Dysuria is a painful or uncomfortable urination, usually associated with stinging and burning. Some diseases cause a painful pain of the bladder or perineum. Dysuria is an extremely common symptom in women, but it can also occur in men of all ages. Pathophysiology dysuria is the result of irritation of the trigone or urethra. Inflammation or stricture of the urethra causing difficulty in the beginning of urination and a burning sensation along the way. Irritation of the trigone causes the contraction of the bladder, resulting in frequent and painful urination. Dysuria is most often the result of an infection of the lower urinary tract, but can also be caused by infections of the upper urogenital tract. A decrease in renal concentration is the main reason for frequent urination in upper HWI. A dysuria etiology is typically caused by inflammation of the urethra or urine bladder, wherein perianal lesions in women (z. B. of vulvovaginitis or herpes simplex virus infection) can be painful with urine on contact. Most cases are caused by an infection, but sometimes non-infectious inflammatory diseases are responsible (see Table: Causes of dysuria). In general, the most common causes of dysuria cystitis urethritis are due to a sexually transmitted disease (STD) causes of dysuria cause suspicious findings diagnostic approach Infectious Diseases * cervicitis often cervical discharge Back Reclining unprotected sex STD testing cystitis Typis cherweise frequency and urgency Sometimes bloody or foul-smelling urine bladder sensitivity Clinical examination with or without urinalysis unless there are warnings No epididymo sensitive, swollen epididymis Clinical examination Prostatitis Enlarged sensitive prostate Often in the past obstructive symptoms Clinical examination urethritis usually visible discharge Back Reclining unprotected Geschlechtsverkeh r STD tests vulvovaginitis Vaginal discharge erythema of the labia and vaginal orifice Clinical examination, urine analysis and culture to exclude HWI Probable catheterization in order to prevent contamination of the sample Inflammatory diseases contact with irritating substances or allergens (eg. As spermicides, lubricants, latex condom), foreign body in the bladder, parasites, calculi External inflammation history family history Clinical examination Urinalysis imaging of the urinary tract and pelvis Interstitial cystitis Chronic symptoms found no other common causes cystoscopy Spondylarthropathies (eg., Reactive arthritis, Behcet’s syndrome) Past gastrointestinal symptoms or joint symptoms, or both times skin and mucous membrane lesions Clinical examination tests for sexually transmitted diseases Other diseases Atrophic vaginitis Postmenopausal (including estrogen deficiencies due to drugs, surgery or radiation) often dyspareunia atrophy or erythema of the vaginal folds Vaginal discharge Clinical examination tumors (usually bladder or prostate cancer) Long-standing symptoms usually hematuria without pyuria or infection cystoscopy prostate biopsy * The frequent pathogens include nichtsex ual transferable bacteria (usually Escherichia coli, Staphylococcus saphrophyticus, Enterococcussp, Klebsiella sp, and Proteus sp) and sexually transmitted diseases (eg. B., Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis, herpes simplex virus). warnings are fever, pain or tenderness of the flanks, recently past instrumental interventions in the urogenital tract, immunocompromised patients, known recurrent episodes urological (r) abnormalities and male sex. STD = sexually transmitted disease. Clarification history The history of the present illness should include the duration of symptoms and whether they have already occurred in the past. Important Accompanying symptoms include fever, pain in the flanks, urethral or vaginal discharge and symptoms of bladder irritation (increased urination, urination) or obstruction (hesitancy, dribbling). Patients should be questioned on whether the urine is bloody, cloudy or foul-smelling and on the nature of the effluent (z. B. thin and watery or thick and purulent). Doctors should also ask whether patients have recently had unprotected sex if they have applied potential irritants to the perineum, recent instrumental procedures on the urinary tract had (z. B. cystoscopy, catheterization, surgery) or whether they may be pregnant. In reviewing the organ systems for symptoms of a possible cause, including back or joint pain and eye irritation (connective tissue disease) as well as gastrointestinal symptoms such as diarrhea (reactive arthritis) should be sought. In the history of previous UTI should be (including those in childhood) and any known abnormality of the urinary tract noted including previous kidney stones. As with any potentially infectious disease, is the history bez. an immunosuppressed state (including HIV / AIDS) or recent hospitalization wichtig.Körperliche investigation The investigation begins with review of vital signs, especially if fever occurs. Skin, mucous membrane and joints indicate lesions, suggesting a reactive arthritis (z. B. conjunctivitis, oral ulcers, vesicular or crusted lesions of the palms, soles