Clinical Medicine 216 - Dysuria

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1

What is dysuria?

Any burning, tingling, stinging, and/or any other sensation of pain or discomfort associated with voiding urine

2

In males, dysuria is usually felt?

In the distal urethra during voiding and resolves shortly after micturition

3

Pain at the start of urination in males usually indicates?

A urethral source of inflammation

4

More severe pain occurring over the suprapubic area on completion of urination in males commonly indicates?

Inflammation of the bladder

5

What are the main lower urinary tract symptoms?

FUND:

F= frequency

U= urgency

N= nocturia

D= dysuria

6

What are the main obstructive lower urinary tract symptoms?

H = Hesitancy

I = Intermittence

S = Straining

7

What are the atypical causes of urinary tract infections?

Tuberculosis, Chlamydia trachomatis, candida, herpes, and gonorrhoea

8

What are the common causes of urinary tract infections?

KEEPS

K= Klebsiella

E= E. coli (most common), other Gram -ve

E= Enterococcus

P= Proteus mirabilis, Pseudomonas

S= Staphylococcus

9

What are the two phases of lower urinary tract function?

Bladder filling and urine storage, and bladder emptying

10

Is dysuria more common in men or women?

Women

11

Dysuria in males is most commonly caused by?

Urethritis, prostatitis, cystitis, or mechanical irritation of the urethra

12

Urinary flow in males may be altered by?

Compression of the urethra as it passes through an enlarged prostate. This may produce hesitancy, slowing of the urinary stream, dribbling, and nocturia.

13

Roles of the kidney:

1. Excretion of waste products and metabolites

2. Regulation of our water and electrolyte balance/concentrations

3. Regulation of our blood pressure

4. Regulates acid-base balance

5. Regulates red blood cell production

6. Secretes, breaks down, and excretes hormones

14

What are some possible reasons for failure to void?

1. Outflow obstruction

2. Loss of bladder innervation

3. Pharmacologic

15

What are some anatomical causes of dysuria?

Urethral stricture, urinary diverticulum, and benign prostatic hyperplasia in men

16

What are some non-inflammatory endocrine causes of dysuria in women?

Atrophic vaginitis (hypoestrogenism) and endometriosis

17

What are some non-inflammatory idiopathic causes of dysuria?

Chronic bladder pain syndrome / interstitial cystitis

18

What are some non-inflammatory neoplastic causes of dysuria?

Kidney, bladder, prostate, penile, or vulvovaginal cancers

19

What are some inflammatory dermatologic causes of dysuria?

Irritant/contact dermatitis, lichen sclerosis, lichen planus, psoriasis, Stevens-Johnson syndrome, and Behcet syndrome

20

What are some common inflammatory infectious causes of dysuria?

Cystitis, urethritis, pyelonephritis, sexually transmitted diseases, and perineal inflammation

21

What are some inflammatory infectious causes of dysuria in men?

Prostatitis, epididymitis, and orchitis

22

What are some inflammatory infectious causes of dysuria in women?

Vulvovaginitis and cervicitis

23

What are some non-inflammatory psychogenic causes of dysuria?

Anxiety, stress, depression, and somatization disorders

24

What are some non-infectious inflammatory causes of dysuria?

Foreign body (e.g., stones, stents, and catheters), urethritis (as the result of reactive arthritis/Reiter’s syndrome), drug side effects, and radiation induced

25

What is urinary diverticulum?

Cystic outpouching-type structure often located just next to the urethra or in the bladder

26

Clinical features of urinary diverticulum:

Dysuria, dyspareunia, dribbling with voiding, recurrent UTIs, vaginal mass (anterior wall), hematuria, vaginal discharge, and urinary incontinence (can be stress incontinence) and obstructive symptoms.

27

What is benign prostatic hyperplasia?

A non-cancerous enlargement of the prostate gland. As it grows throughout the transition zone, it will eventually press and pinch the urethra.

28

What are the complications of benign prostatic hyperplasia?

Hydronephrosis, retention, overflow incontinence, renal insufficiency, infection, gross hematuria, and bladder stones

29

What is acute dysuria?

Dysuria of less than 1 week in duration

30

What is internal dysuria?

Dysuria that is localized to the internal genital structures (urethra, bladder, and suprapubic area)

31

What is external dysuria?

Dysuria that is localized to external genital structures (labia minora and labia majora) and occurs as urine exits the body

32

What is urgency?

A sudden, compelling need to urinate that is often accompanied by bladder discomfort, with the inability to void more than a minimal quantity of urine.

