The Clinical Problem Solvers Episode 414: Spaced Learning Series, dysuria
Aug 19, 2025
Join the discussion as the hosts dive into a clinical case about a 62-year-old patient experiencing dysuria. They share personal insights and highlight the significance of thorough clinical assessments. The importance of distinguishing between infectious and non-infectious causes is emphasized, along with the challenges of diagnosing persistent symptoms. Evaluations of laboratory results and urine analysis bring to light critical factors in treatment. The episode also tackles the complexities of urological issues and innovative management strategies.
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Clarify Dysuria With Targeted History
- Clarify dysuria details: onset, duration, timing within urination, quality, and associated symptoms.
- Use these features to localize pathology along the urinary tract and narrow the differential diagnosis.
Localize By Symptom Pattern
- Dysuria with urgency and frequency localizes to the lower urinary tract, but flank pressure may indicate prostatic referral or early upper tract irritation.
- Absence of fever, hematuria, or discharge lowers likelihood of pyelonephritis, urolithiasis, and HSV respectively.
Check Urinalysis And Post-Void Residual
- Order urinalysis and measure post-void residual (PVR) in older men with recurrent lower urinary symptoms.
- Elevated PVR suggests bladder outlet obstruction from BPH or prostatitis and predisposes to infection and chronic irritation.