Dysuria

Question 1

Cystitis

Answer 1

• UTI
• Lower tract
• E.Coli most common: ascending from rectum
• Risk factors: spermicides- increase pH and lowers lactobacillus, sex, previous UTI, pregnancy, genetics
• Lactobacillus, immunoglobulins and acidity of 4.5: INHIBIT growth of bacteria
• Symptoms: dysuria, suprapubic tenderness, hematuria, stress/urge incontinence, odor/cloudy urine
  CHILDREN:
• Boys under 1yo uncirc, girls less than 4yo
• FTT, sepsis, vomiting, irritability, abdominal pain, incontinence
• Inpatient: less than 2 months, immunocompromised, vomiting/PO intolerance, failure to respond
• Cefexime, Cefdinir, Ceftitoben— x10days
• Can take Pyridium for analgesia
• Consider sexual abuse
  DIAGNOSTICS:
• Urine microscopy better that dipstick
• 5WBCs considered +
• Urine dipstik detects nitrates: E.Coli
• C&S gold standard: for recurrent UTIs. More than 100,000 (10^5) WBCs, UTI while on tx, suspect pyelo, pregnancy.
  TREATMENT:
• Trimethoprim (Septra): first line
• If took Septra within 6 months or resistance take Fluoroquinolone (Cipro)—- resistance!
• Recurrence: 2 or more in 6 months (more than 3/year), take TMP-SMX (Bactrim)
• Post coital prophylaxis: Macrobid- Take 2 hours after sex- for women who get UTI 24-48 hrs after sex

Question 2

Pyelonephritis

renal, pelvis

Answer 2

• Bacteria ascends to kidneys
• Symptoms: same as UTI plus chills, sweat.
  CHILDREN:
• Abdominal pain, palpable bladder, neuro deficits, signs of trauma. CVA tenderness
  DIAGNOSTICS:
• Same as UTI and get C&S: white casts
• Criteria to get C&S in children: girls and uncirmc boys under 2yo + one risk factor. Circm boys under 2 + suprapubic tenderness and: temp, ill
  TREATMENT:
• Cipro if have not taken in 3-6 months
• Recurrent: 2 or more UTIs in one year (more than 3/year)
• Relapse: symptoms return in 1-2 weeks of tx
• If no improvement in 23-48 hrs: hospitalization
• Referral to urology for all children

Question 3

Interstitial cystitis/Bladder pain syndrome

Answer 3

• Significantly under diagnosed
• Recurrent UTIs
• Associated with: fibromyalgia, vulvodynia, IBS, depression/anxiety, dysmenorrhea, GERD, back pain, child abuse
• Symptoms: urinary frequency with small voids, suprapubic pain relieved by voiding, pelvic floor spasms, noxious pain from non-noxious stimulants (Allodynia)
  TX:
• Behavioral therapy, analgesics. Last: surgery