33

What is frequency?

Urinating more frequently than usual without an increase in total urine volume due to the bladder's decreased capacity to hold urine.

34

What is nocturia?

Waking up to urinate 2 or more times during the night

35

What are voiding symptoms?

Symptoms that occur at the time of urination. These include a slow or intermittent urine stream, difficulty initiating urination (hesitancy), prolonged termination of urination (dribbling), and dysuria.

36

What are storage symptoms?

Symptoms that occur during bladder storage and filling. These include urinary urgency or frequency, nocturia, and incontinence.

37

What is an urinary tract infection (UTI)?

An infection of the urethra, prostate, bladder, or kidney

38

What is a lower urinary tract infection (UTI)?

An infection of the urethra and/or bladder (i.e., urethrocystitis or cystitis)

39

What is an upper urinary tract infection (UTI)?

An infection of the kidney (i.e., pyelonephritis)

40

What is a complicated urinary tract infection (UTI)?

A UTI in individuals with functional or structural abnormalities of the urinary tract. These individuals are at higher risk for treatment failure.

41

Referred pain from where can lead to dysuria?

The pelvic or abdominal organs

42

What is atrophic vaginitis?

Thinning, drying, and inflammation of the vaginal walls due to having less estrogen

43

What is chronic prostatitis?

Inflammation of the prostate typically caused by bacterial infection, which is associated with urinary tract infection, cystitis, urethritis, epididymitis, or acute prostatitis.

44

Dysuria with an insidious onset raises the possibility of __________?

Rare neoplastic etiologies

45

Dysuria in the presence of systemic symptoms (e.g., fever or chills, abdominal or flank pain, nausea and vomiting) should prompt consideration of _________?

Acute bacterial causes of dysuria such as pyelonephritis, acute prostatitis, epididymitis, or pelvic inflammatory disease

46

In women, the likelihood of pyelonephritis increases with __________?

Recent spermicide use, new incontinence in the past month, UTI in the past year, diabetes, a history of UTI in the patient's mother, and sexual intercourse more than once per week.

47

What is a serious cause of dysuria with fever and chills?

Urosepsis

48

What are common causes of dysuria with fever and chills?

Pyelonephritis, epididymitis, and acute prostatitis

49

What is a common cause of dysuria with flank pain?

Pyelonephritis

50

What is a common cause of dysuria with flank pain with hematuria?

Nephrolithiasis

51

What is a serious cause of dysuria with flank pain with hematuria?

Renal cancer

52

What is a serious cause of dysuria with hematuria?

Bladder cancer

53

What is a common cause of dysuria with hematuria?

Hemorrhagic cystitis

54

What is a serious cause of dysuria with penile discharge, mass or ulcer, and pain at the tip of the penis?

Penile cancer

55

What is a common cause of dysuria with penile discharge, mass or ulcer, and pain at the tip of the penis?

Urethritis (chlamydia, gonorrhoea, or herpes simplex virus)

56

What is a serious cause of dysuria with pelvic pain and dyspareunia?

Endometriosis and pelvic inflammatory disease

57

What is a serious cause of dysuria with vaginal bleeding?

Vaginal cancer and pelvic inflammatory disease

58

What is a common cause of dysuria with vaginal bleeding?

Menstruation

59

What is a common cause of dysuria with scrotal pain and/or swelling?

Epididymitis

60

What is a common cause of dysuria with painful genital ulcers?

Herpes simplex virus

61

What is a serious cause of dysuria with painful genital ulcers?

Behcet's syndrome

62

Behcet's syndrome, is a rare disorder that causes ________ throughout your body. The disease can lead to numerous signs and symptoms that can seem unrelated at first. They can include mouth sores, eye inflammation, skin rashes and lesions, and genital sores.

Blood vessel inflammation

63

What is a serious cause of dysuria with painful oral ulcers, arthritis, and eye findings?

Behcet's syndrome and reactive arthritis

64

________ is a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella, and Yersinia).

Reactive arthritis

65

What are some serious causes of dysuria with suprapubic pain, incontinence, and obstructive urinary symptoms (weak stream, hesitancy)?

Neurological disease (multiple sclerosis) and Parkinson's disease

66

What are common causes of dysuria with suprapubic pain, incontinence, and obstructive urinary symptoms (weak stream, hesitancy)?

Bladder outlet obstruction due to benign prostatic hyperplasia or urethral stricture.

67

What could cause dysuria with painful urination that lasts for 1-2 days?

