What Causes Dysuria?

Difficulty urinating refers to laborious and inexhaustible urination, which requires increased abdominal pressure to excrete urine. Increasing abdominal pressure in severe cases does not excrete urine from the bladder, causing urinary retention. Treatment should first drain urine for causative and symptomatic treatment.

Basic Information

Visiting department

Urology

Common locations

Bladder, urethra

Common causes

Mechanical obstruction, dynamic obstruction

Common symptoms

Refers to laborious urination and inexhaustible sensation, which requires increased abdominal pressure to excrete

Causes of dysuria

1. Mechanical obstruction (1) Bladder neck obstruction: The most common cause is prostate disease, including benign prostatic hyperplasia, fibrosis, or tumor. Stones in the bladder, pedicated tumors, blood clots or foreign bodies, and lesions in nearby organs such as uterine fibroids, pregnancy incarcerated uterus, etc. can also block or compress the bladder neck and cause obstruction.
(2) Urethral obstruction: Urinary stenosis is most common after inflammation or injury. Urinary stones, foreign bodies, tuberculosis, tumors, diverticulum, etc. can also cause urethral obstruction. Phimosis or congenital posterior urethral valve are the main causes of urethral obstruction in male infants.
2. Dynamic obstruction (1) Nerve injury: brain or spinal cord injury.
(2) Surgical factors: central nerve surgery or extensive pelvic surgery (pelvic plexus injury).
(3) Neurological diseases: tumors, stroke, encephalitis, polio, spinal dysentery, diabetes, multiple sclerosis, etc.
(4) Congenital malformations: spina bifida, meningocele, spinal meningocele, etc.
(5) Post anesthesia and mental factors.
(6) Drug effects: anticholinergics, antidepressants, antihistamines, opioids, etc.

Dysuria common diseases

Difficulty urinating is common in cystitis, bladder stones, bladder tumors, gonorrhea, benign prostatic hyperplasia, urethritis, prostate fibrosis or tumors, pedicled tumors in the bladder, uterine fibroids, incarcerated uterus in pregnancy, postoperative central nervous system, tumors, stroke , Encephalitis, polio, spinal ridge, diabetes, multiple sclerosis, spina bifida, meningocele, spinal meningocele, etc. Often accompanied by frequent urination, urgency and other symptoms.
1. Urinary bladder and neck stones have difficulty urinating before a history of cramps in the lower abdomen. The pain can be radiated to the femoral perineum. Gross hematuria or microscopic hematuria occurs at or after the pain. Cystoscopy can find stones, B-ultrasound and CT examination can find stone shadows in the neck of the bladder.
2. The blood clot in the bladder is not an independent disease. It is often secondary to blood diseases such as hemophilia, leukemia, aplastic anemia, etc. It is not difficult to confirm the diagnosis by relying on blood laboratory tests. Blood clots in the bladder caused by trauma often have a clear history of trauma. Gross hematuria occurs after trauma, and dysuria gradually appears. B-ultrasound can reveal shadows at the inner urethra, and cystoscopy can confirm the diagnosis. It is also the most effective treatment. means.
3. Urination difficulties in bladder tumors have gradually increased. The course of disease is generally long, and distant tumor metastases can be found in advanced stages. Painless gross hematuria or microscopic hematuria are characteristic manifestations of the disease. Cystoscopy biopsy can determine the nature of the tumor.
4. Prostatic hyperplasia and prostatitis are often the first symptoms of frequent urination and urgency, and the main symptoms are nocturia, and the symptoms gradually increase with the increase of residual bladder volume. Progressive dysuria, urination urination, urinary weakness, urinary tapering, intermittent urination, end-drip dripping, and urinary incontinence can occur later. Digital anal diagnosis can determine the size, texture, and smoothness of the prostate, which is of great value in distinguishing benign prostate enlargement from prostate cancer. Prostate massage takes prostate fluid for routine examination and cell culture, which has diagnostic significance for prostatitis.
5. Posterior urethral injury has a history of trauma in the perineal area, difficulty urination or no urine discharge after trauma, and urine retention in the bladder. Urethral angiography can determine the location and extent of the injury and is a necessary means before surgery.
6. Anterior urethral stricture is found in anterior urethral scars, stones, foreign bodies, etc. People with dysuria caused by scars often have a history of trauma. Anterior urethral calculi are rare and often caused by the migration of pelvis, ureter, and bladder stones to the urethra. It is generally not difficult to diagnose based on the history of urinary calculi, and urethral angiography can be used to confirm the diagnosis if necessary.
7. Spinal cord injury caused by dysuria is seen in patients with various causes of paraplegia. In addition to dysuria, urinary retention, there are motor and sensory disorders.
8. Early onset spina bifida age, nocturnal enuresis, and prolonged bedwetting at young age are characteristic manifestations of this disease. X-ray examination of the lumbar and sacral spine can confirm the diagnosis.
9. Diabetic neurogenic bladder has a history of diabetes, and laboratory tests can be used to diagnose blood sugar and urine glucose.
10. Drugs are commonly found in atropine poisoning, narcotic drugs, etc., and have a clear history of medication, which is generally not difficult to diagnose.
11. Patients with hypokalemia often have a large history of hypokalemia caused by diuresis, gastric lavage, vomiting, and fasting. The heart rate is fast, pathological U waves can be seen on the electrocardiogram, and blood potassium is low in blood biochemical examination. Difficulty urinating due to hypokalemia, and dysuria disappeared with potassium supplementation.

