What is Dysuria?
Dysuria is pain, burning, or discomfort experienced during urination, representing one of the most common urological symptoms rather than a disease itself. 1, 2, 3
Clinical Definition and Characteristics
Dysuria manifests as:
- Painful or burning sensation during the act of urination 4, 2
- Discomfort that is typically localized to the urethra or bladder 5
- Symptoms that may occur at the beginning, during, or after voiding 5
The symptom is frequently accompanied by other lower urinary tract symptoms including urgency, frequency, hematuria, and new or worsening incontinence. 1
Diagnostic Significance
Dysuria is central to the diagnosis of urinary tract infection (UTI), with acute-onset dysuria demonstrating more than 90% accuracy for UTI in young women when vaginal irritation or discharge is absent. 1
Key Diagnostic Considerations:
- In younger patients (<35 years), sexually transmitted organisms like Chlamydia trachomatis are common causative agents 6
- In older patients (>35 years), coliform bacteria (particularly E. coli) predominate 6, 2
- The presence of vaginal discharge decreases the likelihood of UTI and suggests alternative diagnoses like cervicitis 3
Etiology Beyond Infection
While UTI is the most frequent cause, dysuria can result from multiple non-infectious etiologies: 4, 2
- Noninfectious inflammation or trauma 2
- Genitourinary neoplasms 2
- Renal or bladder calculi 6, 2
- Hypoestrogenism in postmenopausal women 2
- Interstitial cystitis 2
- Bladder irritants (chemical or mechanical) 3
- Benign prostatic hyperplasia with secondary urinary stasis in older men 6
Clinical Context by Population
In Women:
Dysuria occurs more commonly in younger women, likely due to greater sexual activity. 2 The symptom, when combined with urgency and suprapubic pain, forms the classic triad of acute cystitis. 1
In Men:
Older men experience dysuria more frequently due to prostatic hyperplasia with accompanying inflammation and infection. 2 Evaluation should include assessment for urinary obstruction and prostate pathology. 6
In Older Adults:
In frail or comorbid elderly patients, dysuria should be evaluated in the context of other urogenital symptoms rather than in isolation. 7, 8 According to McGeer's criteria, recent onset of dysuria accompanied by frequency, incontinence, or urgency warrants antibiotic treatment unless urinalysis shows both negative nitrite AND negative leukocyte esterase. 7
In Children:
Dysuria can indicate UTI in pediatric patients but may present differently than in adults, requiring age-appropriate evaluation. 8
Critical Clinical Pitfall
The subjective nature of dysuria symptoms makes careful evaluation of chronicity essential when the diagnosis of UTI is uncertain. 1 Chronic or persistent dysuria without acute onset should prompt investigation for non-infectious causes rather than reflexive antibiotic treatment. 1, 3