Bacterial cystitis, acute bacterial prostatitis, and bacterial epididymitis

68

What could cause dysuria with painful urination that lasts for 2-7 days?

Urethritis / epididymitis (gonorrhoea, chlamydia, or herpes simplex virus)

69

What could cause dysuria with painful urination that lasts for more than 14 days?

Chlamydia infection (in women)

70

What could cause painful urination that lasts for weeks to months?

Interstitial cystitis, chronic bacterial prostatitis, chronic prostatitis/pelvic pain syndrome (men), and vulvodynia (women)

71

_______ is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. For the diagnosis to be made symptoms must last at least 3 months.

Vulvodynia

72

What could cause cyclic menstrual pain several days before onset of menstruation?

Endometriosis

73

What could cause pain during or immediately after the onset of menstruation?

Pelvic inflammatory disease

74

What could cause pain at the beginning of urination?

Urethritis

75

What could cause pain at the end of urination?

Cystitis or prostatitis

76

What could cause one to urinate more frequently than usual during the day?

Decreased bladder capacity (bladder inflammation or infection) or incomplete bladder emptying (benign prostatic hyperplasia or neurologic disease)

77

What could cause pain that gets worse after consuming food and drink?

Interstitial cystitis or painful bladder syndrome

78

Interstitial cystitis or painful bladder syndrome causes pain to ________ when the bladder is full and to ________ after urination?

Increase; decrease

79

What could cause dysuria with bladder incontinence?

Bladder inflammation as seen in acute cystitis, upper motor neuron lesion, detrusor muscle instability, and obstruction or irritation by bladder tumours

80

What could cause dysuria with a decreased amount of urine output?

Bladder inflammation from infection, irritants, systemic disease, or interstitial cystitis

81

What can cause painful urination without frequency or urgency in men?

Urethritis

82

What can cause dysuria with fever and painful or swollen testicles?

Bacterial epidiymitis or prostatitis

83

What can cause dysuria with fever and flank pain or nausea and vomiting?

Pyelonephritis

84

What can cause dysuria with fever and rectal discomfort, pain, or discharge?

Prostatitis (pain only), proctitis due to gonorrhoea, chlamydia, or herpes simplex virus

85

What can cause dysuria with fever and swollen lymph nodes in the groin area or dysuria with a new headache?

Primary genital herpes simplex virus

86

What can cause dysuria with hematuria?

Hemorrhagic cystitis (acute onset), bladder cancer, and benign prostatic hyperplasia (intermittent or chronic)

87

What can cause dysuria with hematuria and pain in the mid-back (flank pain)?

Nephrolithiasis (usually acute onset) or renal cell cancer (chronic)

88

What can cause dysuria with purulent or mucopurulent discharge?

Urethritis or cervicitis due to gonorrhoea or chlamydia. Most women with these infections will be asymptomatic.

89

What can cause burning or pain in the external genital area of women?

Candidal vulvovaginitis

90

What can cause dysuria with lower abdominal pain or vaginal bleeding in women?

Pelvic inflammatory disease

91

What can cause dysuria in men with bloody discharge?

Urethral cancer

92

Kidney and bladder neoplasms often produce?

Painless hematuria

93

What can cause dysuria with unintentional weight loss?

Bladder or renal cancer

94

What can cause dysuria with vaginal dryness?

Atrophic vaginitis

95

What can cause dysuria with a feeling of discomfort or a sensation that something is in the vagina during urination?

Cystocele

96

What is a cystocele?

A weakness of the anterior vaginal wall causing the bladder to protrude into the vagina during urination. (Herniation of the urinary bladder into the vagina)

97

What can cause dysuria as a result of sexual activity?

Chlamydia, gonorrhoea, and trichomoniasis

98

Dyspareunia during initial vaginal penetration in women suggests?

Vulvovaginitis, atrophic vaginitis, or urethritis

99

Dyspareunia during deep vaginal penetration in women suggests?

Endometriosis

100

What surgical-related treatment can cause dysuria?

Catheterization, instrumentation, and urethral stents

101

What is dyspareunia?

Occurrence of pain during sexual intercourse

102

What is urosepsis?

Septic poisoning from retained and absorbed urinary substances

103

What can cause urosepsis?

Infection from extravasated urine, obstruction of infected urine, or an urinary tract infection

104

What is cystitis?

Inflammation of the urinary bladder

105

What is urethritis?

Inflammation of the urethra; which is the passageway that connects the bladder with the exterior of the body

106

What is endometriosis?

