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PubMed2003

Treatment with a combined cystopexy-colopexy for dysuria and rectal prolapse after bilateral perineal herniorrhaphy in a dog.

A 9-year-old castrated male Yorkshire Terrier was evaluated for dysuria and rectal prolapse 2 weeks after bilateral perineal herniorrhaphy. Dysuria was secondary to caudal displacement of the bladder, rather than retroflexion of the bladder. Dysuria and rectal prolapse were associated with disruption of supporting ligaments of the urinary bladder and colon, which may have been caused by tenesmus. Combined cystopexy and colopexy were used successfully to treat the dysuria and rectal prolapse.

Animals↗
PubMedDate not supplied

[Value of radiological investigations in patients with dysuria after prostatic adenomectomy (author's transl)].

Dysuria is a relatively frequent complication after prostatic adenomectomy. The authors review 107 patients with this complication and demonstrate that radiological investigation, including a micturition study, preferably after IVU, shows the presence of an obstructive cause for the dysuria in the vast majority of cases (92.5%). There are two main types of obstructive lesion: - parietal stenosing lesions, - compression lesions. - The most frequent parietal stenosing lesions, apart from those of the bladder neck, are urethral stenoses. - Stenoses with total compression of the capsule are often the cause of severe dysuria. - Localized compression of the capsule and urethral stenosis usually cause only moderate dysuria. - An irregular lacunar image should suggest cancer of the prostate.

Aged↗
PubMed1999

Evaluation of dysuria in men.

Men with pain or a burning sensation on urination should be evaluated with a thorough history, a focused physical examination and urinalysis (both urine dipstick and microscopic examination of the urine specimen). Although dysuria may be caused by anything that leads to inflammation of the urethal mucosa, it is most often the result of urinary tract infection. In younger patients, the infectious agent is usually a sexually transmitted organism such as Chlamydia trachomatis. In patients over 35 years of age, coliform bacteria predominate. Infection in older men most often occurs as a result of urinary stasis secondary to benign prostatic hyperplasia. Other conditions that may cause dysuria include renal calculus, genitourinary malignancy, spondyloarthropathy and medications. Successful treatment of dysuria depends on correct identification of its cause.

Constriction, Pathologic↗
PubMed2001

[The DEGAM guidelines "Dysuria" by the German Society of General Practice and Family Medicine (DEGAM)--possible consequences of the implementation in general practice].

INTRODUCTION: In Germany, there are hardly any reliable data on patient care in the primary care setting which warrant the development and implementation of clinical guidelines. In this paper, data generated by a prospective observational study of patients with urinary tract symptoms are compared to the recommendations of an evidence-based clinical guideline. PATIENTS AND METHODOLOGY: Over a period of 6 months all patients consulting one of 6 General Practitioners in southern Germany with symptoms of dysuria have been documented on a standardised patient record. Data were compared to the recommendations of the guideline "Dysuria" by the German Society of General Practice and Family Medicine (DEGAM) to assess the relevance and feasibility of the guideline. In a scenario, compliance with the guideline is extrapolated to the realm of primary care. RESULTS: Basic demographic and epidemiological data agree with basic assumptions of the guideline. As far as diagnostic and therapeutic strategies are concerned there are significant discrepancies between the recommendations and the realm of primary care. Microbiologic cultures are ordered far less then recommended, second line drugs are prescribed far more often then recommended, macroscopic urinoscopy is performed widely but not covered by the guideline at all. If GPs complied completely with the guideline, many more diagnostic procedures would be performed and a different palette of antimicrobial drugs would be prescribed. CONCLUSION AND OUTLOOK: The "Dysuria-Guideline" of DEGAM was developed for a prevalent and relevant topic in primary care in Germany. There are significant discrepancies between the recommendations and the realm of primary care. Post-hoc-analysis is an informative and feasible tool to identify potential obstacles against implementation of guidelines.

Family Practice↗
PubMed2005

Evaluating dysuria in adolescent females.

Adolescent females presenting with acute dysuria in primary care settings are often assumed to have urinary tract infections and are evaluated accordingly. Dysuria, with or without a change in vaginal discharge, is also often associated with sexually transmitted infections, usually urethritis, even when the patient does not report a history of sexual activity. An adolescent female with dysuria, an abnormal urinalysis, and a negative urine culture has a high probability of having a sexually transmitted infection. Although providers who treat adolescents should not assume all of their patients are sexually active, it is essential that they ask questions about their patients' past and present sexual activity and consider the possibility of sexually transmitted diseases in young women presenting with this symptom.

