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Urodynamic findings, and in particular measures of outflow obstruction in a consecutive series of 156 women presenting with recurrent increased frequency and dysuria, have been analysed. Poor correlation between these various measures has been demonstrated; at most only 8% of these patients have demonstrable outflow obstruction. More than a quarter of the patients had bladder instability.
In a clinical and microbiological study of women with urinary frequency and dysuria (excluding those with bacterial cystitis), 41 patients were compared with 42 control subjects. No difference was found between patients and controls in the incidence of infection by Chlamydia trachomatis or other sexually transmitted organisms. The numbers of lactobacilli and other fastidious organisms in the urine of patients with either mild or severe symptoms were similar and did not differ from the numbers in the urine of control subjects. The numbers of leucocytes in urine were also similar in both patients and controls. Our findings support the view that the urethral syndrome is not caused by bacterial or chlamydial infection.
A 15-month-old bitch was presented for investigation of a two-month history of dysuria. Clinical signs had developed within one day of routine ovariohysterectomy. A rounded mass was palpable in the caudal abdomen which was shown radiographically to displace and compress the urinary bladder. On ultrasonography, the mass was composed primarily of pockets of hypoechoic fluid divided by hyperechoic septae; blood was obtained on fine-needle aspiration. The mass was surgically removed and the dog regained normal urinary function within a few days. Histopathological examination showed the mass to be an encapsulated haematoma, which is likely to have developed as a result of the ovariohysterectomy.
This report describes the case of a 27 year old woman presenting at 19 weeks' gestation with epigastric pain and dysuria. Initially diagnosed with a urinary tract infection, she re-presented 10 days later with acute abdominal pain and haemoperitoneum. The diagnosis of placenta percreta was not made until laparotomy. This case highlights placenta percreta as a rare but serious complication of pregnancy that may become increasingly frequent as the rates of caesarean delivery rise. Early diagnosis, close monitoring, and prompt surgical management are essential as massive blood loss can occur. This can be challenging, as clinical presentation can be unusual.
We report a case of long-standing dysuria due to silent surgical abscess disease. The cause of our patient's complaint was not expected because we focused on dysfunctional voiding and not dysfunction as result of pathology close to the bladder neck since the history given by the patient was unremarkable.
Prazosin HCl was administered in dosages of 1.5-4.5 mg/day for 4 weeks to 40 patients suffering from dysuria accompanying prostatic hyperplasia. Significant reductions were observed in the mean frequency of night-time and 24-hour urination. Additionally, significant improvements were recorded for the time for start of urination, time from start to finish of urination and related variables. The improvements correlated with dosage levels. Objective variables measured by urine flow rates also exhibited significant improvement. A statistically significant decrease in systolic without a decline in diastolic blood pressure was observed. Slight dizziness was observed in 1 patient and elevated laboratory test values in another, but neither warranted discontinuation of the medication; however, 1 patient did have two doses of medication held. Overall, the drug was judged beneficial to some degree in 95% of the patients.
Bladder diverticula are usually encountered in the male. Their occurrence in women is scarcely appreciated. The association of bladder diverticula with urinary tract infection, dysuria, urgency and incontinence is reported in a series of 11 elderly female patients. The etiology of this finding is discussed based on urodynamic evaluation of these patients.
A series of benign prostatic hypertrophy patients were routinely evaluated, including transrectal echography, before and at regular intervals following surgery. Five patients had persistent symptoms of dysuria at 14-30 months after surgery. There was no infection, residual urine or malignancy to explain their symptoms. The seminal vesicles (SVs) were severely dilated on transrectal echography, a finding which was definitely not present on initial examination. The patients were treated by transrectal echo-guided aspiration of the SVs by the perineal approach. The fluid aspirated was examined, and antibiotics were directly injected into the SVs. In 4 of the patients, there was a dramatic relief of symptoms with prolonged improvement. In only 1 case, following transurethral resection, there was but slight improvement. Dilated, obstructed SVs after prostatectomy, clearly diagnosed on transrectal echography, may be the cause of persistent irritative urinary symptoms. Treatment can be instituted by echo-guided aspiration of the fluid with simultaneous injection of a potent antibiotic, resulting in probable immediate relief.
To prevent postoperative dysuria, which occurs inevitably after the radical hysterectomy, several surgical procedures have been tried. The principal method is to suture adnexal flaps to the bladder trigone and fundus. Of four procedures so far tried sequentially, the best one was to fix the bladder trigone and to support it with round ligament flaps sutured with the bladder fundus covered by tubal flaps (Type IV). In follow-up studies, Type IV proved more preferable than the other three types or the non-sutured control group in regard to the following aspects: (1) days necessary for the disappearance of residual urine, (2) appearance of urinary sensation, (3) acquirement of urinary sensation, (4) incidence of urinary incontinence, (5) residual urine/bladder capacity ratio, (6) cystometric findings, and others. Effectiveness of our procedures, particularly of Type IV, may be ascribed to the supported bladder trigone and fundus by sutured tissues and to the acquirement of urinary sensation, rather than to the restoration of nervous contact between the bladder and the micturition center in the spinal cord.
