Skip to Main Content

++

Probability diagnosis

++

UTI (esp. cystitis)

++

Urethritis

++

Urethral syndrome—abacterial cystitis (female)

++

Vaginitis

++

Serious disorders not to be missed

++

Neoplasia:

++

  • bladder

  • prostate

  • urethra

++

Infection:

++

  • gonorrhoea

  • chlamydia/others

  • genital herpes

  • prostatitis

++

Reactive arthritis

++

Calculi (e.g. bladder)

++

Pitfalls (often missed)

++

Menopause syndrome

++

Adenovirus urethritis

++

Prostatitis

++

Foreign bodies in lower urinary tract

++

Acidic urine

++

Acute fever

++

Interstitial cystitis

++

Urethral caruncle/diverticuli

++

Vaginal prolapse

++

Obstruction:

++

  • benign prostatic hyperplasia

  • urethral stricture

  • phimosis

  • meatal stenosis

++

Masquerades checklist

++

Depression

++

Diabetes

++

Drugs

++

UTI

++

Is the patient trying to tell me something?

++

Consider psychosexual problems, anxiety and hypochondriasis.

++

Key history

++

It is important to determine whether dysuria is really genitourinary in origin and not attributable to functional disorders, such as psychosexual problems. Disturbances of micturition are uncommon in the young male and if present suggest sexually transmitted infection (STIs).

++

Key questions:

++

  • Could you describe the discomfort?

  • What colour is your urine?

  • Does it have a particular odour?

  • Have you noticed a discharge?

  • If so, could it be sexually acquired?

  • Do you find intercourse painful or uncomfortable (women)?

  • Have you any fever, sweats or chills?

++

Key examination

++

  • General inspection looking for evidence of kidney disease and vital signs

  • Abdominal palpation to focus on the loins and suprapubic areas

  • The possibility of STIs should be considered and this includes vaginal examination in the female and rectal and genital examination in the male

  • In the menopausal female the cause may be evident from a dry atrophic urethral opening, a urethral caruncle or urethral prolapse

++

Key investigations

++

  • Dipstick testing of the urine

  • Microscopy or culture (midstream specimen of urine or suprapubic puncture in children)

  • Urethral swabs or first pass urine for STIs

  • Further investigations depend on findings

++

Diagnostic tips

++

  • Urethritis causes pain at the onset of micturition and cystitis at the end.

  • Suprapubic discomfort is a feature of bladder infection (cystitis).

  • Unexplained dysuria could be a pointer to chlamydia urethritis.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.