Acute Disease↗
PubMed1976

Dysuria in women.

Only 46% of 84 women with dysuria were found to have significant bacteriuria while 8% had gonorrhea, 1% had herpes progenitalis and 17% had monilia and Trichomonas vaginitis. The remainder were considered to have the urethral syndrome. Neither pyuria, microscopic bacteriuria, nor any single subjective or objective datum definitively predicted cystitis at the initial visit. Therefore, we advise formulating the problem as "dysuria" at the initial evaluation even though one treats with an antimicrobial. The initial workup should include a routine urinalysis, gram stain of the urinary sediment, urine culture, an examination of the urethra and labia as well as a urethral culture. Complete pelvic examination is useful in documenting gonorrhea, herpes progenitalis or vaginitis. If the pelvic examination is deferred and the initial urine culture is negative, reevaluation of the dysuria should include a pelvic examination.

Bacteriuria↗
PubMed1991

Factors associated with regular episodes of dysuria among women in one rural general practice.

The aim of this study was to ascertain the factors associated with frequency-dysuria (urethral) syndrome in a population of women. The study included all women aged 25 years and over on 1 May 1987 who had been registered with one rural, dispensing practice over the study period, 1 May 1985 to 1 May 1989. A self-administered questionnaire was sent to the women on 1 May 1987 and a second, similar, questionnaire was sent two years later. A total of 721 women responded to the two questionnaires (response rate 97%). Regular symptoms of frequency and dysuria were reported by 8% of women in 1987 and 14% in 1989. Four percent of women reported symptoms throughout the four year study period. Symptoms were found to be least common in the 55-74 years age group. Although none of the women who were sexually inactive reported regular symptoms no association was reported between recent sexual intercourse and symptoms. Neither was an association demonstrated between type of contraception used and symptoms. However, it was found that premenopausal women reported significantly more symptoms than postmenopausal women. The number of women involved in this study was too small to allow the importance of change of sexual partner to be determined. Significantly more of the women who reported regular symptoms had been treated for urinary tract infection than of those who did not report regular symptoms. Although a history of regular frequency and dysuria points to a diagnosis of urethral syndrome, general practitioners must assess each case in order to exclude urinary tract infection.

Adult↗
PubMed1990

Dysuria and urinary tract infections.

It has been estimated that up to 25% of American women may experience acute dysuria yearly. Many physicians commonly equate dysuria with urinary tract infection and will treat empirically without adequate evaluation. This therapeutic trial of antibiotics represents undertreatment for many patients and inappropriate treatment for others. It is important that physicians understand that dysuria is only a symptom that can be produced by many different clinical entities.

Cystitis↗
PubMed2006

Two cases of dysuria as a complication of single-session bilateral triple pelvic osteotomy.

Dysuria is a rare, but nevertheless severe postoperative complication associated with single-session bilateral triple pelvic osteotomy. Two cases are described in which contrast radiography of the lower urinary tract was used to diagnose urethral compression due to pelvic canal narrowing. Relief of the pressure on the urethra was achieved with an external fixation device, which distracted the acetabular fragments of the pelvis. In both cases the dysuria was resolved. The significance of this complication and its possible causes, especially regarding surgical technique, are discussed.

Animals↗
PubMed1990

Irritability and dysuria in infants with idiopathic hypercalciuria.

Idiopathic hypercalciuria (IH) is being diagnosed with increasing frequency in the pediatric population and occurs in approximately 2.9-6.2% of normal children. The majority of children with IH are asymptomatic; however, the most common clinical presentation is that of isolated hematuria (gross or microscopic). The prevalence, presentation and clinical course of IH is less well established in infants. We have recently seen two young infants with IH who had dysuria on presentation. Their hypercalciuria was difficult to manage and required frequent manipulations of drug therapy and diet restrictions. These cases emphasize the importance of evaluating infants with dysuria and irritability for IH, even in the absence of hematuria. Further studies are needed to establish the prevalence and classical presentation of IH in this population, and to determine the necessary duration of therapy.