A condition in which small amounts of tissue similar to the lining of the uterus grow in other parts of the body

107

What is pelvic inflammatory disease?

A term used to describe any infection in the lower female reproductive tract that spreads to the upper female reproductive tract

108

What is interstitial cystitis?

Inflammation of the bladder believed to be associated with an autoimmune or allergic response. The bladder wall becomes inflamed, ulcerated, and scarred, causing frequent painful urination.

109

What is orchitis?

Inflammation of the testis, which can be accompanied by swelling, pain, fever, and/or a sensation of heaviness in the affected area

110

What is proctitis?

Inflammation of the rectum

111

Where is prostatic pain felt?

In the perineum and occasionally in the rectum

112

What is hematuria?

Blood in the urine

113

What is gross hematuria?

Blood in the urine that is visible to the naked eye

114

What is microscopic hematuria?

Blood in the urine that is detected only during microscopic urinalysis

115

Kidney pain or flank pain is located __________?

At or below the posterior costal margin near the costovertebral angle. It may radiate anteriorly toward the umbilicus.

116

What is kidney pain?

A visceral-type pain usually produced by distention of the renal capsule and typically is dull, aching, and steady

117

What is ureteral pain?

Usually severe and colicky, originating at the costovertebral angle and radiating around the trunk into the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or labium.

118

What can ureteral pain result from?

Sudden distention of the ureter and associated distention of the renal pelvis

119

You are seeing a 67-year old man who reports mild dysuria for the past 3 months. Which symptom would be least concerning for bladder cancer?

Associated symptoms of difficulty initiating urination and a weak urinary stream

120

A woman presents to your office with dysuria and has not had a medical evaluation for over a year. What condition would not need to be tested for chlamydia?

A woman who has not been sexually active for over a year

121

What can cause dysuria with costovertebral angle tenderness?

Pyelonephritis, nephrolithiasis, or obstruction with hydronephrosis

122

What can cause dysuria with urethral mass or tenderness in women?

Urethral diverticulum or endometriosis

123

What can cause dysuria with cervical motion tenderness and/or mass or tenderness on bimanual examination in women?

Endometriosis, pelvic inflammatory disease, gynaecological mass, or urethral diverticulum

124

—High levels of excreted protein in the urine may indicate:

Kidney failure, diabetes mellitus, inflammation in the kidney, urinary tract infection, or renal carcinoma

125

Clinical presentation of interstitial cystitis (bladder pain syndrome):

Variable dysuria, frequency and urgency as primary symptoms, pain with bladder filling, and relief with emptying

126

Clinical presentation of overactive bladder:

Prominent urgency, frequency, and possible urge incontinence

127

Uncomplicated urinary tract infection:

Within the lower urinary tract, in the setting of a structurally and functionally normal urinary tract

128

Gonococcal urethritis presents with?

Yellow purulent discharge and irritative lower urinary tract symptoms

129

Non-gonococcal urethritis presents with?

Mucoid whitish purulent discharge, with or without irritative lower urinary tract symptoms

130

With urethritis you must rule out?

Reactive arthritis (Reiter's Syndrome)

131

Reactive arthritis clinical presentation?

—Urethritis/cervicitis, uveitis/conjunctivitis, and arthritis

132

All patients with urethritis should be tested for?

N. gonorrheae and C. trachomatis

133

What is acute pyelonephritis?

Infection of renal parenchyma with local and systemic manifestation. It is potentially life-threatening and causes scarring of the kidneys.

134

Acute pyelonephritis is usually caused by?

An infection ascending from an UTI. It can also be caused by hematogenous spread and seeding.

135

Clinical presentation of acute pyelonephritis?

Rapid onset, CVA tenderness or exquisite flank pain, gross hematuria, lower urinary tract symptoms, fever, chills, nausea and vomiting, and possible confusion in the elderly.

136

What are the complications of pyelonephritis?

Permanent kidney scarring, which can predispose the patient to chronic kidney disease, hypertension, and renal failure. It can also cause sepsis.

137

Clinical presentation of acute bacterial prostatitis?

Acute onset, fever, chills, malaise, and vomiting. Pain in the rectal, lower back, and perineal areas. Irritative lower urinary tract symptoms (dysuria, frequency, and urgency) and hematuria. May also see painful ejaculation and hematospermia.

138

Clinical presentation of nephrolithiasis?

Flank pain (severe waxing and waning) which may radiate to the groin, testes, or tip of the penis (men). Nausea and vomiting, writhing, lower urinary tract symptoms, hematuria, diaphoresis, tachycardia, and tachypnea.

