[Studies on dysuria of noncervical origin in young boys; seven cases of dysuria due to seminal calculi].
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Calculi↗
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Dysuria after permanent prostate brachytherapy.
PURPOSE: Although numerous prostate cancer quality-of-life studies have been reported, a paucity of data exists regarding brachytherapy-related dysuria. In this study, we evaluated the incidence and temporal resolution of dysuria, along with the influence of multiple treatment, clinical, and dosimetric parameters. MATERIALS AND METHODS: Five hundred eighty-one consecutive patients without a preimplant history of transurethral resection of the prostate underwent brachytherapy between January 1998 and December 2001 for clinical T1c-T3a (1997 AJCC) adenocarcinoma of the prostate gland. The evaluated population consisted of the 546 patients who had completed at least two postimplant dysuria evaluations. The median patient follow-up was 26.4 months. In all patients, alpha-blocker therapy was initiated before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to baseline. The frequency of dysuria was assessed on a 1-5 scale using the IPSS scoring criteria. The dysuria severity was scored on a 1-10 scale. The clinical parameters evaluated included age, T stage, preimplant IPSS, ultrasound volume, and elapsed time since implantation. The treatment parameters included the use of neoadjuvant hormonal manipulation, use of supplemental external beam radiotherapy, isotope, and total implanted seed strength. The dosimetric parameters included values of the minimal dose received by 90% of the prostate, the percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and the median and maximal urethral doses. RESULTS: The incidence of dysuria peaked at 52% 1 month after implantation. The median dysuria frequency score was 0 of 5 for all patients and 2 of 5 for those reporting dysuria. The median severity score was 0 of 10 for the entire cohort and 3 of 10 for those reporting dysuria. For the entire group, both the frequency and the severity of dysuria steadily improved with time, with near complete resolution of dysuria at 45 months. For those patients reporting dysuria, neither the frequency nor the severity revealed any durable improvement for approximately 36 months. Patients with dysuria displayed higher postimplant IPSSs. Of the 7 IPSS questions, nocturia and incomplete voiding were the best surrogates for dysuria. The isotope, supplemental external beam radiotherapy, hormonal status, minimal dose received by 90% of the prostate, and urethral dose did not predict for dysuria. CONCLUSIONS: After permanent prostate brachytherapy, dysuria is a relatively common event, but only rarely severe in frequency or intensity. At approximately 45 months after brachytherapy, dysuria appears to resolve in almost all patients.
Aged↗
Brachytherapy-related dysuria.
OBJECTIVE: To evaluate the incidence and temporal resolution of dysuria after permanent prostate brachytherapy, and to identify predictors of brachytherapy-related dysuria. PATIENTS AND METHODS: The study included 130 patients with no history of transurethral resection of the prostate before treatment, who had brachytherapy on one of two prospective randomized trials, with explicitly planned and executed urethral-sparing techniques (100-150% minimum peripheral dose) using either 103Pd or 125I for clinical T1c-T2c prostate cancer. The median follow-up was 22.6 months. An alpha-blocker was initiated either prophylactically 2 weeks before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to normal, or withheld until the onset of significant brachytherapy-related urinary morbidity. Dysuria was evaluated on a 0-10 scale, before brachytherapy and then at 1, 3, 6 and 12 months afterward, with a median of four dysuria questionnaires per patient. Clinical, treatment and dosimetric variables evaluated included alpha-blocker, age, IPSS before and the maximum after treatment, prostate volume on ultrasonography, hormonal status, supplemental radiotherapy, isotope, urethral dose, V(100/200), D90, and time to obtaining a normal IPSS. RESULTS: The maximum incidence of dysuria was 85% at 1 month after brachytherapy, with subsequent resolution over time. The use of prophylactic tamsulosin resulted in a statistically lower dysuria severity score (difference of 2.7 vs 4.2, P < 0.005) at 1 month, with no discernible differences at 3, 6, 12 and 18 months. Patients with dysuria had a statistically higher IPSS. The dysuria resolved faster in patients implanted with 103Pd but was unaffected by the use of supplemental radiotherapy and/or androgen deprivation therapy. In multivariate analysis, prophylactic alpha-blockers resulted in statistically lower maximum dysuria scores, while the maximum IPSS after implantation and isotope type (but only at 6 months) were the best predictors of the resolution of dysuria. CONCLUSIONS: Dysuria is common after brachytherapy but is typically mild. Prophylactic alpha-blockers gave significantly lower maximum dysuria scores but did not affect the time to the resolution of dysuria. The maximum IPSS after the implant was the best predictor of the resolution of dysuria.
