Dysuria and Frequency Dysuria: difficult and painful passage of urine. Frequency: repetetive voiding of relatively small amounts of urine

Dysuria and FrequencyDysuria and Frequency

Dysuria: difficult and painful passage Dysuria: difficult and painful passage of urine.of urine.

Frequency: repetetive voiding of Frequency: repetetive voiding of relatively small amounts of urine.relatively small amounts of urine.


Is seen far more frequently in women than Is seen far more frequently in women than in men.in men.

Causes : UTI, vaginitis, genital infection, Causes : UTI, vaginitis, genital infection, estrogen deficiency, interstitial cystitis, estrogen deficiency, interstitial cystitis, chemical irritants, impedence to flow, chemical irritants, impedence to flow, systemic or regional disease, bladder systemic or regional disease, bladder tumor tumor


Infectious causes : pyelonephritis, cystitis, Infectious causes : pyelonephritis, cystitis, urethritis, vaginitis, prostatitisurethritis, vaginitis, prostatitisPyelonephritis: fever, CVA tenderness (unilateral Pyelonephritis: fever, CVA tenderness (unilateral or bilateral), frequency and dysuria, pyuria or bilateral), frequency and dysuria, pyuria (WBC>200000/ml urine), urine culture>1000000 (WBC>200000/ml urine), urine culture>1000000 cc/ml ,leukocyte esterase, nitrite dipstick.cc/ml ,leukocyte esterase, nitrite dipstick.Cystitis, urethritis: without upper u.t. symptoms.Cystitis, urethritis: without upper u.t. symptoms.Vaginitis: dysuria with vaginal discharge, vulvar Vaginitis: dysuria with vaginal discharge, vulvar pruritus, and painful intercourse (candida, pruritus, and painful intercourse (candida, trichomonas, gardnerella, nisseria gonorrhea trichomonas, gardnerella, nisseria gonorrhea and herpes simplex.and herpes simplex.


Prostatitis: the most frequent cause of Prostatitis: the most frequent cause of recurrent bacterial infection in men.recurrent bacterial infection in men.

Sign and symptoms: terminal dysuria, Sign and symptoms: terminal dysuria, perineal discomfort purulent fluid by perineal discomfort purulent fluid by prostatic massage.poor antibacterial prostatic massage.poor antibacterial peneteration, prolonged therapy (6 -12 m) peneteration, prolonged therapy (6 -12 m)


Differential Dx of painful urination in Differential Dx of painful urination in female:female:

Vaginal symptoms:Vaginal symptoms: external dysuria , external dysuria , vaginal discharge, itching, swelling, vaginal discharge, itching, swelling, redness, soreness or vulvar burning, fishy redness, soreness or vulvar burning, fishy odor.odor.

Sug: vaginitis pelvic exam, Sug: vaginitis pelvic exam, microscop exam of the vaginal secretionsmicroscop exam of the vaginal secretions


Urinary symptoms:Urinary symptoms: internal dysuria, internal dysuria, frequency, urgency,small volume of frequency, urgency,small volume of urination,pain on termination of urination,pain on termination of urination,suprapubic pressure,foul odor, urination,suprapubic pressure,foul odor, sug:UTI microsco exam,leukocyte sug:UTI microsco exam,leukocyte esterase and nitrite test.esterase and nitrite test.


No pyuria or bacteriuria:No pyuria or bacteriuria: mechanichal or mechanichal or chemical irritation.chemical irritation.

If chronic :cystoscopy for bladder tumor , If chronic :cystoscopy for bladder tumor , dysuria frequency syndrome, interstitial dysuria frequency syndrome, interstitial cystitis. Do not treat with antibiotic cystitis. Do not treat with antibiotic


Pyuria without bacteriuria:Pyuria without bacteriuria: sex sex transmitted urethritis gonorrhrea & transmitted urethritis gonorrhrea & chlamydia,partially treated UTI, radiation chlamydia,partially treated UTI, radiation cystitis. Do not treat for cystitis .cystitis. Do not treat for cystitis .


Pyuria with low count bacteriuria:Pyuria with low count bacteriuria: suges: bacterial urethritis( pyuria, dysuria suges: bacterial urethritis( pyuria, dysuria

synd. Treat as for UTI.synd. Treat as for UTI.Pyuria with high count bacteriuria:Pyuria with high count bacteriuria:

sug: bacterial cystitis. Treat without sug: bacterial cystitis. Treat without waiting for cuture results.waiting for cuture results.Hematuria without bacteriuria:Hematuria without bacteriuria:

sug: non bacterial cause sug: non bacterial cause (stone,radiation,cyclophosphamide,virus, (stone,radiation,cyclophosphamide,virus, immune:B lactams,NSAIDs). Diag: hystory. immune:B lactams,NSAIDs). Diag: hystory.