and around the nails, tenderness of the joints) examined. The edge is tapped on sensitivity over the kidneys. The abdomen is palpated on sensitivity over the bladder. Women should be gynecological examination to detect perineal inflammation or lesions and vaginal or cervical discharge. Smears to test for sexually transmitted diseases and for wet preparation should be taken at this time, instead of conducting a second investigation. Men should undergo äüßerlichen investigation to determine lesions of the penis and vaginal discharge; the area under the foreskin should be investigated. Testis and epididymis are scanned to detect tenderness or swelling. The rectal examination is performed to the prostate size, consistency and sensitivity to palpieren.Warnzweichen The following findings are of particular importance: fever pain or sensitivity of the flanks Recent instrumental interventions immunocompromised patients Recurrent episodes (including frequent infections in childhood) Known Harnwegsanomalie male gender interpretation of the findings Some findings are very significant (see table: causes of dysuria). In young, healthy women with dysuria and significant symptoms of bladder irritation cystitis is the most likely cause. Visible urethral or vaginal discharge is indicative of a STD. Viscous purulent discharge is caused usually by gonococcal, thin or watery discharge by Nichtgonokokken. Vaginitis, and ulcerative lesions of herpes simplex virus infection are clearly visible in general in an investigation. In men, suggests a very sensitive prostate prostatitis back and swollen epididymis to epididymitis. Additional results can also be helpful, but not diagnostic; z. As can women have with the finding of vaginitis, a UTI or any other cause of dysuria. The diagnosis of UTI based on symptoms is less accurate in older people. Results that indicate an infection, affecting more frequently patients with suspicious findings. Fever, flank pain, or it is indicative of an accompanying pyelonephritis. Past frequent urinary tract infections should suspect an underlying anatomic abnormality or a weakened immune status. Infections that occur after hospitalization or instrumental interventions can, atypical or resistant pathogens hindeuten.Tests No approach is fully accepted. Many doctors (sometimes not even urinalysis) prescribe young, otherwise healthy women with a classic dysuria, increased urination and urinary urgency with no a suspicious finding on cystitis allegedly antibiotics without investigation. Other generally perform a urinalysis and culture with clean midstream urine. Some doctors place only to a culture when leukocytes are detected on urine strip test. In women of childbearing age, a pregnancy test is performed (UTIs during pregnancy is of concern because it increases the risk of preterm labor or premature rupture of membranes). Vaginal discharge justifies a wet mount. Many doctors routinely take samples from cervical (women) or urethral (men) exudates, to test for STDs (gonococcal and chlamydial culture or PCR), because many infected patients are not typical symptoms. A finding of> 105 bacteria colony forming units (CFU) / ml speaks for infection. In symptomatic patients, sometimes interpret results that are as low as 102 or 103 CFU of a UTI out. Leukocytes, which are detected in a urine analysis in patients with sterile cultures are nonspecific and may be related to an STD, vaginitis, prostatitis, TB, a tumor or other causes occur. Red blood cells are detected in a urine analysis in patients without leukocytes and with sterile cultures, the cause of cancer, tartar, debris, glomerular abnormalities or recent instrumentation of the urinary tract surgery can be. Cystoscopy and imaging of the urinary tract may be indicated to rule out obstruction, anatomical abnormalities, cancer and other problems in patients who do not respond to antibiotics, have recurrent symptoms or hematuria without infection. Pregnant patients, men, elderly patients and patients with prolonged or recurrent dysuria need Closer observation and a thorough investigation. The therapy treatment depends on the particular cause. Many doctors do not treat dysuria in women without ernstzunehmnde findings when there is no obvious reason because of the investigation and the results of urinalysis. If the decision is in for a treat, a 3-day application with trimethoprim / sulfamethoxazole, trimethoprim alone or with a fluoroquinolone is recommended. Some doctors prescribe men in an STD and similar inconspicuous findings a putative treatment; other doctors wait for the STD test results, especially in patients reliable. An acute, intolerable dysuria due to cystitis, by phenazopyridine 100-200 mg p.o. be alleviated 3 times daily for the first 24 to 48 hours. The drug-orange colored urine. Patients should be advised that this effect is not to be interpreted as worsening of the infection or hematuria. A complicated UTI requires 10-14 days of treatment with an antibiotic that is effective against gram-negative organisms, especially Escherichia coli. Summary dysuria is not always caused by a bladder infection. STDs should be considered.