Download Dysuria and Frequency

Dysuria and Frequency
Dysuria: difficult and painful passage
of urine.
Frequency: repetetive voiding of
relatively small amounts of urine.
Dysuria and Frequency
Is seen far more frequently in women than
in men.
Causes : UTI, vaginitis, genital infection,
estrogen deficiency, interstitial cystitis,
chemical irritants, impedence to flow,
systemic or regional disease, bladder
tumor
Dysuria and Frequency
Infectious causes : pyelonephritis, cystitis,
urethritis, vaginitis, prostatitis
Pyelonephritis: fever, CVA tenderness (unilateral
or bilateral), frequency and dysuria, pyuria
(WBC>200000/ml urine), urine culture>1000000
cc/ml ,leukocyte esterase, nitrite dipstick.
Cystitis, urethritis: without upper u.t. symptoms.
Vaginitis: dysuria with vaginal discharge, vulvar
pruritus, and painful intercourse (candida,
trichomonas, gardnerella, nisseria gonorrhea
and herpes simplex.
Dysuria and Frequency
Prostatitis: the most frequent cause of
recurrent bacterial infection in men.
Sign and symptoms: terminal dysuria,
perineal discomfort purulent fluid by
prostatic massage.poor antibacterial
peneteration, prolonged therapy (6 -12 m)
Dysuria and Frequency
Differential Dx of painful urination in
female:
Vaginal symptoms: external dysuria ,
vaginal discharge, itching, swelling,
redness, soreness or vulvar burning, fishy
odor.
Sug: vaginitis pelvic exam, microscop
exam of the vaginal secretions
Dysuria and Frequency
Urinary symptoms: internal dysuria,
frequency, urgency,small volume of
urination,pain on termination of
urination,suprapubic pressure,foul odor,
sug:UTI
microsco exam,leukocyte
esterase and nitrite test.
Dysuria and Frequency
No pyuria or bacteriuria: mechanichal or
chemical irritation.
If chronic :cystoscopy for bladder tumor ,
dysuria frequency syndrome, interstitial
cystitis. Do not treat with antibiotic
Dysuria and Frequency
Pyuria without bacteriuria: sex
transmitted urethritis
gonorrhrea &
chlamydia,partially treated UTI, radiation
cystitis. Do not treat for cystitis .
Dysuria and Frequency
Pyuria with low count bacteriuria:
suges: bacterial urethritis( pyuria, dysuria
synd. Treat as for UTI.
Pyuria with high count bacteriuria:
sug: bacterial cystitis. Treat without
waiting for cuture results.
Hematuria without bacteriuria:
sug: non bacterial cause
(stone,radiation,cyclophosphamide,virus,
immune:B lactams,NSAIDs). Diag: hystory.
Hematuria
Normal red cell excretion is up to 2 million RBCs
per day.
Hematuria defined as 2-5 RBCs per hpf and can be
detected by dipstick.
Common causes of isolated hematuria: stones,
neoplasm, tuberculosis, trauma, and prostatitis.
Gross hematuria with blood clots : never
glomerular bleeding.
Single U/A with hematuria is common and results
from: mens, viral illness, allergy, exercise,or mild
trauma.
Hematuria
Persistent or significant hematuria: >3 RBCs
/hpf on three urinalysis ,or single urinalysis with>
100 RBCs ,or gross hematuria.
Suspicion of urogenital neoplasm: isolated
painless hematuria(isomorphic RBCs).
Hematuria with pyuria and bacteriuria, typical of
infection .
Hypercalciuria and hyperuricosuria can cause
unexplained isolated hematuria.
Hematuria
Isolated microscopic hematuria can be a
manifestation of glomerular disease (dysmorphic
RBCs).irregular shape of RBCs may also occure
due to pH and osmolarity changes.
The most common cause of isolated glomerular
hematuria are IgA nephropathy, hereditary
nephritis, thin basement membrane disease.
Hematuria with dysmorphic RBCs, RBC casts,
and protein excretion > 500 mg/d : diagnostic of
GN. Even in the absence of azotemia these
patients should undergo renal biopsy.
Hematuria
In case of macroscopic Hemat without
glomerular or parenchymal source, do a
3 glass test:
1. 10-15 cc of first urine urethral cause.
2. 10-30 cc of final urine (terminal
hematuria) bladder origin.
3. In all three samples
upper U.T.
bleeding.
Hematuria
In the case of NL renal function, no RBC
dysmorph, no significant proteinuria:
1. IVU or CT scan with contrast for stone or
tumor. In the absence of Dx :
2. Cystoscopy .
3. Age > 40 + smoking : bladder Ca.
Cystoscopy + urine cytology.
Hematuria
Proteinuria ) < 500 mg / d )
Dysmorphic RBC or cast
-
Pyuia , WBC cast
+ Urine culture
Hb electroph.
urine cytology
UA of family members
24 h urinary ca , uricaud
-
Urine eosinophils
+
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
Follow periodic
urinalysis
+
Open renal biopsy