Dysuria
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Synonyms and keywords: Micturition painful, pain passing urine, painful urination; painful micturition

# Overview
Dysuria is define as  pain or burning, stinging, or itching of the urethra or urethral meatus during or just after urination.Dysuria happens due to bladder muscle contraction and peristalsis of the urethra, which  cause the urine to come in contact with the inflamed mucosal lining, which in turn stimulates pain receptors and causes one to feel pain or burning.

# Epidemiology
- Dysuria can happen in both males and females. One of the most common causes of dysuria is urinary tract infection. Urinary tract infections are more common in females than males due to female anatomy, having a shorter and straight urethra compared to males who have longer and curved urethra due to male anatomy.
- In females, bacteria can reach the bladder more easily due to shorter and straight urethra as they have less distance to travel.
- females who use the wrong wiping technique from back to front instead of front to back can predispose themselves to more frequent urinary tract infections due to the opening of the urethra being closer to the rectum. Because of these reasons, females tend to experience dysuria more frequently compared to males.

# Pathophysiology
- Dysuria from inflammatory causes like urinary tract infection results from bladder muscle contraction and urethral peristalsis, causing urine to come in contact with inflamed mucosa.
- This contact causes stimulation of sensory nerves and pain receptors and causes pain along with burning, stinging, or itching.
- The sensitivity of these receptors can become enhanced during the inflammatory or neuropathic processes
- Inflammation from the surrounding organs such as colon can also sometimes result in dysuria.
- Dysuria from non-inflammatory causes like stone, tumor, trauma, or foreign body can cause irritation of the urethral or bladder mucosa .

# Classification
Dysuria can be divided broadly into two categories
- Infectious
- Infectious causes include
- Urinary tract infection or urethritis
- Kidney or prostate infections
- Vaginal infections
- Sexually transmitted diseases
- interstitial cystitis
- Non-infectious
- Non-infectious causes include
- Foreign body or stone in the urinary tract
- Trauma
- Benign prostatic hypertrophy
- Tumors
- Certain medications
- Anatomic abnormalities
- Menopause 

# Causes

## Life Threatening Causes
- Toxic epidermal necrolysis
- StevensJohnson syndrome

## Common Causes
- Balanitis
- Balanoposthitis
- Cervicitis
- Lower urinary tract infections
- Pelvic inflammatory disease
- Pyelonephritis
- Urethritis
- Vaginitis

## Causes by Organ System

# Causes in Alphabetical Order
- Abciximab
- Acute abacterial cystitis
- Acute cystitis
- Acute intermittent porphyria
- Acute pyelonephritis
- Acute urethritis
- Adenine phosphoribosyltransferase deficiency
- Appendicitis
- Arsenic trioxide
- Arsenicals
- Atrophic vaginitis
- Autoimmune orchitis
- Bacterial vaginosis
- Balanitis
- Balanitis xerotica obliterans
- Balanoposthitis
- Baneberry poisoning
- Behcet syndrome
- Benign prostatic hyperplasia
- Bilharziasis
- Bladder cancer
- Bladder diverticulum
- Bladder stone
- Candidal vaginitis
- Cervical cancer
- Cervicitis
- Chemical irritants
- Chlamydia
- Clofibrate
- Complication of pregnancy
- Congenital giant megaureter
- Contraceptive foam
- Contraceptive sponge
- Cystitis
- Cystocele
- Dehydration
- Diarrhea
- Dysfunctional elimination
- Ectopic pregnancy
- Endometriosis
- Eosinophilic cystitis
- Epididymitis
- Fallopian tube conditions
- Functional disorders
- Fungal infection
- Genital herpes
- Genital schistosomiasis
- Gonorrhea
- Goodpasture syndrome
- Granulomatous prostatitis
- Granulosa cell tumor of the ovary
- Hemorrhagic cystitis
- Hunner ulcer
- Hydatid cyst
- Hydroxyurea
- Hypercalciuria
- Idiopathic hyperuricosuria
- Indinavir
- Interstitial cystitis
- Irritant
- Irritative dermatitis
- Kidney infection
- Kidney stone
- Labial adhesion
- Lichen sclerosus
- Local trauma
- Lower urinary tract infection
- Malakoplakia
- Masturbation
- Meatal stenosis
- Melarsoprol
- Menopause
- Milnacipran
- Neisseria gonorrhoeae
- Non-gonococcal urethritis
- Nonspecific (chemical) urethritis
- Oxaprozin
- Paraurethral gland inflammation
- Pelvic inflammatory disease
- Pelvic lipomatosis
- Perineal trauma
- Periurethral herpes simplex
- Pinworms
- Poor perineal hygiene
- Postoperative septicaemia
- Prolapsed uterus
- Prostatic carcinoma
- Prostatic disease
- Prostatic tuberculosis
- Prostatitis
- Psychogenic disorder
- Pyelitis
- Pyelonephritis
- Pyrazinamide
- Radiation therapy
- Reactive arthritis
- Rectovesical fistula
- Reiter's Syndrome
- Renal nutcracker syndrome
- Renal tuberculosis
- Schistosoma haematobium
- Sexual abuse
- Sexually transmitted disease
- Spermicidal gel
- Stevens-Johnson syndrome
- Tiagabine
- Tiaprofenic acid
- Toxic epidermal necrolysis
- Trauma
- Trichomoniasis
- Urethral cancer
- Urethral caruncle
- Urethral catheterization
- Urethral stricture
- Urethral syndrome
- Urethral trauma
- Urethritis
- Urinary incontinence
- Urinary obstruction
- Urinary stone
- Urinary tract infection
- Urinary tract malformation
- Urinary tract neoplasm
- Urolithiasis
- Vaginal douche
- Vaginal lubricant
- Vaginal ulcers
- Vaginitis
- Valrubicin
- Vancomycin resistant enterococcal bacteremia
- Varicella
- Vesical calculus
- Vesicoureteral reflux
- Vesicovaginal fistula
- Vulvar cancer
- Vulvitis
- Xanthine oxydase deficiency
- Xanthinuria
- X-linked alpha thalassemia mental retardation syndrome

# Treatment
Treatment of dysuria depends on its cause the most common cause of dysuria is urinary tract infection for which empiric  antibiotic are used.If the cause of dysuria is renal stones, then various treatment options can be considered depending on the size and location of stones. Stones smaller than 5 mm typically pass on their own, and patients should be asked to hydrate themselves and strain the urine to document the evidence of a passed stone. The stones that are bigger than 5 mm are treatable through various modalities, including extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) or open surgery.
When dysuria is occurring due to chronic prostatitis in males, oral antibiotics merit consideration after obtaining urine culture.