A 13-year-old castrated male Bassett Hound was examined because of a 2-week history of severe constipation and tenesmus. Radiography revealed a large cystic mass in the caudal portion of the abdomen that was compressing the urethra and obstructing the pelvic canal. A small perianal mass was also noticed in the region of the left anal sac. Exploratory surgery was performed, but the mass was deemed unresectable. Instead, the mass was incised, drained, and omentalized in an attempt to establish continuous drainage after surgery. Cytologic evaluation of the perianal mass was consistent with a diagnosis of anal sac adenocarcinoma. Histologic evaluation of the abdominal mass revealed it was a lymph node effaced by adenocarcinoma. Despite the poor prognosis for anal sac adenocarcinoma with metastatic spread to the sublumbar lymph nodes, tenesmus and dysuria in this dog remained palliated until the dog's death 18 months after surgery. Omentalization was successful in providing a continuous method of fluid drainage for this cystopapillary abdominal tumor.
Bacteria in excess of 10(4) colony-forming units per ml (CFU/ml), were isolated from voided urine specimens from 127 (79%) of 160 women, 15-45 years of age, consulting in general practice due to frequency and dysuria. Escherichia coli was the species most frequently isolated, followed by Staphylococcus saprophyticus. Chlamydia trachomatis was isolated from 8 (5%) patients, in 6 of whom greater than 10(4) CFU/ml urine were isolated. A 2-fold titre increase in micro-immunofluorescence antibodies to C. trachomatis was demonstrated in 8 cases, the organism itself being isolated in 1 case only. No viruses were isolated in any of 18 women with negative urine cultures. Proteinuria and/or haematuria was found more frequently in patients with S. saprophyticus than in patients with gram-negative rods. Tests for nitrite indicated bacteriuria in only 58% of the patients with greater than 10(4) CFU/ml urine, which can be partly explained by the fact that S. saprophyticus only occasionally reduces nitrate. Cocci were noted in urine sediment in 75% of patients in whom S. saprophyticus was isolated.
Dysuria-frequency in 78 patients was treated for 3 consecutive days with 300 mg trimethoprim administered in a single dose at night. Symptomatic cure was noted in 90% of the patients one week after initiation of therapy. In this investigation a positive urinary culture was found in 74% of the patients and bacteriological cure was obtained in all patients but one. A new infection was registered in 2 patients when controlled one week after the start of therapy. The isolated microorganisms were Escherichia coli in 52% of the cases and Staphylococcus saprophyticus in 29%. The high frequency of the latter offers an explanation to the low reliability of the nitrite dip test in diagnosing significant bacteriuria in this study.
The effect of a 3-day course of nalidixic acid was studied in 82 women, presenting with the dysuria-frequency syndrome and significant bacteriuria, mostly Escherichia coli sensitive to nalidixic acid. 62/76 patients (82%) that could be evaluated about 1 week after initiation of therapy were subjectively cured. Negative urinary cultures were found in 64/76 patients (84%). Two patients (2.4%) developed resistance to nalidixic acid. Bacteriological cure rate was 76% of 71 patients that could be controlled 1 month after the initiation of therapy. Nalidixic acid in the used granulate preparation initiated only mild side-effects.
A decision-analysis model was developed to estimate the effects and costs of alternative initial management strategies for women presenting with dysuria and pyuria. We compared days of morbidity and direct medical costs associated with single-dose and multiple-dose regimens of amoxicillin and trimethoprim-sulfamethoxazole and examined the cost-effectiveness of doing an initial urine culture. We used varying assumptions for prevalence of etiologic agents, treatment efficacy, frequency of side effects, and duration of symptoms. Single-dose regimens were preferable to multiple-dose regimens of either drug, and trimethoprim-sulfamethoxazole was preferable to amoxicillin. Single-dose trimethoprim-sulfamethoxazole therapy resulted in the fewest expected symptom-days (2.7) and the lowest expected cost (+54). The advantage of single-dose strategies in minimizing expected symptom-days resulted largely from the threefold to fourfold increase in the incidence of side effects reported with multiple-dose therapy. Obtaining an initial urine culture in all patients reduced expected symptom-days by about 10% but increased expected cost by about 40%.
