Epidemiology

Approximately 50% of women experience dysuria at some time in their lives; ∼20% report having had dysuria within the past year. Dysuria is less common among men.

Clinical Manifestations

The underlying syndromes that cause dysuria differ somewhat between men and women.

• In women, most dysuria syndromes can be categorized as either bacterial cystitis or lower genital tract infection (e.g., vaginitis, urethritis, sexually transmitted infection [STI]) (see Chap. 86 Sexually Transmitted and Reproductive Tract Infections). The presence of urinary frequency, urinary urgency, suprapubic pain, and/or hematuria is more typical of bacterial cystitis than of STIs.
• In men, dysuria is often due to STIs or involvement of the prostate (e.g., acute or chronic bacterial prostatitis) (see Chap. 86 Sexually Transmitted and Reproductive Tract Infections). In addition, dysuria and other symptoms of cystitis can occur in the setting of significant benign prostatic hyperplasia that leads to urinary stasis with an accompanying bacterial infection.
• In both sexes, dysuria can result from noninfectious disorders. Noninfectious causes of acute dysuria include lower urinary tract stones, trauma, and urethral exposure to topical chemicals. Chronic dysuria may be attributable to lower urinary tract cancers, certain medications, Behçet's syndrome, or interstitial cystitis/bladder pain syndrome.

Diagnosis

Among women presenting with dysuria, the probability of bacterial cystitis is ∼50%. This figure rises to >90% if four criteria are fulfilled: (1) dysuria and (2) frequency without either (3) vaginal discharge or (4) irritation.

• Healthy, nonpregnant women who meet the ealier criteria can be diagnosed with uncomplicated bacterial cystitis; other women with dysuria should be further evaluated by urine dipstick, urine culture, and a pelvic examination.
• Men should be evaluated with urinalysis, urine culture, and prostate examination.