Dysuria and Frequency

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Dysuria and Frequency

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

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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

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Dysuria and Frequency

• Infectious causes pyelonephritis, cystitis,
  urethritis, vaginitis, prostatitis
• Pyelonephritis fever, CVA tenderness (unilateral
  or bilateral), frequency and dysuria, pyuria
  (WBCgt200000/ml urine), urine culturegt1000000
  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.

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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)

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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

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Dysuria and Frequency

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

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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

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Dysuria and Frequency

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

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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, immuneB lactams,NSAIDs). Diag hystory.
  

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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.

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Hematuria

• Persistent or significant hematuria gt3 RBCs
  /hpf on three urinalysis ,or single urinalysis
  withgt 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.

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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 gt 500 mg/d diagnostic of GN.
  Even in the absence of azotemia these patients
  should undergo renal biopsy.

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Hematuria

• In case of macroscopic Hemat without glomerular
  or parenchymal source, do a 3 glass test
• 10-15 cc of first urine urethral cause.
• 10-30 cc of final urine (terminal hematuria)
  bladder origin.
• In all three samples upper U.T. bleeding.

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Hematuria

• In the case of NL renal function, no RBC
  dysmorph, no significant proteinuria
• IVU or CT scan with contrast for stone or tumor.
  In the absence of Dx
• Cystoscopy .
• Age gt 40 smoking bladder Ca. Cystoscopy
  urine cytology.

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Hematuria
Proteinuria ) lt 500 mg / d ) Dysmorphic RBC or
cast
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Pyuia , WBC cast

Serologic and hematologic evaluation, blood
cultures, anti GBM Ab ANCA, complement,
cryoglobalins hepatitis B and C serology VDRL,
HIV , ASLO
Urine culture Urine eosinophils
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Hb electroph. urine cytology UA of family
members 24 h urinary ca , uricaud
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IVP /- renal Ultrasound
Retrograde Arteriogram Cyst aspiration

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Cystoscopy

Biopsy and evaluation
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Renal CT scan

Open renal biopsy
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Follow periodic urinalysis
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