Evaluation of Dysuria in Adults -- American Family Physician

Infection is the most common cause of dysuria and presents as cystitis, prostatitis, pyelonephritis, or urethritis, depending on the area of the urogenital tract that is most affected. The hollow or tubular structures of the urinary system are vulnerable to infection by coliform bacteria. These bacteria are believed to gain access to the urethral meatus through sexual intercourse or local contamination and then ascend to the affected region. A community-based study found that about two thirds of culture-proven UTIs are caused by Escherichia coli. Other less frequent pathogens include Staphylococcus (15 percent), Proteus mirabilis (10 percent), Staphylococcus aureus (5 percent), Enterococcus species (3 percent), and Klebsiella species (3 percent). Abnormalities in urinary anatomy or funcD ysuria is the sensation of pain, burning, or discomfort on urination. Although many physicians equate dysuria with urinary tract infection (UTI), it is actually a symptom that has many potential causes. Empiric treatment with antibiotics may be inappropriate, except in carefully selected patients. Dysuria most often indicates infection or inflammation of the bladder and/or urethra. Other common causes of dysuria include prostatitis and mechanical irritation of the urethra in men, and urethrotrigonitis and vaginitis in women. Dysuria can also result from malformations of the genitourinary tract, neoplasms, neurogenic conditions, trauma, hormonal conditions, interstitial cystitis, and psychogenic disorders (Table 1). Dysuria accounts for 5 to 15 percent of visits to family physicians. Approximately 25 Dysuria, defined as pain, burning, or discomfort on urination, is more common in women than in men. Although urinary tract infection is the most frequent cause of dysuria, empiric treatment with antibiotics is not always appropriate. Dysuria occurs more often in younger women, probably because of their greater frequency of sexual activity. Older men are more likely to have dysuria because of an increased incidence of prostatic hyperplasia with accompanying inflammation and infection. A comprehensive history and physical examination can often reveal the cause of dysuria. Urinalysis may not be needed in healthier patients who have uncomplicated medical histories and symptoms. In most patients, however, urinalysis can help to determine the presence of infection and confirm a suspected diagnosis. Urine cultures and both urethral and vaginal smears and cultures can help to identify sites of infection and causative agents. Coliform organisms, notably Escherichia coli, are the most common pathogens in urinary tract infection. Dysuria can also be caused by noninfectious inflammation or trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders. Although radiography and other forms of imaging are rarely needed, these studies may identify abnormalities in the upper urinary tract when symptoms are more complex. (Am Fam Physician 2002;65:1589-96, 1597. Copyright© 2002 American Academy of Family Physicians.)