Medical Council of Canada

Medical expert

Dysuria, Urinary Frequency and Urgency, and/or Pyuria - 110-1

Rationale

Cystitis describes a common clinical syndrome of dysuria, urinary frequency and urgency, which is sometimes associated with suprapubic pain, and often found in the presence of pyuria. These symptoms, although generally indicative of bacterial cystitis, may also be associated with other infections of the urethra or vagina.

Causal Conditions

(list not exhaustive)
  1. Urinary tract infection (e.g., cystitis, prostatitis, pyelonephritis)
  2. Sexually transmitted infection
  3. Non-infectious urinary tract inflammation (e.g., traumatic, interstitial cystitis, bladder carcinoma, bladder stones, urethral stricture)
  4. External to lower urinary tract (vulvo-vaginitis)

Key Objectives

Given a patient who presents with dysuria, urinary frequency and urgency, urethral discharge and/or pyuria, the candidate will diagnose the cause, predisposing conditions, severity, and complications, and will initiate an appropriate management plan

Enabling Objectives

Given the patient with dysuria, urinary frequency and urgency, urethral discharge and/or pyuria, the candidate will

  1. list and interpret critical clinical findings, including
    1. differentiation of urinary tract infections from non-infectious causes of cystitis and conditions outside the urinary tract with similar presentation;
    2. in case of recurring urinary tract infections, determination as to whether a predisposing condition may be present (e.g., urine stasis, presence of stone or foreign body);
    3. results of prostate and urethra examinations, as the case may be;
    4. a differential diagnosis based on age, gender and lifestyle;
  2. list and interpret critical investigations, including
    1. urinalysis;
    2. urine culture and sensitivity;
    3. other investigations (e.g., vaginal and/or urethral swab, if indicated);
  3. construct an effective initial management plan, including
    1. a selection of the most appropriate treatment for the underlying condition, including selection of appropriate antibiotics, if indicated;
    2. an assessment of the illness severity and the need for hospitalization;
    3. a determination as to whether additional investigation and/or referral are required;
    4. a brief outline of strategies for the prevention of recurrent urinary tract infections.
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