These patients should be referred to hospital for a full septic screen, including
lumbar puncture and paediatric review.7,15 Antibiotic choice is governed by
microbial sensitivities and local policies (Table 3, available online only). Every
patient should be reassessed 48 hours after starting antibiotics, and treatment
should be modified as per cultures and sensitivities. Empirical gentamicin therapy
should not be used for longer than three days. If empirical therapy is still required,
switching to ceftriaxone should be considered to reduce the risk of nephrotoxic and
ototoxic side effects.
Surgical management-Evidence suggests that boys have a 1%
UTI risk in their first year, but this risk is reduced to 0.1% if
they are circumcised.2 Routine circumcision is not
recommended, given that approximately 111 boys would need
to be circumcised to prevent one UTI. However, having
already had a first UTI in the first year of life confers further
risk and circumcision may provide additional benefit,
especially for those with recurrent UTI or grades III–V
VUR.15 Prior to circumcision, hypospadias should be
evaluated. Furthermore, surgical VUR correction should be
considered only for persistent grade III–V VUR and/or failed
continuous antibiotic coverage.
The used literature
Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence
of urinary tract infection in childhood: A meta-
analysis. Pediatr Infect Disease J
Williams GJ, Wei L, Lee A, Craig JC. Long-term
antibiotics for preventing recurrent urinary tract
infection in children.
THANKYOU

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Presentation on dysuria

• High grade Fever, rigors (shaking chills), nausea,

• Flu like symptoms low backache, few urinary

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