139

What is urethral stricture?

A decrease in the lumen of the urethra due to scar formation, injury, instrumentation, infection, and certain non-infectious forms of urethritis. Most commonly seen in men.

140

Some patients with severe urethral strictures are completely unable to urinate. This is referred to as ________ , and is a medical emergency. Hydronephrosis and renal failure may also occur.

Acute urinary retention

141

Interstitial cystitis symptoms can be defined as ________ .

Chronic urgency, frequency, with or without pain, and without any other reasonable causation. Can be ulcerative or non-ulcerative (more common).

142

What is interstitial cystitis?

A severely debilitating disease of the urinary bladder. Symptoms include excessive urgency and frequency of urination, suprapubic pain, dyspareunia and chronic pelvic pain. It can interfere with employment, social relationships, and sexual activity.

143

What are the symptoms of ulcerative interstitial cystitis?

Can result in fissures and cracks, inflammatory changes, mast cell infiltration, fibrosis, which can lead to reduced bladder capacity.

144

Non-ulcerative interstitial cystitis can present with?

Glomerulations, mucosal tears, and submucosal hemorrhages

145

__________________ refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC).

Glomerulation

146

Clinical presentation of interstitial cystitis?

Acute onset with exacerbation and remission, frequency, urgency, pain, dysuria, pain with pressure in the pelvis, sense of incomplete bladder emptying, compulsion to void, and dyspareunia

147

What is renal carcinoma?

Deposition of malignant cells in the lining of the tubules of the kidney

148

Clinical presentation of renal cell carcinoma?

—Hematuria—, lower back pain specific to one side (not traumatic), a palpable mass on side with lower back— pain, fatigue—, loss of appetite—, unintentional weight loss, —elevated temperature—, and/or anemia (low RBC) on CBC—. Or can be completely asymptomatic.

149

Renal cell carcinoma can metastasize to?

Bone, brain, lung, and liver

150

Prognosis of renal cell carcinoma that is still within the renal structures and without metastasis?

73% of patients survive for 5 years

151

Renal failure findings?

High levels of urea, build-up of phosphates, build-up of potassium, failure to remove excess fluid, decreased EPO, and decreased circulating proteins

152

What is a sudden decrease in urinary output?

Anuria

153

A sudden decrease in urinary output may result from _________ ?

Compromised renal blood supply (prerenal); damaged interstitia, glomeruli, or tubules (intrarenal); or obstructed urine flow (postrenal)

154

Patients at greater risk for renal failure are the ________ .

Elderly, diabetic, and those with history of renal, heart, or liver failure

155

Total hematuria is usually characteristic of lesions in the ________ .

Kidneys and ureters

156

Bladder lesions may produce bleeding independent of ________ .

Micturition

157

_________ gross hematuria is consistent with upper or lower tract tumours, systemic coagulopathy, or excessive anticoagulant effect.

Painless

158

Less common causes of painless gross hematuria are ________

Acute necrosis or sloughing of papilla

159

In the elderly, painless hematuria may be a __________ of renal cancer.

Late presenting sign

160

In men older that 50, the presence of slow urinary stream, hesitancy, intermittency, and dribbling of urine with a gradual onset over time indicates _________ .

Obstructive problems from benign prostatic hypertrophy

161

Renal tract pain may present with a constant dull ache in the __________ area.

Costovertebral angle (CVA)

162

Dislodged kidney stones will produce an acute ureteral pain that is ________ .

Colicky and cyclic in nature

163

In men, pain from a dislodged kidney stone may _________ .

Radiate to the abdomen, testes, and penis

164

Other than a kidney stone, _________ do not frequently cause pain.

Renal disorders

165

True renal pain can originate from the ________.

Calyces or renal pelvis

166

Other than a kidney stone, renal pain can result from _________ , but this is a seldom occurrence.

Stretching of the kidney capsule, interstitial edema, or inflammation of the capsule

167

Primary bladder disease from infection, stones, or tumours can produce __________ .

Nocturia

168

Prostate __________ characteristically produces nocturia.

Enlargement

169

_________ is defined as a volume greater than 3L of urine/day, and depends on the fluid intake and the patient's state of hydration.

Polyuria

170

Polyuria may be an early indication of ________ because of the kidney's inability to concentrate urine.

Renal disease progression

171

What is glycosuria?

The excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reabsorb all of the filtered glucose from the tubular fluid back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.

