2. Dysuria and Frequency Dysuria: difficult and painful passage of urine. Frequency: repetetive voiding of relatively small amounts of urine.

3. Dysuria and Frequency Is seen far more frequently in women than in men. Causes : UTI, vaginitis, genital infection, estrogen deficiency, interstitial cystitis, chemical irritants, impedence to flow, systemic or regional disease, bladder tumor

4. Dysuria and Frequency Infectious causes : pyelonephritis, cystitis, urethritis, vaginitis, prostatitis Pyelonephritis: fever, CVA tenderness (unilateral or bilateral), frequency and dysuria, pyuria (WBC>200000/ml urine), urine culture>1000000 cc/ml,leukocyte esterase, nitrite dipstick. Cystitis, urethritis: without upper u.t. symptoms. Vaginitis: dysuria with vaginal discharge, vulvar pruritus, and painful intercourse (candida, trichomonas, gardnerella, nisseria gonorrhea and herpes simplex.

5. Dysuria and Frequency Prostatitis: the most frequent cause of recurrent bacterial infection in men. Sign and symptoms: terminal dysuria, perineal discomfort purulent fluid by prostatic massage.poor antibacterial peneteration, prolonged therapy (6 -12 m)

6. Dysuria and Frequency Differential Dx of painful urination in female: Vaginal symptoms: external dysuria, vaginal discharge, itching, swelling, redness, soreness or vulvar burning, fishy odor. Sug: vaginitis pelvic exam, microscop exam of the vaginal secretions

7. Dysuria and Frequency Urinary symptoms: internal dysuria, frequency, urgency,small volume of urination,pain on termination of urination,suprapubic pressure,foul odor, sug:UTI microsco exam,leukocyte esterase and nitrite test.

8. Dysuria and Frequency No pyuria or bacteriuria: mechanichal or chemical irritation. If chronic :cystoscopy for bladder tumor, dysuria frequency syndrome, interstitial cystitis. Do not treat with antibiotic

9. Dysuria and Frequency Pyuria without bacteriuria: sex transmitted urethritis gonorrhrea & chlamydia,partially treated UTI, radiation cystitis. Do not treat for cystitis.

10. Dysuria and Frequency Pyuria with low count bacteriuria: suges: bacterial urethritis( pyuria, dysuria synd. Treat as for UTI. suges: bacterial urethritis( pyuria, dysuria synd. Treat as for UTI. Pyuria with high count bacteriuria: sug: bacterial cystitis. Treat without waiting for cuture results. Hematuria without bacteriuria: sug: non bacterial cause (stone,radiation,cyclophosphamide,virus, immune:B lactams,NSAIDs). Diag: hystory.

11. Hematuria Normal red cell excretion is up to 2 million RBCs per day. Hematuria defined as 2-5 RBCs per hpf and can be detected by dipstick. Common causes of isolated hematuria: stones, neoplasm, tuberculosis, trauma, and prostatitis. Gross hematuria with blood clots : never glomerular bleeding. Single U/A with hematuria is common and results from: mens, viral illness, allergy, exercise,or mild trauma. trauma.

12. Hematuria Persistent or significant hematuria: >3 RBCs /hpf on three urinalysis,or single urinalysis with> 100 RBCs,or gross hematuria. Suspicion of urogenital neoplasm: isolated painless hematuria(isomorphic RBCs). Hematuria with pyuria and bacteriuria, typical of infection. Hypercalciuria and hyperuricosuria can cause unexplained isolated hematuria.

13. Hematuria Isolated microscopic hematuria can be a manifestation of glomerular disease (dysmorphic RBCs).irregular shape of RBCs may also occure due to pH and osmolarity changes. The most common cause of isolated glomerular hematuria are IgA nephropathy, hereditary nephritis, thin basement membrane disease. Hematuria with dysmorphic RBCs, RBC casts, and protein excretion > 500 mg/d : diagnostic of GN. Even in the absence of azotemia these patients should undergo renal biopsy.

14. Hematuria In case of macroscopic Hemat without glomerular or parenchymal source, do a 3 glass test: 1. 10-15 cc of first urine urethral cause. 2. 10-30 cc of final urine (terminal hematuria) bladder origin. 3. In all three samples upper U.T. bleeding.

15. Hematuria In the case of NL renal function, no RBC dysmorph, no significant proteinuria: 1. IVU or CT scan with contrast for stone or tumor. In the absence of Dx : 2. Cystoscopy. 3. Age > 40 + smoking : bladder Ca. Cystoscopy + urine cytology.

16. Hematuria Proteinuria ) < 500 mg / d ) Dysmorphic RBC or cast Pyuia, WBC cast - - Urine culture Urine eosinophils + Hb electroph. urine cytology UA of family members 24 h urinary ca, uricaud - Serologic and hematologic evaluation, blood cultures, anti GBM Ab ANCA, complement, cryoglobalins hepatitis B and C serology VDRL, HIV, ASLO +

17. IVP +/- renal Ultrasound Retrograde Arteriogram Cyst aspiration + - Cystoscopy + Biopsy and evaluation - Renal CT scan + - Open renal biopsy Follow periodic urinalysis