Affect↗
PubMed1994

Pancreas transplantation and dysuria.

Bladder drainage of the pancreatic graft remains the most common technique in pancreatic transplantation. Graft and patient survival is superior to duct injection and bowel drainage techniques. However, several urological complications develop as a result of bladder drainage. We report 6 cases of the dysuria syndrome after combined kidney/pancreas transplantation. Retrograde urethrography or cystoscopy showed extravasation from the bulbous urethra in all cases, which was most likely caused by activated proteolytic exocrine enzymes from the transplanted pancreas. Minor urethral trauma due to Foley catheterization or cystoscopy may predispose patients to this syndrome. Short-term urethral catheterization or suprapubic catheter drainage led to resolution in all cases. A high index of suspicion coupled with early intervention is recommended for patients with the dysuria syndrome.

Adult↗
PubMed1993

Valve of Guerin as a cause of dysuria and hematuria in young boys: presentation and difficulties in diagnosis.

A valve of Guerin, or lacuna magna, is a common anatomical finding in young boys. It occasionally causes dysuria and/or bloody urethral discharge or spotting due to its location distal to the external urethral sphincter. We report on 10 patients who underwent transmeatal marsupialization of a valve of Guerin between 1984 and 1991, and review the embryology and clinical presentation. Despite evidence suggesting that a valve of Guerin is a frequent, normal anatomical variant, the incidence of clinical detection is extremely low. While many patients with this condition remain totally asymptomatic, a valve of Guerin should be suspected in boys presenting with bleeding distal to the urethral sphincter with or without voiding symptoms. In most cases physical examination is normal. A carefully performed voiding cystourethrogram visualizing the distal urethra, coupled with endoscopic examination and gentle probing of the fossa navicularis, optimizes the likelihood of correct diagnosis. Treatment is indicated solely to ameliorate symptoms, which are probably caused by distention of the lacuna magna during voiding. Transmeatal incision and marsupialization of the valve leaflet into the urethral lumen usually effectively relieve dysuria and stop the bleeding.

Adolescent↗
PubMed1988

Urodynamic studies in acupuncture for women with frequency, urgency and dysuria.

Urodynamic measurements were performed before and after acupuncture at 2 different points in 52 women who presented with frequency, urgency and dysuria. Measurements included cystometry, anal sphincter electromyography, urethral pressure profilometry and uroflowmetry. The results of this study showed a significant increase in maximum cystometric capacity and a decrease in peak urinary flow rate after acupuncture at the Sp. 6 point, which has traditionally been used for the treatment of urinary problems. During acupuncture at the Sp. 6 point there were periodic increases in intraurethral pressure at the distal urethra, which were measured with a microtip transducer. Acupuncture-induced detrusor inhibition and external sphincteric contractions were demonstrated. Clinically symptomatic improvement was noted in 22 of the 26 patients who were treated by acupuncture at the Sp. 6 point. Our studies indicated that acupuncture could be used as a simple and effective method to treat female patients with frequency, urgency and dysuria.

Acupuncture Therapy↗
PubMed1981

Lactobacilli do not cause frequency and dysuria syndrome.

Mid-stream specimens (MSU) of urine were collected from 142 healthy women (pregnant and non-pregnant) and cultured for lactobacilli and other fastidious bacteria. The latter either require CO2 or are obligate anaerobes. Lactobacilli were present in counts of 10(4)/ml or more in 34.8% of the women, and in counts of 10(5)/ml or more in 20.2%. Besides lactobacilli, which were the bacteria most frequently isolated, anaerobic gram-positive cocci (peptococci and peptostreptococci) were often found. This flora is typical of that of the lower vagina, and none of these women had either symptoms of urinary infection of pyuria. Therefore, the bacteria isolated were commensals or contaminants. Cultures of MSUs taken from 26 women with symptoms of dysuria and/or frequency, but without significant numbers of conventional pathogens such as Escherichia coli, contained commensals and contaminants of the same variety and in similar numbers. Urine samples from 50% of these patients contained at least 10(4) lactobacilli/ml and 27% had 10(5) or more/ml. Lactobacilli were absent from the suprapubic urine specimens cultured from a further 44 women. There was no significant difference between the isolation rate of lactobacilli in urine cultures from healthy women and the rate in women with dysuria and frequency.

