Chapter 12 DYSURIA
Dysuria is the sensation of burning, pain, or discomfort on urination, most often the result of infection or inflammation of the bladder, the urethra, or both. Infection may manifest as urethritis, cystitis, or pyelonephritis. Although dysuria often is equated with urinary tract infection, dysuria also may result from vaginitis, malformations of the urinary tract, malignancy, hormonal conditions, trauma, interstitial cystitis, neurogenic conditions, and psychogenic disorders.
Key Historical Features
✓ Onset and duration of dysuria
✓ Fever, chills, nausea, or vomiting
✓ Timing of dysuria, particularly if related to menstrual cycle
✓ External versus internal dysuria
✓ Pain at onset of urination versus suprapubic pain after voiding
✓ Urinary frequency, urgency, or hesitation
✓ Use of topical irritants such as lubricants, douches, or soaps
✓ Sexual history, including history of sexually transmitted diseases
Key Physical Findings
Suggested Work-Up
| Urinalysis | To evaluate for pyuria or hematuria |
| Urine culture | To accurately diagnose infection and determine antimicrobial susceptibility of infecting bacteria |
| Vaginal wet mount preparation | To detect infection with Trichomonas vaginalis and Candida species |
| Urethral smear or urine ligase chain reaction and polymerase chain reaction tests for Neisseria gonorrhoeae and Chlamydia trachomatis | To detect gonorrhea and chlamydia |
Additional Work-Up
| Urine cytologic testing | If urinary tract malignancy is suspected |
| Cystoscopy | To detect bladder or urethral pathology and confirm the diagnosis of interstitial cystitis; used in the evaluation of noninfectious hematuria |
| Renal ultrasonography | If kidney or ureter disease such as abscess or hydronephrosis is suspected |
| Bladder ultrasonography | If bladder or urethral stones are suspected or if bladder diverticula are suspected |
| Plain films of kidneys, ureters, and bladder | For rapid evaluation of suspected renal stones |
| Computed tomographic (CT) scan with contrast media (preferred) | To visualize avascular structure such as infarcts, cysts, abscesses, and necrotic tumors |
| CT scan without contrast media | To evaluate for renal stones/calcifications and to evaluate solid tissue in the urinary tract |
| Voiding cystourethrography | To assess for abnormalities such as vesicoureteral reflux, neurogenic bladder, urethral strictures, and diverticula |
| Intravenous pyelography | To evaluate recurrent urinary tract infection or localize ureteral calculi |
| Magnetic resonance imaging (MRI) with gadolinium enhancement | To identify urinary obstruction or mass in patients with renal insufficiency or allergy to iodinated contrast media |
Bremnor JD, Sadovsky R. Evaluation of dysuria in adults. Am Fam Physician. 2002;65:1589-1596.
Roberts RG, Hartlaub PP. Evaluation of dysuria in men. Am Fam Physician. 1999;60:865-872.
Thomas A, Woodard C, Rovner ES, et al. Urologic complications of nonneurologic medications. Urol Clin North Am. 2003;30:123-131.
