A. When did painful urination begin? Trauma to the urinary tract must be ruled out if pain develops after an injury. Bicycle and straddle injuries commonly cause damage to the kidneys or urethra, leading to hematuria or dysuria, or both. Consider behavioral problems, including attention seeking, if symptoms occur only at a particular time of day (ie, during school).
B. Where is the pain located? In the urethra? In the pelvis or abdomen? Is there back pain? Pain originating from another organ system may be referred to the urethra. An intra-abdominal abscess or a low-lying inflamed appendix may produce complaints
of dysuria. Dysuria associated with back pain is a common presentation of pyelonephritis. Renal stones in the pelvis, calyx, or ureter can cause abdominal or flank pain with radiation into the scrotum or vulva. Stones in the urethra or distal ureter cause dysuria. Stones in the bladder are not associated with pain.
C. Are there associated complaints (eg, fever, drainage or discharge between urinations, abnormal urine odor or color, or changes in volume or frequency of urination)? Fever, dark and foul-smelling urine, frequency, and urgency are all symptoms associated with UTIs. If patient is sexually active and experiencing discharge or dyspareunia, consider STDs (eg, gonorrhea, chlamydia).
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