Differential Diagnosis for Dysuria

Dysuria, or painful urination, can be caused by a variety of conditions. Here's a categorized differential diagnosis list:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI): This is the most common cause of dysuria, especially in women. UTIs occur when bacteria enter the urinary tract, leading to inflammation and pain during urination. The typical presentation includes dysuria, frequent urination, and sometimes hematuria.

• Other Likely Diagnoses

  • Sexually Transmitted Infections (STIs): STIs such as chlamydia, gonorrhea, and herpes simplex virus can cause dysuria. These infections are often accompanied by other symptoms like genital discharge, itching, or lesions.
  • Urethral Stricture: A narrowing of the urethra can cause obstructive symptoms including dysuria. This condition is more common in men and may result from trauma, infection, or inflammation.
  • Prostatitis: Inflammation of the prostate gland can cause dysuria, especially in men. Symptoms may also include pelvic pain, frequent urination, and discharge.

• Do Not Miss Diagnoses

  • Kidney Stones: While not always the first consideration, kidney stones can cause severe dysuria, especially if they are obstructing the flow of urine. Other symptoms include flank pain (renal colic), nausea, and vomiting.
  • Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can worsen as the bladder fills and may improve with urination.
  • Tuberculosis of the Urinary Tract: Although rare, urinary TB can cause dysuria along with other symptoms like hematuria, frequency, and flank pain. It's crucial to consider this diagnosis, especially in endemic areas or in patients with a history of TB.

• Rare Diagnoses

  • Bladder Cancer: Can cause dysuria, especially if the tumor is located near the bladder neck or urethra. Other symptoms may include hematuria, weight loss, and pelvic pain.
  • Sickle Cell Disease: Patients with sickle cell disease can experience dysuria due to sickling in the kidneys or ureters, leading to obstruction or damage.
  • Chemical Cystitis: Exposure to certain chemicals (e.g., some medications, radiation) can cause inflammation of the bladder, leading to dysuria and other urinary symptoms.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and diagnostic tests (such as urinalysis, culture, and imaging studies) are essential for making an accurate diagnosis.