Hematuria Hematuria

Normal red cell excretion is up to 2 million RBCs Normal red cell excretion is up to 2 million RBCs per day. per day. Hematuria defined as 2-5 RBCs per hpf and can be Hematuria defined as 2-5 RBCs per hpf and can be detected by dipstick.detected by dipstick.Common causes of isolated hematuria: stones, Common causes of isolated hematuria: stones, neoplasm, tuberculosis, trauma, and prostatitis. neoplasm, tuberculosis, trauma, and prostatitis. Gross hematuria with blood clots : never Gross hematuria with blood clots : never glomerular bleeding.glomerular bleeding.Single U/A with hematuria is common and results Single U/A with hematuria is common and results from: mens, viral illness, allergy, exercise,or mildfrom: mens, viral illness, allergy, exercise,or mild

trauma.trauma.

HematuriaHematuria

Persistent or significant hematuria: >3 RBCs Persistent or significant hematuria: >3 RBCs /hpf on three urinalysis ,or single urinalysis with> /hpf on three urinalysis ,or single urinalysis with> 100 RBCs ,or gross hematuria.100 RBCs ,or gross hematuria.

Suspicion of urogenital neoplasm: isolated Suspicion of urogenital neoplasm: isolated painless hematuria(isomorphic RBCs).painless hematuria(isomorphic RBCs).

Hematuria with pyuria and bacteriuria, typical of Hematuria with pyuria and bacteriuria, typical of infection .infection .

Hypercalciuria and hyperuricosuria can cause Hypercalciuria and hyperuricosuria can cause unexplained isolated hematuria.unexplained isolated hematuria.

HematuriaHematuria

Isolated microscopic hematuria can be a Isolated microscopic hematuria can be a manifestation of glomerular disease (dysmorphic manifestation of glomerular disease (dysmorphic RBCs).irregular shape of RBCs may also occure RBCs).irregular shape of RBCs may also occure due to pH and osmolarity changes.due to pH and osmolarity changes.The most common cause of isolated glomerular The most common cause of isolated glomerular hematuria are IgA nephropathy, hereditary hematuria are IgA nephropathy, hereditary nephritis, thin basement membrane disease.nephritis, thin basement membrane disease.Hematuria with dysmorphic RBCs, RBC casts, Hematuria with dysmorphic RBCs, RBC casts, and protein excretion > 500 mg/d : diagnostic of and protein excretion > 500 mg/d : diagnostic of GN. Even in the absence of azotemia these GN. Even in the absence of azotemia these patients should undergo renal biopsy.patients should undergo renal biopsy.

HematuriaHematuria

In case of macroscopic Hemat without In case of macroscopic Hemat without glomerular or parenchymal source, do a glomerular or parenchymal source, do a 33 glass test: glass test:

1.1. 10-15 cc of first urine urethral cause.10-15 cc of first urine urethral cause.

2.2. 10-30 cc of final urine (terminal 10-30 cc of final urine (terminal hematuria) bladder origin.hematuria) bladder origin.

3.3. In all three samples upper U.T. In all three samples upper U.T. bleeding.bleeding.

HematuriaHematuria

In the case of NL renal function, no RBC In the case of NL renal function, no RBC dysmorph, no significant proteinuria:dysmorph, no significant proteinuria:

1.1. IVU or CT scan with contrast for stone or IVU or CT scan with contrast for stone or tumor. In the absence of Dx :tumor. In the absence of Dx :

2.2. Cystoscopy .Cystoscopy .

3.3. Age > 40 + smoking : bladder Ca. Age > 40 + smoking : bladder Ca. Cystoscopy + urine cytology.Cystoscopy + urine cytology.

Hematuria

Proteinuria ) < 500 mg / d )

Dysmorphic RBC or cast

Pyuia , WBC cast-

-

Urine culture

Urine eosinophils

+

Hb electroph.

urine cytology

UA of family members

24 h urinary ca , uricaud

-

Serologic and hematologic evaluation, blood cultures, anti GBM Ab ANCA, complement, cryoglobalins hepatitis B and C serology

VDRL, HIV , ASLO

+

IVP +/- renal

Ultrasound

Retrograde

Arteriogram

Cyst aspiration

+

-

Cystoscopy + Biopsy and evaluation

-

Renal CT scan +

-

Open renal biopsy

Follow periodic urinalysis

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Dysuria and Frequency Dysuria: difficult and painful passage of urine. Frequency: repetetive voiding of relatively small amounts of urine