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Dysuria in Women

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1. Assessment of dysuria

for between 5% and 15% of visits to family physicians. Bremnor J, Sadovsky R. Evaluation of dysuria in adults. Am Fam Physician. 2002;65:1589-1597. http://www.aafp.org/afp/2002/0415/p1589.html http://www.ncbi.nlm.nih.gov/pubmed/11989635?tool=bestpractice.com It is generally more common in women, with a reported prevalence in women of up to 25% in the US per year, Richardson DA. Dysuria and urinary tract infections. Obstet Gynecol Clin North Am. 1990;17:881-888. http://www.ncbi.nlm.nih.gov/pubmed/2092247 (...) ?tool=bestpractice.com and 27% in the UK per year. Jolleys JV. The reported prevalence of urinary symptoms in women in one rural general practice. Br J Gen Pract. 1990;40:335-337. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371312/pdf/brjgenprac00077-0025.pdf http://www.ncbi.nlm.nih.gov/pubmed/2121180?tool=bestpractice.com Although dysuria is uncommon in men, incidence increases with advancing age. Rasanathan M. Dysuria in general practice. N Z Med J. 1979;89:54-56. http://www.ncbi.nlm.nih.gov

2018 BMJ Best Practice

2. A cost minimization analysis of treatment options for postmenopausal women with dysuria. (PubMed)

A cost minimization analysis of treatment options for postmenopausal women with dysuria. Empiric therapy for urinary tract infection is difficult in postmenopausal women due to higher rates of confounding lower urinary tract symptoms and differential resistance profiles of uropathogens in this population.To determine the least costly strategy for treatment of postmenopausal women with the primary complaint of dysuria.We performed a cost minimization analysis modeling the following clinical (...) of urinalysis ($38.23), high rate of both urinary tract infection (91%) and positive urinalysis (69.3%) with dysuria in postmenopausal women, and resultant high rate of antibiotic use with or without urinalysis. Options with fosfomycin were the most expensive due to highest drug costs ($98/dose), and tornado analyses showed fosfomycin cost was the most impactful variable for model outcomes. Sensitivity analyses showed empiric fosfomycin became the least costly option if drug costs were $25.80, a price still

2019 American Journal of Obstetrics and Gynecology

3. Dysuria in Women

Dysuria in Women Dysuria in Women Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Dysuria in Women Dysuria in Women Aka: Dysuria (...) discharge Cervical motion tenderness Skin exam Localized genitourinary dermatitis (e.g. HSV, , chronic inflammatory condition) V. Symptoms and Signs See See See See VI. Evaluation Urine Sample suspected: examination Saline Preparation (Wet Prep) Sexually active patient PCR and PCR Consider of cervical discharg VII. Management: Persistent Dysuria with unremarkable evaluation Consider Topical or systemic irritants Discontinue offending agents Consider treating for in sexually active women for 7 days

2018 FP Notebook

4. Dysuria

. Definition Burning or stinging of the with voiding III. Causes: By Cohort See See See IV. Causes: Infectious itis Urethritis s (15-40% of cases) (following anal intercourse) Genital ( ) genitalium urealyticum vaginalis Other genitourinary infections Women See (e.g. , yeast ) Men See or V. Causes: Dermatologic See Spermacidal gel Topical deodorants Behcet Syndrome VI. Causes: Medication and food causes of Dysuria Medications G Cyclophosphamide s Food and herbal supplement adverse effects Pumpkin seeds VII (...) . Causes: Miscellaneous l l stricture l diverticulum Local l (e.g. , horse back riding) and Pelvic Irradiation Genitourinary foreign body (e.g. stent) VIII. Causes: Miscellaneous - Men See IX. Causes: Miscellaneous - Women See and Vagina Vaginal cancer s (paraurethral) X. Causes: Psychogenic and social (e.g. ) Sexual abuse XI. History: Characteristics of Dysuria Timing Start of void: l source End of void: source Pain location itis and l pain Suprapubic or retropubic pressure External pain distribution