Chlamydia Infections↗
PubMed1984

Diagnosis of dysuria in adolescent girls. A protocol encompassing common, often nonurinary, causes.

Vulvovaginitis, not urinary tract infection, is the most common cause of dysuria in adolescent girls, and the work-up for this condition involves more than just ordering urinalysis and urine culture. Factors essential to proper evaluation of dysuria include determination of the patient's age, stage of pubertal development, and sexual activity, as well as assessment of associated symptoms, concomitant conditions, and use of contraceptive or feminine hygiene products that may cause irritation. Thus, a thorough history and physical examination, including examination of the genital area, are mandatory.

Adolescent↗
PubMed1995

Hypergastrinemia, dysuria-hematuria and metabolic alkalosis: complications associated with gastrocystoplasty.

PURPOSE: To help determine the etiology and most appropriate treatment regimen for hypergastrinemia, dysuria-hematuria and metabolic alkalosis following augmentation gastrocystoplasty. MATERIALS AND METHODS: Two patients who presented with refractory metabolic alkalosis (1 with dysuria-hematuria) underwent extensive laboratory evaluation, complete upper gastrointestinal evaluation and intravesical pH probe placement. RESULTS: Both patients eventually required high dose oral potassium chloride supplementation. Bladder mucosal pH was not reflected by buffered urinary pH. Both patients demonstrated significant gastroesophageal reflux and diminished overall gastric acid output. CONCLUSIONS: Outpatient maintenance on potassium chloride supplementation may be warranted in select patients and appears to be preferable to histamine blockade or omeprazole. Postoperative screening esophagogastroscopy and an additional surgical maneuver might be indicated to prevent possible adverse sequelae of reflux esophagitis. Gastrocystoplasty may be an inappropriate operation in children with renal insufficiency who have not had metabolic acidosis.

Alkalosis↗
PubMed2004

Correlates of engaging in unprotected sex while experiencing dysuria or discharge: a study of men with confirmed gonorrhea.

OBJECTIVES: To identify the prevalence and correlates of engaging in unprotected sex while experiencing symptoms of gonorrhea among a sample of men with a laboratory confirmed diagnosis. METHODS: Cross-sectional interview data were analyzed from 237 men, reporting dysuria or discharge, with a laboratory-confirmed diagnosis of gonorrhea. RESULTS: A total of 21.1% reported engaging in unprotected sex while having symptoms. In multivariate analyses, men engaging in sex > or = 5 times in the past 30 days were 3.5 times more likely to report unprotected sex while symptomatic (P = 0.001). Men reporting condom use < or = 50% of the time (past month) were 2.7 times more likely to report the risk behavior under investigation (P = 0.008). Men never having a previous STD were 2.7 times more likely to engage in the risk behavior (P = 0.006). CONCLUSIONS: The prevalence of this risk behavior was markedly lower compared to a recent study that was not restricted to gonorrhea. Counseling protocols specifically designed for men who continue to engage in unprotected sex after experiencing gonorrhea-related dysuria and discharge may be valuable for preventing the transmission of gonorrhea to women.

Adult↗
PubMed1988

Urethral dilatation compared with cystoscopy alone in the treatment of women with recurrent frequency and dysuria.

The relative merits of cystoscopy alone and cystoscopy plus urethral dilatation were compared in a randomised study of women with recurrent frequency and dysuria. One hundred women were studied before and at least 6 months after operation. A detailed questionnaire was completed, the severity of the symptoms was scored and patients underwent urodynamic investigation. Forty-eight patients underwent cystoscopy alone and 52 underwent urethral dilatation. The two groups were well matched with regard to age, parity, menopausal status, previous gynaecological surgery and severity of symptoms. A significant improvement in symptoms was observed in both groups after treatment: 30% had no residual symptoms, 50% were improved and 20% were no better. However, no difference in final outcome was observed between those who had undergone cystoscopy alone and those who had undergone urethral dilatation. Furthermore, 7 patients who underwent urethral dilatation experienced transient stress incontinence of urine, a complication not observed in women who underwent cystoscopy alone. No benefit was observed from the addition of urethral dilatation to cystoscopy alone in women with recurrent frequency and dysuria.

Adult↗