Definition
• Sensation of pain, burning, or discomfort on urination; generally indicates infection or inflammation of the bladder &/or urethra
Approach to the Patient
History
• Onset/frequency/severity/location? Hematuria? Urinary frequency/hesitancy/urgency? Abnl penile or vaginal d/c? Lesions? Perineal pain? Pain on intercourse?
• ROS (fever, trauma, flank pain, abdominal or suprapubic pain, joint/back pain)
• PMH (STDs or PID)
• MEDS (topical irritants)
• SOCIAL (recent intercourse, multiple sexual partners)
Physical Exam
• Most pts should have at least an assessment of costovertebral angle tenderness & an abdominal exam
• Women: Consider pelvic exam if at risk for STDs, w/ vaginal sxs, postmenopausal
• Men: Should invariably perform penile exam, testicular exam, & prostate exam given risk of complicated dz
Evaluation
• Urine studies (clean catch UA, hCG ± culture, NAAT for GC/Chlamydia); CBC/Chemistries rarely indicated, unless suspected complicated dz (see below)
• Consider vaginal/urethral studies (smear w/ wet mount, cx), renal U/S, IV pyelography, CT abdomen/pelvis if warranted
• Further studies may include urine cytology, voiding cystourethrography, cystoscopy, urodynamic testing, but not routinely performed in ED