2018 FP Notebook

5. Urinary tract infections in women

Urinary tract infections in women Urinary tract infections in women - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Urinary tract infections in women Last reviewed: February 2019 Last updated: January 2019 Summary Can be clinically categorised into uncomplicated/complicated, acute, or recurrent. Escherichia coli is the most common organism in uncomplicated infections. Costovertebral angle tenderness together (...) . Pyelonephritis is an infection of the kidney that often occurs via bacterial ascent, and urethritis is an infection causing an inflammation of the urethra. History and exam presence of risk factors dysuria urinary frequency haematuria back/flank pain costovertebral angle tenderness fever urinary urgency supra-pubic pain and tenderness sexual activity spermicide use post-menopause positive family history of UTIs history of recurrent UTI presence of a foreign body insulin-treated diabetes high lifetime number

2019 BMJ Best Practice

6. Urinary tract infections in women

Urinary tract infections in women Urinary tract infections in women - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Urinary tract infections in women Last reviewed: February 2019 Last updated: January 2019 Summary Can be clinically categorised into uncomplicated/complicated, acute, or recurrent. Escherichia coli is the most common organism in uncomplicated infections. Costovertebral angle tenderness together (...) . Pyelonephritis is an infection of the kidney that often occurs via bacterial ascent, and urethritis is an infection causing an inflammation of the urethra. History and exam presence of risk factors dysuria urinary frequency haematuria back/flank pain costovertebral angle tenderness fever urinary urgency supra-pubic pain and tenderness sexual activity spermicide use post-menopause positive family history of UTIs history of recurrent UTI presence of a foreign body insulin-treated diabetes high lifetime number

2018 BMJ Best Practice

7. Urinary incontinence in women

Urinary incontinence in women Urinary incontinence in women - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Urinary incontinence in women Last reviewed: February 2019 Last updated: September 2018 Summary Involuntary, spontaneous urine loss that occurs either with strenuous physical activity (stress incontinence) or is associated with an uncontrollable sense of urgency (urge incontinence), or both (mixed incontinence (...) ). May be caused by alterations in anatomical support and/or neuromuscular function of the pelvic floor, or may be idiopathic. Risk factors are multifactorial. Increased prevalence in puerperal period and in older, obese women with neurological conditions. Treatment approach depends on type of incontinence, but can include biofeedback, pharmacotherapy, neuromodulation, or surgery. Definition Urinary incontinence is a complaint of involuntary loss of urine. Bo K, Frawley HC, Haylen BT, et al

2018 BMJ Best Practice

8. Urinary incontinence in women

Urinary incontinence in women Urinary incontinence in women - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Urinary incontinence in women Last reviewed: February 2019 Last updated: September 2018 Summary Involuntary, spontaneous urine loss that occurs either with strenuous physical activity (stress incontinence) or is associated with an uncontrollable sense of urgency (urge incontinence), or both (mixed incontinence (...) ). May be caused by alterations in anatomical support and/or neuromuscular function of the pelvic floor, or may be idiopathic. Risk factors are multifactorial. Increased prevalence in puerperal period and in older, obese women with neurological conditions. Treatment approach depends on type of incontinence, but can include biofeedback, pharmacotherapy, neuromodulation, or surgery. Definition Urinary incontinence is a complaint of involuntary loss of urine. Bo K, Frawley HC, Haylen BT, et al

2018 BMJ Best Practice

9. Chronic pelvic pain in women

Chronic pelvic pain in women Chronic pelvic pain in women - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Chronic pelvic pain in women Last reviewed: February 2019 Last updated: March 2018 Summary Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles. A methodical, complete, criteria-based history is required to determine how many (...) ?tool=bestpractice.com Patients typically present with at least two of several common pain-related diagnoses: interstitial cystitis, irritable bowel syndrome, fibromyalgia, levator ani syndrome (pelvic floor tension myalgia), endometriosis, adenomyosis, leiomyoma, or vulvodynia. Common comorbid conditions include depression, anxiety, and traumatic stress disorder. History and exam presence of risk factors dysuria dyspareunia dysmenorrhoea abdominal trigger points levator ani tenderness cervical

2018 BMJ Best Practice

10. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU

, and new or worsening incontinence. Dysuria is central in the diagnosis of UTI ; other symptoms of frequency, urgency, suprapubic pain, and hematuria are variably present. Acute-onset dysuria is a highly specific symptom, with more than 90% accuracy for UTI in young women in the absence of concomitant vaginal irritation or increased vaginal discharge. 10,11 In older adults, the symptoms of UTI may be less clear. Given the subjective nature of these symptoms, careful evaluation of their chronicity (...) becomes an important consideration when the diagnosis of UTI is in doubt. Acute-onset dysuria, particularly when associated with new or worsening storage symptoms, remains a reliable diagnostic criterion in older women living both in the community and in long-term care facilities. 12–14 Older women frequently have nonspecific symptoms that may be perceived as a UTI, such as dysuria, cloudy urine, vaginal dryness, vaginal/perineal burning, bladder or pelvic discomfort, urinary frequency and urgency