172

Rarely, _______ is due to an intrinsic problem with glucose reabsorption within the kidneys (such as Fanconi syndrome), producing a condition termed renal glycosuria.

Glycosuria

173

________ intake inhibits antidiuretic hormone; ________ promotes excess solute excretion, and resulting water loss.

Alcohol; glycosuria

174

Nocturia can also occur with the __________ of fluid during sleep, secondary to __________ .

Mobilization; congested heart failure

175

A patient who appears ill or who is in pain, is likely to have an __________ urinary tract problem such as pyelonephritis, urolithiasis, or acute prostatitis.

Upper

176

Patients with ________ urinary tract problems usually do not present with signs of systemic involvement, are fever free, and generally appear well.

Lower

177

________ is seen in patients with nephritis.

Hypertension

178

A pale skin colour may suggest anemia caused by _________ .

Poor nutrition or chronic renal failure

179

What is termed a toxic condition resulting from kidney disease in which there is retention in the bloodstream of waste products normally excreted in the urine?

Uremia

180

Yellow-coloured to brown-coloured skin without _________ may indicate severe chronic uremia.

Scleral icterus

181

If the patient is hypertensive, auscultate the abdominal aorta, renal, and iliac arteries for bruits, which could indicate a _________ cause of the hypertension.

Renovascular

182

On urine dipstick, a positive ________ result is indicative of urethritis.

Leukocyte esterase or nitrite test

183

________ may indicate kidney involvement.

Proteinuria

184

Suspect proximal renal tubular damage if urine __________ is elevated while ________ glucose levels are normal.

Glucose; serum

185

Serum ________ and blood ________ levels are used to indicate kidney function.

Creatinine; urea nitrogen

186

Dysuria usually reflects irritation or inflammation of the ________ (urethral meatus, labia majora/minora) or _________ (urethra, bladder), or ________ (ureters, kidneys).

External genitalia; lower; upper

187

In women with dysuria and vaginal discharge ________ is much more common than a urinary tract infection (UTI).

Vulvovaginitis

188

In women with dysuria but no vaginal symptoms ________ is more common.

Urinary tract infection (UTI)

189

Symptoms that support an urinary tract infection (UTI) are ________ .

Recent-onset dysuria, urinary urgency, frequency, nocturia, suprapubic pain, and cloudy urine

190

When symptoms recur in a women who has previously had cystitis, her pretest probability of an urinary tract infection (UTI) is ________ .

90%

191

In older individuals, what are the risk factors that may increase the risk of an urinary tract infection (UTI)?

Atrophic vaginitis, benign prostatic hyperplasia, chronic prostatic, and urinary tract instrumentation

192

Infection or inflammation of the bladder may _________ , resulting in urinary frequency, nocturia, incontinence, and discomfort with holding even small amounts of urine leading to urinary urgency.

Decreases its capacity

193

Dysuria with insidious onset raises the possibility of ________ .

Rare neoplastic etiologies

194

Dysuria in the presence of systemic symptoms (e.g., fever, chills, abdominal or flank pain, nausea and vomiting) should prompt the consideration of other acute bacterial causes such as _________ .

Pyelonephritis, acute prostatitis, epididymitis, or pelvic inflammatory disease

195

What is the major structural abnormality associated with UTI and renal damage?

Vesicoureteral reflux

196

Nausea and vomiting often accompany an ________ .

Upper UTI, pyelonephritis, or lithiasis

197

Strenuous exercise can cause ________ often caused by trauma to the kidney and bladder.

Transient hematuria

198

Infants with a UTI may present with ________ and continuous damp diapers.

Strong foul smelling urine

199

Young children with pinworms may present with dysuria and vaginitis because of the ________ .

Abrasions that result from scratching

200

Women who use a ________ may experience mechanical compression of the urethra, with subsequent urine retention that predisposes them to the development of cystitis.

Diaphragm

201

Foods that can cause dysuria without pyuria are ________ .

Spicy foods, caffeine, carbonated beverages, and alcohol

202

Mechanical factors related to compression of the bladder and bladder neck by a ________ may cause an UTI.

Hard mass of stool from constipation

203

In women, vulvovaginitis is a common cause of dysuria. The patient often describes the dysuria as ________ , which is a burning sensation as the urine passes inflamed labia.

External

204

In older women, ________ may present with vaginal dryness or discomfort during sexual intercourse. On physical examination, the vaginal mucosa is thin, pale, and dry with fewer rugae.

Atrophic vaginitis