Dysuria test

Can choose urethral catheterization, bladder puncture, ultrasound, X-ray (understand the bladder, urethral stones), urethral cystoscopy (clear the cause and location of obstruction), urodynamics (diagnosing neurogenic bladder) and other tests.

Diagnosis of dysuria

Diagnosis is based on medical history, clinical manifestations, and related examinations.

Differential diagnosis of dysuria

Renal tubular acidosis, gossypol poisoning, hyperthyroidism, and connective tissue disease can also cause refractory hypokalemia, which can be identified based on its unique clinical manifestations and corresponding laboratory tests.

Dysuria treatment

1. Draining urine The treatment of acute urinary retention should first drain the urine. Chronic urinary retention is often secondary to infection. Before the primary disease is cured, the urine should also be drained. Urine drainage methods include the following.
(1) Catheterization: the preferred method, pay attention to aseptic operation to prevent retrograde urinary tract infection, pay attention to the selection of a suitable urinary catheter, and use a metal urinary catheter for unsuccessful intubation.
(2) Syringe urine extraction method: suitable for patients with large residual urine volume, severe symptoms, unconditional catheterization and ostomy, or unsuccessful catheterization.
(3) suprapubic bladder puncture fistula: for failure of catheterization, pay attention to the puncture location and the depth of the needle. Too low a position can easily damage the prostate; too high a position can easily enter the abdominal cavity to damage the bowel; penetration too deep can damage the triangular area of the bladder and the rectum.
(4) Open cystostomy: It is suitable for those who have persistent urinary retention that cannot be eliminated, or who perform permanent cystostomy for other reasons.
2. Etiology and treatment If the cause is clear and the condition is removed in time, the cause should be immediately lifted and urination resumed. Endoscopic treatment is preferred for urethral strictures, lower urinary tract stones, urinary retention due to bladder tumors, and prostatic hyperplasia.
3. Symptomatic treatment (1) Subarachnoid block (lumbar anesthesia) or urinary retention after anorectal rectal surgery: Acupuncture is preferred, and the acupoints often used are Zhongji, Qugu, Yinlingquan, Sanyinjiao, etc.
(2) Acute urinary retention due to spinal cord injury: Strive for urinating with palm pressure when the bladder is not fully full, that is, continue to compress the palm from above the bladder, but not too hard, so as not to rupture the bladder. Passive discharge of urine can avoid infection caused by catheterization or indwelling catheter.
(3) Separation disorder (rickets) urinary retention: suggestive, acupuncture, and electroacupuncture can be used for treatment.
(4) Intermittent urination: bladder function training is optional.
4. Complication treatment is mainly anti-infective treatment.