Adrenergic alpha-Antagonists↗
The impact of radiation dose to the urethra on brachytherapy-related dysuria.
PURPOSE: To determine the effect of urethral dose on dysuria after permanent prostate brachytherapy. METHODS AND MATERIALS: One hundred eight patients without a preimplant history of a transurethral resection underwent brachytherapy on one of two prospective randomized trials for clinical T1c-T2c (2002 AJCC) prostate cancer. Urethral dose was stratified into cohorts of <150% and 150% minimum peripheral dose (mPD) respectively. No patient received prophylactic alpha blockers. The median follow-up was 27.4 months. Dysuria was defined as pain and/or burning on urination and was evaluated on a 0-10 scale. Normalization of dysuria was defined as a return to within 1 point of baseline. Dysuria surveys were obtained before brachytherapy and at 1, 3, 6, and 12 months after implantation. Clinical, treatment, and dosimetric parameters evaluated included urethral dose, age, preimplant International Prostate Symptom Score (I-PSS), ultrasound volume, hormonal status, supplemental XRT, isotope, V(100/200), D(90), the maximum post-implant I-PSS, and the time to I-PSS resolution. RESULTS: The incidence of dysuria peaked at 85% one month after brachytherapy with subsequent resolution over time. Radiation dose to the urethra (stratified into cohorts of <150%, and 150% mPD) was not a significant predictor of prevalence, severity, or resolution of dysuria. In a multivariate analysis, isotope predicted for dysuria normalization while preimplant I-PSS and D(90) predicted for maximum dysuria; however, the area under the ROC curve and the Pearson correlation coefficient revealed weak correlations. CONCLUSIONS: Dysuria is common after brachytherapy, but typically minimal in severity. Urethral doses did not predict for either dysuria severity or normalization. Although preimplant I-PSS was the strongest predictor of maximum dysuria and isotope the best predictor for dysuria normalization, robust predictors for brachytherapy-related dysuria were not identified.
Aged↗
Specificity of dysuria and discharge complaints and presence of urethritis in male patients attending an STD clinic in Malawi.
OBJECTIVE: This study evaluated the specificity of discharge and dysuria for laboratory confirmed urethritis in symptomatic men presenting to an urban STD clinic in Malawi for treatment and returning for follow up evaluation. METHODS: Clinical treatment trial where consecutive consenting men with urethritis were enrolled and administered a questionnaire, examined, tested, and given one of five urethritis treatments with an efficacy range of 33-95%. Men returning for follow up were questioned, examined, and tested. RESULTS: The presence of both discharge and dysuria were highly specific for laboratory confirmed urethritis (over 90%). Compared with men who had complaints of both discharge and dysuria, men with complaints of dysuria alone were more likely to have reported prior treatment, 72% v 48% (p = 0.003), and less likely to have had gonorrhoea, 64% v 83% (p = 0.04). Men with complaints of discharge or dysuria without evidence of discharge were rare but half of them had documented urethritis. Among men who returned for follow up, 72% had no symptoms of either discharge or dysuria. However, among the 238 men with no symptoms at follow up, laboratory documented gonorrhoea occurred in 9% and non-gonococcal urethritis in 21%. DISCUSSION: In this population of men discharge or dysuria were specific symptoms for urethritis. The symptom of dysuria should be added as an entry criterion for evaluation for urethritis in the World Health Organisation's treatment recommendations. The high prevalence of asymptomatic infection at follow up in a population of men who received suboptimal antimicrobial therapy suggests that the most effective therapy available should be given at the first visit.
Adolescent↗
The prevalence of dysuria in women in London.
A postal questionnaire was used in a survey of dysuria in women aged 20-54 years in four London general practices. Twenty per cent of all women reported dysuria in the previous year (recent dysuria) and half of these women suffered at least one further episode in the same year. The prevalence of recent dysuria showed a decline with increasing age, a small increase with increasing number of pregnancies, no social class effect and no difference with marital status. Frequent recent episodes were more likely in women whose first reported episode of dysuria occurred before the age of 20 years. The risk of dysuria occurring in any pregnancy was about 12 per cent, and a small group - about 6 per cent of those who had had more than one pregnancy - reported dysuria in every pregnancy. Comparison of the practice records of non-responders and responders suggested that the true prevalence of recent dysuria was over-estimated by about one third. The routine use of a few specific questions in clinical and epidemiological practice may help to identify those women at increased risk from urinary tract infection, particularly in pregnancy.