2019 Canadian Urological Association

11. Urethral injection therapy for urinary incontinence in women. (PubMed)

Urethral injection therapy for urinary incontinence in women. Urinary incontinence imposes a significant health and economic burden to society. Periurethral or transurethral injection of bulking agents is a minimally invasive surgical procedure used as one the surgical treatments of stress urinary incontinence (SUI) in adult women.To assess the effects of periurethral or transurethral injection therapy on the cure or improvement of urinary incontinence in women.We searched the Cochrane (...) sought directly from the investigators.Excluding duplicate reports, we identified 14 trials (excluding one that was subsequently withdrawn from publication and not included in this analysis) including 2004 women that met the inclusion criteria. The limited data available were not suitable for meta-analysis because they all came from separate trials. Trials were small and generally of moderate quality.One trial of 45 women that compared injection therapy with conservative treatment showed early

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2017 Cochrane

12. Dysuria in Women

Dysuria in Women Dysuria in Women Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Dysuria in Women Dysuria in Women Aka: Dysuria (...) discharge Cervical motion tenderness Skin exam Localized genitourinary dermatitis (e.g. HSV, , chronic inflammatory condition) V. Symptoms and Signs See See See See VI. Evaluation Urine Sample suspected: examination Saline Preparation (Wet Prep) Sexually active patient PCR and PCR Consider of cervical discharg VII. Management: Persistent Dysuria with unremarkable evaluation Consider Topical or systemic irritants Discontinue offending agents Consider treating for in sexually active women for 7 days

2015 FP Notebook

13. Dysuria in the Emergency Department: Missed Diagnosis of Chlamydia trachomatis (PubMed)

Dysuria in the Emergency Department: Missed Diagnosis of Chlamydia trachomatis The clinical presentation of genital Chlamydia trachomatis infection (chlamydia) in women is often indistinguishable from a urinary tract infection. While merited in the setting of dysuria, emergency department (ED) clinicians do not routinely test for chlamydia in women. The primary aim of our study was to evaluate the frequency of chlamydia testing among women presenting to the ED with dysuria.We conducted (...) a retrospective chart review of women 19-25 years of age presenting with dysuria to an urban ED and who had been coded with urinary tract infection (UTI) as their primary diagnosis (ICD-9 599.0) from October 2005 to March 2011. We excluded women who were pregnant, had underlying anatomical or neurological urinary system pathology, had continuation of symptoms from UTI or a sexually transmitted infection (STI) diagnosed elsewhere, or were already on antibiotics for a UTI or STI. We identified the rates

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2014 Western Journal of Emergency Medicine

14. Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women. (PubMed)

Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women. Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women, characterised by dysuria and urinary frequency. Urinary alkalisers are widely used in some countries for the symptomatic treatment of uncomplicated UTI, and they are recommended in some national formularies. However, there is a lack of empirical evidence to support their use for UTI and some healthcare guidelines advise (...) of uncomplicated UTI amongst women aged 16 and over, were included. Studies were eligible if they included patients whose diagnosis of UTI was decided by symptoms alone, or positive urine dipstick test or urine culture; and patients with recurrent UTI, provided patients had no symptoms of UTI in the two weeks prior to the onset of symptoms that lead them to seek medical advice. Studies were ineligible if they studied patients with complicated UTIs; immune-compromising conditions; acute pyelonephritis

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2016 Cochrane

15. Asymptomatic Microscopic Hematuria in Women

with imaging for unrelated symptoms ( ). Risk of Diagnostic Testing Routine evaluation of all men and women older than 35 years with cystoscopy and CT urography has substantial cost and adverse event implications. In patients undergoing outpatient cystoscopy, 50% reported dysuria and 3% had a documented urinary tract infection ( ). In addition, nephropathy from intravenous contrast has been calculated to be greater than 2% in the general population and greater than 20–30% in high-risk patients (...) Asymptomatic Microscopic Hematuria in Women Asymptomatic Microscopic Hematuria in Women - ACOG Menu ▼ Asymptomatic Microscopic Hematuria in Women Page Navigation ▼ Number 703, June 2017 Committee on Gynecologic Practice American Urogynecologic Society This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and the American Urogynecologic Society in collaboration with committee members Charles W. Nager, MD, Vivian W. Sung

