1.10 Painful and difficult voiding

Question 1

Dysuria def

Answer 1

=Dysuria
pain, discomfort or burning when urinatin (more common in women)

Painful voiding

Question 2

etiology of Painful and difficult voiding (dysuria)

Answer 2

• Infectious: UTI (no. 1 cause) in any part of urinary tract, also vaginal infections, STD
  *Cystitis, Urethritis
  *Pyelonephritis
  *STDs
  *Prostatitis, Epididymitis-orchitis
• Inflammation and irritations:
  *Foreign body, stone
  *Urethral stricture
  *BPH
  *Phimosis
• Anatomical
• Neoplastic
  *Bladder cancer
  *Renal cancer
  *Prostate cancer
  *Penile cancer
• Iatrogenic
  *Previous surgery or catheterization
  *Post-irradiation of pelvic region

Question 3

history taking and physical exam of dysuria

Answer 3

• onset: started suddenly or gradually,
• frequency: occurred once or many times
• felt at onset of urination,
• fever
• abnormal discharge
• flank pain
• change in urine flow (eg. dribbling, difficult initiation, increased
  frequency or urgency),
  urine character (color, amount, blood/pus/cloudiness)

Question 4

diagnosis of dysuria

Answer 4

o Urinalysis and urine culture: exclude infections
o Imaging: stones, tumors
*US
*Cystoscopy
*CT
*Xray
o Blood test: CBC, CRP, hormone levels (detect menopause?)

Question 5

difficulty voiding symptoms

Answer 5

can manifest as a variety of symptoms
* urinary hesitancy=Difficulty starting or maintaining a urine stream
* difficult emptying
* bladder/straining
* slow/weak stream
* urinary dribbling

Question 6

difficulty voiding in men etiology

Answer 6

etiology related to obstructive causes
* enlarged prostate
* urethral stricture
* bladder stone
* bladder tumor
* pelvic floor hyperactivity

Question 7

difficulty voiding female etiologies

Answer 7

• nerve dysfunction
• non relaxing pelvic floor muscles
• underactivity of detrusor muscle OR urethra

Question 8

diagnosis of difficulty voiding

Answer 8

uroflowmetry
postvoid residual volume
pressure flow studies (voiding cystometry)

Question 9

treatment of painful and difficult voiding

Answer 9

• individualized depending on etiology
  *pelvic floor therapy
  *intermittent self-catherization
  *muscle relaxant
  *placement of neuromodulation device

Question 10

pharmacotherapy of voiding dysfunction

Answer 10