Can symptoms of ovarian torsion mimic urinary tract infections (UTIs) in terms of dysuria (painful urination)?

Ovarian Torsion Can Mimic UTI Symptoms Including Dysuria

Yes, ovarian torsion can mimic urinary tract infection symptoms, including burning during urination (dysuria). 1, 2

Clinical Presentation of Ovarian Torsion

• Ovarian torsion typically presents as severe, constant pain that may fluctuate in intensity but rarely completely resolves without intervention 3
• The pain is commonly located in the lower abdomen, particularly in the right lower quadrant, and does not typically radiate or migrate unlike appendicitis 2
• Associated symptoms include nausea and vomiting in many cases 2, 4
• Peripheral leukocytosis is common in laboratory findings 2

Urinary Symptoms in Ovarian Torsion

• About half of patients with ovarian torsion demonstrate pyuria (white blood cells in urine) without bacteriuria on urinalysis, which can be mistaken for a UTI 2
• This "sterile pyuria" can lead to misdiagnosis as a urinary tract infection 2
• Dysuria (painful urination) can occur due to the anatomical proximity of the ovaries to the bladder and urinary tract, with inflammation from the torsion affecting nearby structures 1

Diagnostic Challenges

• Cystitis (bladder inflammation) is typically diagnosed through symptoms including dysuria, urgency, and suprapubic pain 1
• The diagnostic value of urinalysis for UTI is limited, as pyuria often indicates genitourinary inflammation that can be caused by many non-infectious conditions, including ovarian torsion 1
• The absence of pyuria can help rule out infection, but the positive predictive value of pyuria for diagnosing UTI is exceedingly low 1
• Diagnosis of ovarian torsion is frequently delayed (median 101.8 hours) due to its mimicry of other conditions 5

Imaging for Suspected Ovarian Torsion

• Ultrasound is the first-line imaging modality for suspected ovarian torsion 3
• Key ultrasound findings include:
  • Unilaterally enlarged ovary (>4 cm or volume >20 cm³) 3
  • Peripheral follicles (found in up to 74% of cases) 3
  • Abnormal or absent venous flow (100% sensitivity, 97% specificity) 3
  • "Whirlpool sign" representing the twisted vascular pedicle (90% sensitivity) 3
• When ultrasound is inconclusive but clinical suspicion remains high, MRI provides 80-85% sensitivity for torsion 3

Important Clinical Considerations

• Ovarian torsion should be considered in any female with acute onset lower abdominal pain accompanied by vomiting 2
• Ovarian torsion is the fifth most common gynecological emergency, with a reported incidence of 3% 6
• Early detection and prompt management are essential to preserve fertility and ovarian function 6
• The presence of an ovarian mass is the main risk factor for torsion 4
• Pregnancy increases the risk of ovarian torsion (odds ratio 18:1), though it remains an uncommon event (0.167%) 7

Diagnostic Algorithm

1. For females with acute lower abdominal pain and dysuria:
   • Perform urinalysis - note that sterile pyuria (WBCs without bacteria) may suggest ovarian torsion rather than UTI 2
   • Consider ovarian torsion if pain is severe, constant, accompanied by nausea/vomiting 2, 4
   • Proceed with pelvic ultrasound as the first-line imaging study 3
2. If ultrasound findings are inconclusive but clinical suspicion remains high:
   • Consider MRI or CT for further evaluation 3
3. Surgical evaluation is the definitive diagnostic and therapeutic approach 4

Remember that evidence-based diagnosis of UTI should be primarily based on clinical symptoms integrated with urinalysis findings, not solely on urinalysis alone 1.