Burning on Urination

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of dysuria

Described as a ‍mildmoderatesevere ‍burningstingingpaindiscomfort during urination in ‍urethrabladder

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍frequency

‍urgency

‍foul-smelling urine

‍hematuria

‍suprapubic pressure

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍incontinence

‍hesitancy

‍nocturia



Contributing factors:

‍STI risk factors

‍new sexual partner

‍pregnancy

‍use of scented products

‍poor hygiene

no history of: ‍post-menopausal in females, ‍recurrent UTI, ‍sexually transmitted infections, ‍kidney stones, ‍interstitial cystitis, ‍prostatitis, ‍genital herpes

no use of: ‍recent antibiotics





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Urinary tract infection ‍likelysuspectedpossible

DDx: urinary tract infection, sexually transmitted infection, interstitial cystitis, urethral stricture, prostatitis, kidney stones, bladder cancer, vaginitis, irritant urethritis, balanitis, prostate cancer, benign prostatic hyperplasia, medication side effect, genital herpes, chlamydia, gonorrhea, overactive bladder, pelvic inflammatory disease, vulvodynia, radiation cystitis





PLAN:

Investigations:

- Urinalysis

- Urine culture

- STI testing for chlamydia and gonorrhea

- Blood work: ‍CBC, ‍creatinine, ‍CRP

- Pelvic ultrasound

- CT scan of the abdomen and pelvis

- Cystoscopy

Treatments:

- ‍Antibiotics

- ‍Analgesics

- ‍Phenalgesics

- ‍Fluconazole

- ‍Valacyclovir

- Increase fluid intake

- Avoid caffeine, alcohol, and spicy foods

Further care:

- Referral to urologist

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if fever develops