STUDY OBJECTIVE: To compare single-dose and 10-day treatment regimens of trimethoprim-sulfamethoxazole in women with acute dysuria, urgency, or urinary frequency. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Student health center at a major university. PATIENTS: Consecutive sample of 255 young women including 216 with a bacteriologically documented urinary tract infection. INTERVENTION: Single-dose treatment (trimethoprim, 320 mg and sulfamethoxazole, 1600 mg) given to 116 women and 10-day treatment (trimethoprim, 160 mg and sulfamethoxazole, 800 mg, twice daily) given to 125 women. Women with a history of sulfonamide allergy were given trimethoprim alone: 10 received single-dose treatment (200 mg) and 5 received 10-day treatment (100 mg, twice daily). MEASUREMENTS AND MAIN RESULTS: The rates for resolution of symptoms at 3 days, 13 days, and 6 weeks after entry into the study were not significantly different between treatment groups. Among women with urinary tract infections, cumulative crude rates of recurrence in the single-dose and 10-day treatment groups, respectively, were 24% compared with 5% at 13 days after entry (P = 0.0002; 95% confidence interval [CI] for difference in proportions, 10%, 28%) and 32% compared with 21% at 6 weeks after entry (P = 0.07; 95% Cl, -2%, 24%). Factors independently associated with lower cure rates were a history of a urinary tract infection within the previous 6 weeks (adjusted odds ratio [OR], 3.8; 95% Cl, 1.4 to 10.6) and presence of 10(5) bacteria/mL or greater in an initial midstream culture (adjusted OR, 2.9; 95% Cl, 1.2 to 7.0). After controlling for these factors, the risk of failure after single-dose treatment was not statistically significantly different from 10-day treatment at 6 weeks (adjusted OR, 1.6; 95% Cl, 0.8 to 3.2; P = 0.21). Compared to 10-day treatment, single-dose treatment less effectively eradicated Escherichia coli from the vaginal flora (P less than 0.001) and led more often to early same-strain recurrences (P = 0.003). Meaningful adverse effects occurred in 12% of women given single-dose treatment compared with 25% of women receiving 10-day treatment (P = 0.009). CONCLUSIONS: Compared with single-dose treatment, 10-day treatment yields a superior cure rate at 2 weeks after the start of treatment, but by 6 weeks the advantage of longer treatment no longer exists. This effect may be explained by the lesser effectiveness of single-dose treatment in eradicating vaginal E. coli, resulting in more frequent same-strain recurrences within 2 weeks of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
OBJECTIVE: To evaluate the validity of clinical algorithms proposed in Benin for the diagnosis of gonococcal or chlamydial infections among men with urethral discharge or dysuria and women with vaginal discharge consulting health services in Benin. These algorithms were adapted from those proposed by the World Health Organisation. METHODS: Consecutive patients with these symptoms were enrolled at three primary healthcare centres. The reference test for gonorrhoea was a combination of results from culture and polymerase chain reaction and chlamydial infection was ascertained by enzyme linked immunosorbent assay and PCR. In women, two algorithms were evaluated, one based on symptoms and risk assessment (algorithm A), the other relying also on speculum examination (algorithm B). The first algorithm evaluated in men relied on clinical examination only (algorithm C) whereas the other used microscopic examination of urethral smears (algorithm D). Sensitivity, specificity, and positive and negative predictive values of these algorithms were assessed using standard methods. RESULTS: In 192 women, the prevalence of gonococcal and chlamydial infections was 5.7% and 2.1% respectively (combined prevalence of 7.8%). The sensitivity, specificity, positive and negative predictive values of algorithm A (algorithm B) were respectively 86.7% (93.3%), 41.8% (34.5%), 11.2% (10.8%), and 97.4% (98.4%). In 105 men, the corresponding prevalences were 39.0% and 7.6% respectively (for a combined prevalence of 44.8%). The sensitivity, specificity, positive and negative predictive values of algorithm C (algorithm D) were respectively 91.5% (87.2%), 60.3% (67.2%), 65.2% (68.3%), and 89.7% (86.7%). CONCLUSION: A syndromic approach for the diagnosis of urethritis in men appears appropriate. In women, the diagnosis of gonococcal or chlamydial infection without specific laboratory tests, which are not easily affordable in developing countries, remains highly problematic.
Uroflowmetry is a non invasive objective criterion for the evaluation of micturition. The values depend on resistance to voiding, but also detrusor pressure. Correct interpretation must take into account the limits of the examination, related to voiding volume, number of micturitions, age, individual factors, and circadian variations. Some artefacts, such as the initial peak or abdominal straining, induce a difference between automatic reading and manual reading, justifying comparison of the result displayed with the appearance of the curve. Uroflowmetry can detect dysuria, which may be poorly perceived or even unknown to the subjects themselves. It also completes the data of symptom scores. It is a good criterion for assessment of the results of treatment, but is insufficient, on its own, to define surgical indications. There is no strict correlation between flow rate and residual volume.
A 52 year old male consulted his clinician because of dysuria, difficulty in voiding and cutaneous lesions that were cured with high daily ingestion of acid substances (vinegar and lemon). For the last 20 years he had made several consultations without finding any solution to his problem. The patient was advised to stop acid ingestion after which he presented disuria and skin lesions compatible with rosacea. Due to the known association between this skin disorder and gastric colonization with H. pylori an upper gastrointestinal endoscopy was performed and the presence of the bacteria was confirmed. The patient received specific treatment with permanent resolution of the symptoms. We repeated the endoscopy with biopsy that did not show the presence of H. pylori. It is suggested that gastric colonization with H. pylori could be related to irritative symptoms of the lower urinary tract that are not due to other disease processes.