Adult↗
The syndrome of dysuria and hematuria in pediatric urinary reconstruction with stomach.
Between July 1989 and March 1992 at a single institution 27 male and 30 female patients underwent lower urinary reconstruction with stomach. Mean patient age was 9.9 years (range 1.5 to 28 years). The diagnoses were epispadias/exstrophy complex (19 patients), myelodysplasia (11), cloacal exstrophy (6), posterior urethral valves (6), Hinman syndrome (4), sacral agenesis (3) and other (8). Indications for surgery were urinary incontinence, upper tract deterioration or undiversion. A total of 54 patients underwent augmentation gastrocystoplasty and 3 had total bladder replacement. Mean followup time was 23.2 months (range 12 to 39 months). The syndrome of dysuria and hematuria is defined as 1 or a combination of the following symptoms: bladder spasm or suprapubic, penile or periurethral pain, coffee brown or bright red hematuria without infections, skin irritation or excoriation and dysuria without infections. Telephone and clinic interviews identified 21 patients (36%) with symptoms of the dysuria and hematuria syndrome. The most common symptoms were hematuria (71%) and bladder or suprapubic pain (76%). Of the patients 18 (86%) ranked the severity of symptoms as mild to moderate and 3 (14%) ranked them as severe. No medications were required to control the symptoms in 13 patients (62%) and 3 other patients only required medications on an as needed basis. Overall patients who required no medications had lower symptom scores than those who required medications. Patients with decreased renal function may be more at risk for the dysuria and hematuria syndrome than those with normal renal function. Patients who were wet were more prone to have the dysuria and hematuria syndrome than those who were totally dry. The pathophysiology of the dysuria and hematuria syndrome is currently unknown. Patients who require urinary reconstruction with stomach tissue need to be made aware of the potential of the dysuria and hematuria syndrome.
Adolescent↗
[Dysuria in male elderly outpatients evaluated by a questionnaire survey].
We surveyed complaints of dysuria in male elderly outpatients by questionnaire survey. Seven hundred and twenty outpatients (39 aged 30-39, 63 aged 40-49, 170 aged 50-59, 229 aged 60-69, and 219 aged 70 or more) visiting our outpatient internal medicine clinics were asked by a questionnaire about the subjective symptoms of dysuria, including frequencies of nocturia, prolongation of the start of urination, straining at urination, and residual urine, graded as asymptomatic, mild, moderate and severe. The subjects were divided into three groups as to the dysuria; normal group without symptoms or one mild symptom, borderline group with two or more mild symptoms, and dysuria group with one moderate or severe symptom or more. The rates of the patients in the dysuria group were increased with age, being 15%, 16%, 21%, 31% and 53%, respectively, in the above-mentioned age groups. This finding emphasized the importance of questions about dysuria in elderly patients also in internal medicine outpatient clinics, and of differential diagnosis for the causal factor(s) for dysuria in elderly patients including benign prostate hypertrophy.
Adult↗
Acute dysuria among female soldiers.
OBJECTIVE: To assess behavior patterns among active duty female soldiers presenting to military care facilities for acute dysuria. METHODS: A self-administered questionnaire was developed. One hundred twelve female soldiers presenting with acute dysuria and one hundred twenty-six presenting for other reasons were surveyed. RESULTS: During regular duty hours, the dysuria group drank less than the control group (21% and 14%, respectively; p = 0.004). However, field duty appeared to compound this problem, with the dysuria group drinking considerably less than the control group (79% and 19%, respectively; p = 0.002). Both groups stated that they postponed urination during working hours. The dysuria group postponed urination more than did the control group during regular duty (75% and 53%, respectively; p = 0.006) and field duty (79% and 65%, respectively; p = 0.008). CONCLUSIONS: Female soldiers presenting with dysuria were more likely to report fluid restriction and to postpone voiding during duty, behaviors that were reported even more frequently during field duty. Fluid restriction and postponed urination may be significant factors in the development of acute dysuria among female soldiers.
Acute Disease↗
[Is dysuria useful for the diagnosis of infection of the urinary tract?].