2017 American College of Obstetricians and Gynecologists

16. Frequency and dysuria in women. (PubMed)

Frequency and dysuria in women. 678808 1978 10 18 2018 11 13 0007-1447 2 6129 1978 Jul 01 British medical journal Br Med J Frequency and dysuria in women. 53-4 eng Letter England Br Med J 0372673 0007-1447 AIM IM Family Practice Female Gonorrhea complications Humans Syndrome Urination Disorders etiology therapy 1978 7 1 1978 7 1 0 1 1978 7 1 0 0 ppublish 678808 PMC1605671 Lancet. 1972 Oct 28;2(7783):893-8 4116601 Lancet. 1975 Sep 20;2(7934):537-8 51350

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1978 British medical journal

17. Dysuria in women. (PubMed)

Dysuria in women. 5428729 1970 08 31 2018 11 13 0007-1447 2 5712 1970 Jun 27 British medical journal Br Med J Dysuria in women. 741-2 eng Journal Article England Br Med J 0372673 0007-1447 AIM IM Adolescent Adult Bacteriuria complications Female Humans Kidney Diseases complications Middle Aged Urination Disorders complications 1970 6 27 1970 6 27 0 1 1970 6 27 0 0 ppublish 5428729 PMC1700842 Q J Med. 1968 Jul;37(147):361-77 5676879 Br Med J. 1969 Nov 15;4(5680):390-4 4187693 Lancet. 1965 Mar

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1970 British medical journal

18. Clinical Significance of Dysuria in Women (PubMed)

Clinical Significance of Dysuria in Women During a community survey 22% of women were found to have had dysuria in the previous year and half had had dysuria at some time in their lives. Various measurements were made in a random sample of 282 of these women. The means and the variances of the systolic and diastolic blood pressures in women with a past history of dysuria tended to be higher than in women who gave no such history. There were no significant differences in the means of plasma urea (...) , plasma creatinine, and renal concentrating power between women with and without a previous history of dysuria, but a significant impairment of renal concentrating power was found in an additional group of 30 women who dated the onset of their dysuria to childhood.These findings suggest that urinary tract infection in adult women does not usually lead to progressive impairment of kidney function, whereas infection in childhood is more often associated with kidney damage.

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1970 British medical journal

19. Extraurethral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women

Extraurethral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women Extr Extraurethr aurethral (non-circumferential) retropubic al (non-circumferential) retropubic adjustable compression de adjustable compression devices for stress urinary vices for stress urinary incontinence in women incontinence in women Interventional procedures guidance Published: 22 March 2017 nice.org.uk/guidance/ipg576 Y Y our responsibility our responsibility (...) NICE recommendations wherever possible. This guidance replaces IPG133. © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 of 71 1 Recommendations Recommendations 1.1 Current evidence on the safety and efficacy of extraurethral (non- circumferential) retropubic adjustable compression devices for stress urinary incontinence in women is inadequate in quantity and quality. Therefore, this procedure should only be used

2017 National Institute for Health and Clinical Excellence - Interventional Procedures

20. Transurethral radiofrequency collagen denaturation for the treatment of women with urinary incontinence. (PubMed)

Transurethral radiofrequency collagen denaturation for the treatment of women with urinary incontinence. Transurethral radiofrequency collagen denaturation is a relatively novel, minimally invasive device-based intervention used to treat individuals with urinary incontinence (UI). No systematic review of the evidence supporting its use has been published to date.To evaluate the efficacy of transurethral radiofrequency collagen denaturation, compared with other interventions, in the treatment (...) of women with UI.Review authors sought to compare the following.• Transurethral radiofrequency collagen denaturation versus no treatment/sham treatment.• Transurethral radiofrequency collagen denaturation versus conservative physical treatment.• Transurethral radiofrequency collagen denaturation versus mechanical devices (pessaries for UI).• Transurethral radiofrequency collagen denaturation versus drug treatment.• Transurethral radiofrequency collagen denaturation versus injectable treatment for UI

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2015 Cochrane

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