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Dysuria is the sensation of painful or uncomfortable urination. Patients typically describe their discomfort as a burning, tingling, or stinging sensation that occurs when urine passes through an inflamed or irritated urethra. Bladder contractions can also worsen this pain.
The main causes of dysuria are categorized into infectious and non-infectious. A good approach is to first assess for genital tract infections like cervicitis and epididymitis; next, look for lower urinary tract infections or pyelonephritis; and finally look for non-infectious causes like benign prostatic hyperplasia, nephrolithiasis, urologic malignancy, and interstitial cystitis.
When approaching a patient with dysuria, first you should perform an ABCDE assessment to determine if they are unstable or stable.
If unstable, stabilize their airway, breathing, and circulation. Next, obtain IV access, and put your patient on continuous vital sign monitoring, including blood pressure, heart rate, and pulse oximetry.
Here’s a clinical pearl! If a patient with dysuria is exhibiting signs of instability, there’s a concern that they may have developed sepsis. It's crucial to closely monitor their condition for any additional symptoms of systemic infection, and seek medical attention promptly.
Now, let’s go back to the ABCDE assessment and take a look at stable patients.
If your patient is stable, you should perform a focused history and physical examination. Next, assess the history for symptoms of a genital tract infection, like vaginal irritation or discharge, urethral discharge, and scrotal pain.
Additionally, the patient might report risk factors for sexually transmitted infections, such as unprotected sexual intercourse or having multiple sexual partners. In this case, you should consider a genital tract infection.
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