OBJECTIVE: To assess the validity of criterion and predictive value of dysuria for the diagnosis of UTI. DESIGN: Cross-sectional study to assess a symptom. SETTING: Six general medicine clinics (four urban clinics and two rural clinics) in the 11th Health Area in Madrid. PATIENTS: The sample consists of 232 patients aged above fourteen who consulted during six consecutive months (116 of them reported having dysuria and 116 were asymptomatic). MEASUREMENTS AND MAIN RESULTS: The diagnosis of urinary tract infections (UTI) was achieved through positive urine cultures or bacteriuria and leukocyturia in the centrifuged urine sediment. The sensitivity (S) of dysuria analysis for the diagnosis of UTI, its specificity (E), its predictive value (VP), and its probability coefficient (CP) were considered. Average age of the sample was 54 years old (range 19-82); 73% of the patients were female. No statistically significative difference of sex and age was found between cases and non-cases (p > 0.1). Dysuria showed a 96% of sensitivity (95% CI, 86-98%), a 69% of E (95% CI, 61-76%) and 3.1 of CPP (95% CI, 2.7-3.5) for UTI diagnosis. In the women subgroup there was 95% of sensitivity (95% CI, 84-99%) and 67% of E (95% CI, 58-75%). A positive predictive value of 30% (95% CI, 22-40) and a negative predictive value of 99% (95% CI, 95-100) were estimated for this symptom. CONCLUSIONS: The diagnosis of urinary tract infections is unlikely in the absence of dysuria, but to treat all dysuria patients as UTI entails a high rate of overtreatment.
Case-Control Studies↗
Evaluation of dysuria in adults.
Dysuria, defined as pain, burning, or discomfort on urination, is more common in women than in men. Although urinary tract infection is the most frequent cause of dysuria, empiric treatment with antibiotics is not always appropriate. Dysuria occurs more often in younger women, probably because of their greater frequency of sexual activity. Older men are more likely to have dysuria because of an increased incidence of prostatic hyperplasia with accompanying inflammation and infection. A comprehensive history and physical examination can often reveal the cause of dysuria. Urinalysis may not be needed in healthier patients who have uncomplicated medical histories and symptoms. In most patients, however, urinalysis can help to determine the presence of infection and confirm a suspected diagnosis. Urine cultures and both urethral and vaginal smears and cultures can help to identify sites of infection and causative agents. Coliform organisms, notably Escherichia coli, are the most common pathogens in urinary tract infection. Dysuria can also be caused by noninfectious inflammation or trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders. Although radiography and other forms of imaging are rarely needed, these studies may identify abnormalities in the upper urinary tract when symptoms are more complex.
Adult↗
The frequency and frequency dysuria syndromes of childhood: hypercalciuria as a possible etiology.
OBJECTIVES: The syndromes of frequency and frequency dysuria of childhood are believed to have multifactorial etiologies. Hypercalciuria has been reported to be associated with the frequency dysuria syndrome and a direct cause and effect relationship has been postulated due to a positive response to treatment with hydrochlorothiazide. This study was designed to compare the urinary calciums of children with the frequency syndrome and the frequency dysuria syndrome. METHODS: Calcium screening in 30 consecutive patients with the frequency syndrome and 39 consecutive patients with the frequency dysuria syndrome is reported. RESULTS: There was no statistical difference in the urinary calcium excretion in the two groups. CONCLUSIONS: There was no significant difference in the calcium excretion in children with isolated urinary frequency or frequency dysuria. No definite cause and effect relationship to hypercalciuria could be identified in these two groups.
Adolescent↗
Clinical significance of dysuria in women.
During a community survey 22% of women were found to have had dysuria in the previous year and half had had dysuria at some time in their lives. Various measurements were made in a random sample of 282 of these women. The means and the variances of the systolic and diastolic blood pressures in women with a past history of dysuria tended to be higher than in women who gave no such history. There were no significant differences in the means of plasma urea, plasma creatinine, and renal concentrating power between women with and without a previous history of dysuria, but a significant impairment of renal concentrating power was found in an additional group of 30 women who dated the onset of their dysuria to childhood.These findings suggest that urinary tract infection in adult women does not usually lead to progressive impairment of kidney function, whereas infection in childhood is more often associated with kidney damage.
Adult↗
Long-term followup of the hematuria-dysuria syndrome.
