Dysuria resident survival guide: Difference between revisions
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{{CMG}}; {{AE}} {{IQ}} {{RAB}} | {{CMG}}; {{AE}} {{IQ}} {{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|Herpes]],[[Dermatitis|Irritant dermatitis]],Erosive, [[Lichen planus]],[[Contact dermatitis|Contact Dermatitis]].It may also be due to an [[STD]], bladder stones, bladder tumors and any condition of the [[prostate]]. It can also occur as a side effect of medications. It is one of a constellation of irritative bladder symptoms, which includes frequency of urination and [[haematuria]]. | [[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|Herpes]],[[Dermatitis|Irritant dermatitis]],Erosive, [[Lichen planus]],[[Contact dermatitis|Contact Dermatitis]].It may also be due to an [[STD]], bladder stones, bladder tumors and any condition of the [[prostate]]. It can also occur as a side effect of medications. It is one of a constellation of irritative bladder symptoms, which includes frequency of urination and [[haematuria]]. | ||
==Causes== | ==Causes== | ||
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==Diagnosis== | ==Diagnosis== | ||
*Shown below is two algorithms summarizing the diagnosis of Dysuria | *Shown below is two algorithms summarizing the diagnosis of [[Dysuria]] | ||
*Algorithm showing diagnosis of dysuria in woman | *Algorithm showing diagnosis of dysuria in woman | ||
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Algorithm showing diagnosis of dysuria in Male patients{{Family tree/start}} | Algorithm showing diagnosis of [[dysuria]] in Male patients{{Family tree/start}} | ||
{{Family tree | | | | | A01 | | | |A01= Male patient with dysuria}} | {{Family tree | | | | | A01 | | | |A01= Male patient with dysuria}} | ||
{{Family tree | | | | | |!| | | | | }} | {{Family tree | | | | | |!| | | | | }} | ||
| Line 206: | Line 206: | ||
** Patient should always wipe front to back | ** Patient should always wipe front to back | ||
** Patient should wear cotton/comfortable underwear | ** Patient should wear cotton/comfortable underwear | ||
** Patient should use menstrual | ** Patient should use [[menstrual cup]]<nowiki/>s, sanitary pads, or clean period-proof underwear | ||
** Maintain personal hygiene | ** Maintain personal [[hygiene]] | ||
==Don'ts== | ==Don'ts== | ||
Revision as of 11:51, 13 August 2020
| Dysuria Resident Survival Guide |
|---|
| Overview |
| Causes |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2] 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 STD, bladder stones, bladder tumors and any condition of the prostate. It can also occur as a side effect of medications. It is one of a constellation of irritative bladder symptoms, which includes frequency of urination and haematuria.
Causes
Life Threatening Causes
Life-threatening causes of dysuria include
These conditions may result in death or permanent disability within 24 hours if left untreated
Common Causes
- Acute Cystitis
- Urethritis from sexually transmitted infections
- Female genital structure related
- Male genital Structure related
- Foreign Body in urinary tract
- Indwelling Foley catheter
- Stone
- Urethral or ureteral stent
- Pyelonephritis
- Urethral Stricture
- Dermatological
- Local trauma
- Medication use
- Neoplasia
Diagnosis
- Shown below is two algorithms summarizing the diagnosis of Dysuria
- Algorithm showing diagnosis of dysuria in woman
| Woman with dysuria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Take complete history | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Presence of Comcomitant fever,flank pain, abnormal vital signs(Tachycardia,Tachypnea,Hypotension),nausea,vomiting | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Urethritis(Chlamydia trachomatis,Neisseria gonorrhoeae or Herpes simplex virus) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Firm, painless, non-itchy skin ulceration with multiple sores OR A diffuse rash involving the palms of the hands and soles of the feet OR Presence of gummas | Painless genital ulcer,anorectal pain, tenesmus, and 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
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Patient should always stay hydrated
- Patient should urinate after sexual intercourse
- Patient should always wipe front to back
- Patient should wear cotton/comfortable underwear
- Patient should use menstrual cups, sanitary pads, or clean period-proof underwear
- Maintain personal hygiene
Don'ts
- Patient should avoid delays in urinating
- Patient should try to decrease the inatke of
- Caffeinated sodas
- Alcohol
- Spicy foods
- Acidic fruits