Dysuria refers to discomfort, burning, or sensation of pain during micturition. Patients may also complain of urethral discomfort not associated with micturition. It is a common condition and can be challenging to diagnose, as it is often present in conjunction with other lower urinary tract symptoms. Dysuria may be external (i.e., urine irritating the inflamed genital organs) or internal (i.e., pain felt in the urethra).

Although infection is the most common cause (urinary tract infection being the most common infection), there is a large list of differential diagnoses that need to be carefully considered, as any infectious or inflammatory condition affecting the genitourinary system may cause dysuria.

Dysuria accounts for between 5% and 15% of visits to family physicians. [1] 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, [2] 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. [3] 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. [4] Rasanathan M. Dysuria in general practice. N Z Med J. 1979;89:54-56. http://www.ncbi.nlm.nih.gov/pubmed/372868?tool=bestpractice.com Lower urinary tract symptoms increase dramatically in men aged >40 years due to bladder outlet obstruction secondary to benign prostatic hyperplasia. [5] Sommer P, Nielsen KK, Bauer T, et al. Voiding patterns in men evaluated by a questionnaire survey. Br J Urol. 1990;65:155-160. http://www.ncbi.nlm.nih.gov/pubmed/2317647?tool=bestpractice.com Among men of all ages who seek medical advice for urological symptoms, dysuria is present in about 5% of cases. [6] Wolfs GG, Knottnerus JA, Janknegt RA. Prevalence and detection of micturition problems among 2,734 elderly men. J Urol. 1994;152:1467-1470. http://www.ncbi.nlm.nih.gov/pubmed/7933185?tool=bestpractice.com

Kasra Saeb-Parsy, BSc, MBBS, AFHEA, FRCSEd (Urol) Consultant Urologist

Cambridge University Hospitals NHS Foundation Trust

Honorary Lecturer

Anglia Ruskin University

KS-P declares that he has no competing interests.

Elaine Lee, MBBS, MA, FRCS (Urol)

Post-CCT Specialty Registrar

EL declares that she has no competing interests.

Kasra Saeb-Parsy and Elaine Lee would like to acknowledge Dr Vincent J. Gnanapragasam, a previous contributor to this topic. VJG declares that he has no competing interests.

Robert Pickard, MD, FRCS (Urol)

Professor of Urology

Institute of Cellular Medicine

Newcastle University

Newcastle upon Tyne

RP has received funding from the UK NHS (NIHR) to undertake commissioned reviews of treatment for benign prostatic enlargement.

George Martin, MD

Mayo Clinic

GM declares that he has no competing interests.
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