Dysuria
Dr.mohammed almansour
OUTLINES
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Scenarios
Definition
Causes
Pathogenes
Pathophysiology
Clinical presentation
Diagnosis
Management
conclusion
• An 18-year old woman presents with urinary frequency,
dysuria, and low-grade fever. Urinalysis shows pyuria
and bacilli. She has never had similar symptoms or
treatment for urinary tract infection
• An 18-year old woman present with her third episode of
urinary frequency, dysuria, and pyuria in the past 4
months
• A 24-year old woman presents with fever, chills, nausea,
vomiting, flank pain and tenderness. Her temperature is
40°C, pulse rate is 120/min., and blood pressure is 100/60
mm Hg.
• A 78-year old female presents with an indwelling foley
catheter and pyuria.
• 58-year old man presents with his first episode of urinary
frequency and dysuria. Urinalysis shows pyuria and
bacilli.
• A 28-year old male had a sexual encounter with
a prostitute while on a business trip in Seattle 1
week ago. After returning home, he noted a
burning sensation on urination and a yellow
discharge in his underwear. Microscopic
examination of the discharge reveals 4+
leukocyte esterase, and the following gram
stain.
definition
• Burning
micturition
(pain during
micturition)
causes
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Infection>>infection>>infection
Outlet obstruction
Stricture
Chemical
radiation
Infection
• Upper urinary tract Infections(UTI):
– Pyelonephritis
• Lower urinary tract infections
– Cystitis (“traditional” UTI)
– Prostatitis
– Epididymitis/orchitis
– Urethritis (often sexually-transmitted)
• UTI is classified to:
– Uncomplicated (simple)cystitis
Normal (anatomy,physiology&renal function)
No disorder impair defence mechanism
– Complicated cystitis
The reverse of above
Causative organisms
• 1- Bacterial :the most common
– Escherichia coli(>70-80% of cases)
– Staphylococcus saprophyticus(10-15%
– Proteus mirabilis
– Klebsiella
– Enterococcus
• 2- viral: adenovirus , Rubella,
Mumps and HIV
• 3-fungal:Candida, Histoplasma
capsulatum
• 4- Protozoal : T. vaginalis, S.
haematobium
Pseudomonas, Proteus, Klebsiella and S. aureus
are associated with hospital acquired infections
because their resistance to antibiotics favor their
selection in hospital patients
(catheterization, gynaecological surgery)
Proteus infections are associated with renal stones
Proteus produce a potent urease which act on
ammonia, rendering the urine alkaline
S. saprohyticus infections are found in
sexually active young women
Candida urinary infection is usually found in
diabetic patients and immunosuppression
* Infection of the anterior urinary tract (urethritis) is
mainly caused by N. gonorrhoae, staphylococci,
streptococci and chlamydiae
* M. tuberculosis is carried in blood to kidney from
another site of infection
(e.g. respiratory T.B.)
Mechanism of UTI
Disruption of urine flow or complete emptying of bladder
- Pregnancy - Renal stones -Tumor
- Prostate hypertrophy - Strictures
* Loss of neurologic control of bladder and sphincters
Paraplegia, and multiple sclerosis
* Vesicouretral reflux
(reflux of urine from bladder up the ureter)
Anatomic abnormalities in children
* Catheterization facilitate bacterial access to bladder
- During insertion
- In situ, bacteria access to bladder
Bacterial colonization in urinary tract is
prevented by:
- pH of urine (acidic)
- Chemical content of urine
- Flushing mechanisms(strength of stream)
Clinical presentation
Acute lower UTIs (Urithritis and cystitis):
Rapid onset of:
- Dysuria
- Urgency (the urgent need to pas urine)
- Frequency of micturition.
-uratheral discharge(STD’S)
- Pain in the perineum(prostatitis/epididmoorchitits)
Upper UTIs (Pyelonephritis):
- Fever
- Chills /rigors
- Dysuria
- Urgency
- Frequency of micturition
examination
High tempreture
Costo-vertebral angle
tendreness
Suprabupic /lower
abdominal tenderness
diagnosis
• dip-stick
• urinalysis
• Urine culture
Specimen :
- An aseptic collection technique essential to
prevent contamination
- The first urine passed by patient in the morning
- A ”mid stream” urine sample under a septic
precaution
- Boric acid is used as a preservative for urine
specimens
Difference between infected and
contaminated urine
infection
contamination
More than 105 Organisms/ml
less than 104 Organisms/ml
A single bacterial spp.
More than one organism
management
General measures:
Hydration
Protective measures against STD’S
Hygine
Specific measures:
Treat the cause
Antibiotic
analgesics
conclusion
• Dysuria(pain in urination) is one of
irritation symptoms
• Most common cause is infection
• E-coli is most common pathogen
• Presentation either(simple cystits)or
complicated(pyelonephritis)
• Diagnosis urine work up(>More than 105
Organisms/ml )
• Treatment :treat the cause(mainly
antibiotic)
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