From the Guidelines
For a 56-year-old male experiencing dysuria and lower abdominal pain 3 weeks after anterior lumbar interbody fusion (ALIF), I strongly recommend obtaining a urinalysis and urine culture to evaluate for a possible urinary tract infection (UTI) as suggested by the AUA/SUFU guideline 1. Given the patient's symptoms, it is crucial to consider the possibility of a UTI, which can be a complication following surgical procedures, especially those involving catheterization.
- The patient should undergo the following laboratory tests:
- Urinalysis
- Urine culture
- Complete blood count
- C-reactive protein
- Empiric antibiotic therapy should be considered, with options including ciprofloxacin 500 mg orally twice daily for 7 days, or trimethoprim-sulfamethoxazole DS twice daily for 7 days, if no contraindications exist, as these are common treatments for UTIs.
- To alleviate symptoms, the patient should increase fluid intake to 2-3 liters daily and consider taking phenazopyridine 200 mg three times daily for 2 days to relieve dysuria symptoms.
- Pain management can include acetaminophen 1000 mg every 6 hours and/or NSAIDs if not contraindicated.
- It is essential to follow up within 48-72 hours to review culture results and assess symptom improvement, and if symptoms worsen, fever develops, or neurological changes occur, immediate surgical consultation is necessary, as these could indicate a deeper infection at the surgical site or other complications 1.
From the Research
Evaluation of Dysuria
- Dysuria, a feeling of pain or discomfort during urination, can be caused by various factors, including urinary tract infection, sexually transmitted infection, bladder irritants, skin lesions, and chronic pain conditions 2, 3.
- A comprehensive history and physical examination can often reveal the cause of dysuria, and urinalysis may not be needed in healthier patients with uncomplicated medical histories and symptoms 4.
Laboratory Tests and Diagnosis
- Urinalysis can help determine the presence of infection and confirm a suspected diagnosis, and urine cultures can identify the causative agents of infection 2, 4.
- The presence of pyuria (pus in the urine) is a significant indicator of bacteriuria requiring therapy, and values significant for infection differ depending on the method of analysis 5.
- Automated urinalysis can provide more sensitive detection of leukocytes and bacteria in the urine, and a value of > 2 WBC/hpf is significant pyuria indicative of inflammation of the urinary tract 5.
Treatment Options
- Uncomplicated lower urinary tract infections can be treated with antibiotics, such as ciprofloxacin, or symptomatic treatment with ibuprofen 6.
- A randomized controlled pilot trial found that ibuprofen was non-inferior to ciprofloxacin for the treatment of symptomatic uncomplicated urinary tract infection, but further trials are needed to confirm these results 6.
- In cases of uncomplicated symptomatic urinary tract infection, a positive value for nitrites and leukocyte esterase by urine dipstick can be treated without the need for a urine culture 5.
Considerations for the 56-year-old Male Patient
- Given the patient's recent history of anterior lumbar interbody fusion (ALIF) surgery, it is essential to consider the possibility of a urinary tract infection or other complications related to the surgery 2, 3.
- A thorough evaluation, including urinalysis and urine culture, should be performed to determine the cause of the patient's dysuria and low abdominal pain, and to guide appropriate treatment 2, 4.