Evaluation of dysuria

Dysuria refers to discomfort, burning, or sensation of pain during micturition. Patients may also complain of urethral discomfort not associated with micturition. Dysuria may be external (i.e., urine irritating the inflamed genital organs) or internal (i.e., pain felt in the urethra).

Although urinary tract infection is the most common cause, any infectious or inflammatory condition affecting the genitourinary system may cause dysuria.

Epidemiology

Dysuria is a common presentation in primary care. It is generally more common in women, with a reported prevalence in women of up to 25% in the US per year and 27% in the UK per year.[1]Richardson DA. Dysuria and urinary tract infections. Obstet Gynecol Clin North Am. 1990;17:881-8. http://www.ncbi.nlm.nih.gov/pubmed/2092247?tool=bestpractice.com [2]Jolleys JV. The reported prevalence of urinary symptoms in women in one rural general practice. Br J Gen Pract. 1990;40:335-7. https://bjgp.org/content/bjgp/40/337/335.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/2121180?tool=bestpractice.com Approximately 1 million urinary tract infections are treated every year in US emergency departments, with a female:male ratio of 6:1.[3]Best J, Kitlowski AD, Ou D, et al. Diagnosis and management of urinary tract infections in the emergency department. Emerg Med Pract. 2014 Jul;16(7):1-23; quiz 23-4. https://www.ebmedicine.net/topics/hepatic-renal-genitourinary/urinary-tract-infection http://www.ncbi.nlm.nih.gov/pubmed/25379602?tool=bestpractice.com

Although dysuria is uncommon in men, incidence increases with advancing age.[4]Rasanathan M. Dysuria in general practice. N Z Med J. 1979;89:54-6. http://www.ncbi.nlm.nih.gov/pubmed/372868?tool=bestpractice.com Lower urinary tract symptoms increase dramatically in men ages >40 years due to bladder outlet obstruction secondary to benign prostatic hyperplasia.[5]Sommer P, Nielsen KK, Bauer T, et al. Voiding patterns in men evaluated by a questionnaire survey. Br J Urol. 1990;65:155-60. http://www.ncbi.nlm.nih.gov/pubmed/2317647?tool=bestpractice.com Among men of all ages who seek medical advice for urologic symptoms, dysuria is present in about 5% of cases.[6]Wolfs GG, Knottnerus JA, Janknegt RA. Prevalence and detection of micturition problems among 2,734 elderly men. J Urol. 1994;152:1467-70. http://www.ncbi.nlm.nih.gov/pubmed/7933185?tool=bestpractice.com