PURPOSE: The hematuria-dysuria syndrome is the most common reported complication of gastrocystoplasty. We reviewed our cases of gastrocystoplasty to determine the long-term incidence and significance of the syndrome. MATERIALS AND METHODS: We performed a retrospective study of 78 patients who underwent gastrocystoplasty at our institution between July 1989 and October 1994. A total of 72 of the 78 cases were evaluated within the last year to elicit symptoms of the hematuria-dysuria syndrome. RESULTS: Spina bifida and bladder exstrophy were the most common diagnoses of patients undergoing gastrocystoplasty. There were 3 (4%) patients who required medications on a continuous basis to control symptoms of the hematuria-dysuria syndrome. However, using broad criteria 17 (24%) patients would be categorized as having the syndrome. Of these patients 9 did not require any medications and 4 occasionally took medications to control symptoms. A significant increase in the incidence of the hematuria-dysuria syndrome was detected in those cases with a sensate compared to those with an insensate urethra. CONCLUSIONS: The hematuria-dysuria syndrome is a clinically significant problem at long-term followup in a small percentage of patients treated with gastrocystoplasty. The lowest incidence is in those children with an insensate urethra who are continent. When symptoms occur they are easily treated in the majority of cases. We believe that gastrocystoplasty remains a viable option in the armamentarium of bladder augmentation.
Bladder Exstrophy↗
Urodynamic morbidity and dysuria prophylaxis.
A group of 324 patients received prophylactic treatment with either sodium bicarbonate, potassium citrate or a glucose placebo following urodynamic studies. Urine was screened for infection both before and after testing and the incidence of dysuria assessed by postal questionnaire; 63% of patients experienced some degree of dysuria and this was severe and prolonged in 6.3%, the majority of whom were male. Neither sodium bicarbonate nor potassium citrate was any more effective in preventing dysuria than placebo. The presence of severe prolonged dysuria was not associated with a urinary tract infection or with any particular urodynamic diagnosis.
Bacteriuria↗
All dysuria is local. A cost-effectiveness model for designing site-specific management algorithms.
OBJECTIVE: To determine the cost-effectiveness of management strategies for dysuria in different office settings. DESIGN: Decision and cost-effectiveness analyses, assuming the payer's perspective. Data on disease prevalence, test characteristics, treatment efficacy, and adverse effects were drawn from the English language literature using medline searches and bibliographies. SETTING: Hypothetical primary care practice. PATIENTS: Otherwise healthy, nonpregnant women with symptoms of dysuria, urgency, and frequency. INTERVENTIONS: All reasonable combinations of urinalysis, urine culture, pelvic examination, chlamydia and gonorrhea cultures, and empiric treatment with trimethoprim-sulfamethoxazole. RESULTS: The cost-effectiveness of strategies varied substantially among different patient settings. In all settings, empiric trimethoprim-sulfamethoxazole for all patients was least expensive and least effective. Most testing increased both cost and effectiveness. Compared to empiric antibiotics, performing pelvic examination and urine culture for women with normal urinalyses had a marginal cost-effectiveness ratio of $4 to $32 per symptom-day avoided (SDA). Adding urine culture for patients with pyuria had a marginal cost of $34 to $107 per SDA, which fell to $40/SDA when the prevalence of resistance to trimethoprim-sulfamethoxazole exceeded 40%. Pelvic examination and urine culture for all patients regardless of urinalysis results achieved the greatest benefit but at the highest cost (>$300 per SDA). CONCLUSIONS: In otherwise healthy women with symptoms of dysuria and no vaginal complaints, performing pelvic exam and urine culture based on urinalysis offers a reasonable alternative to empiric therapy. Other testing may be warranted, depending on antibiotic resistance and the value of avoiding a day of dysuria.
Acute Disease↗
Treatment with a combined cystopexy-colopexy for dysuria and rectal prolapse after bilateral perineal herniorrhaphy in a dog.
A 9-year-old castrated male Yorkshire Terrier was evaluated for dysuria and rectal prolapse 2 weeks after bilateral perineal herniorrhaphy. Dysuria was secondary to caudal displacement of the bladder, rather than retroflexion of the bladder. Dysuria and rectal prolapse were associated with disruption of supporting ligaments of the urinary bladder and colon, which may have been caused by tenesmus. Combined cystopexy and colopexy were used successfully to treat the dysuria and rectal prolapse.
Animals↗
[Value of radiological investigations in patients with dysuria after prostatic adenomectomy (author's transl)].
Dysuria is a relatively frequent complication after prostatic adenomectomy. The authors review 107 patients with this complication and demonstrate that radiological investigation, including a micturition study, preferably after IVU, shows the presence of an obstructive cause for the dysuria in the vast majority of cases (92.5%). There are two main types of obstructive lesion: - parietal stenosing lesions, - compression lesions. - The most frequent parietal stenosing lesions, apart from those of the bladder neck, are urethral stenoses. - Stenoses with total compression of the capsule are often the cause of severe dysuria. - Localized compression of the capsule and urethral stenosis usually cause only moderate dysuria. - An irregular lacunar image should suggest cancer of the prostate.
Aged↗