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Abnormalities in micturition


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

Micturition is the act of passage of urine which is a normal physiological process. Any abnormality in urine can cause difficulty in passage of urine. Abnormality of micturition usually present with symptoms like dysuria, nocturia, increased frequency, dribbling, hesitancy and suprapubic tenderness. Various causes include cystitis, pyelonephritis, cervicitis, prostatitis, benign prostatic hyperplasia. It is important to differentiate among the different causes which can help guide the treatment.

Causes

Abnormalities of Micturition Differential Diagnosis

Differentiating the diseases that can cause abnormality in micturition:

Abbreviations: N= Normal, UTI= Urinary tract infection, CBC= Complete blood count, CT= Computed tomography, IBS= Irritable bowel syndrome, DRE= Digital rectal examination, HSV= Herpes simplex virus, RBCs= red blood cells, STI= Sexually transmitted infection, PCR=Polymerase chain reaction, Nl=Normal

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Fever Urinary symptoms Supra-pubic tenderness Skin lesions Other CBC Urinalysis Ultrasonography CT scan
Dysuria Frequency Dribbling Hesitancy Nocturia
Inflammatory Dermatological disorders Lichen sclerosus[1] – + – – + – – Lichenified plaques – Nl Findings of UTI in women is quite often Nl Nl Biopsy
Behcet’s syndrome[2][3][4] – + + – + + – Aphthous ulcer in mouth Nl Nl Nl Nl None
Infectious diseases Cystitis[5][6] + + + + + + + Nl – Leukopenia
  • Bladder wall thickening
  • Intraluminal gas in emphysematous cystitis
 Urine culture and sensitivity –
Urethritis[7][8][9] + + + – + – + – Leukocytosis Nl Nl Nl Urethral swab for culture, NAAT –
Pyelonephritis[10][11] + + + – – + ± Nl Urgency Leukocytosis Urinalysis and Urine culture –
Diseases Fever Dysuria Frequency Dribbling Hesitancy Nocturia Suprapubic tenderness Skin lesions Other CBC Urinalysis Ultrasonography CT scan Gold standard Additional findings
Vulvovaginitis[12] ± + + + + – – Thick white discharge Nl Nl Nl Nl Microbiological diagnosis –
Cervicitis + ± + ± – – + Thick yellow green pus Leukocytosis WBC Nl or show PID like feature Nl or show PID like feature Culture of vaginal discharge NAAT for gonocooccal cervicitis
Prostatitis + + + + + + ± – Tender prostate Leukocytosis Nl Nl Urine culture Prostate massage for chronic prostatitis leads to raised leukocytes in urine
Epididymoorchitis[13] ± + + + – – – – Leukocytosis WBC Nl Nl Urine culture
Non-inflammatory Anatomic Urethral stricture – + ± + – – – – – Nl RBCs Post void residual; volume is high – Retrograde urethrogram+cystoscopy(urodynamic studies) –
Benign prostatic hyperplasia (BPH)[14] – + + + + + – – Enlarged and smooth prostate on DRE Nl May have UTI like picture ocassionally Enlarged prostate – None TURP is gold standard treatment
Diseases Fever Dysuria Frequency Dribbling Hesitancy Nocturia Suprapubic tenderness Skin lesions Other CBC Urinalysis Ultrasonography CT scan Gold standard Additional findings
Gynecological Atrophic vaginitis[15] – + + ± ± + – Vaginal discharge Nl Nl Thinning of endometrium Nl Clinical examination –
Endometriosis – + – – – – – – Nl Nl Cystic masses attached to adnexa Cysts Laparoscopy
Malignancy Bladder cancer – + + – – – – – Hematuria Anemia Hematuria Nl Nodal involvement in the pelvis or retroperitoneum, visceral, pulmonary, or osseous metastasis Cystoscopy and biopsy –
Vulvovaginal cancer[16] – ± ± ± – – –
  • Edematous vulva
  • Lesion on the inner edges of vulva
 – Nl When infected, Nl Contrast enhancement (vascularity) showing the extent of the disease Biopsy –
Iatrogenic Genitourinary instrumentation/ pelvic irradiation – + ± – ± ± ± Erythema – Leukocytosis maybe present When infected, Nl Nl Culture –
Trauma ± ± – – – – ± Laceration/bruise Hematuria Hematuria Blood in pelvic cavity Blood in pelvic cavity Laparotomy –

References

  1. ↑ Ventolini G, Patel R, Vasquez R (2015). “Lichen sclerosus: a potpourri of misdiagnosed cases based on atypical clinical presentations”. Int J Womens Health. 7: 511–5. doi:10.2147/IJWH.S82879. PMC 4431497. PMID 26056492.
  2. ↑ Theodorou C, Floratos D, Hatzinicolaou P, Vaiopoulos G (August 1999). “Neurogenic bladder dysfunction due to Behçet’s disease”. Int. J. Urol. 6 (8): 423–5. PMID 10466456.
  3. ↑ Porru D, Pau AC, Scarpa RM, Zanolla L, Cao A, Usai E (May 1996). “Behçet’s disease and the neuropathic bladder: urodynamic features: case report and a literature review”. Spinal Cord. 34 (5): 305–7. PMID 8963981.
  4. ↑ Cetinel B, Akpinar H, Tüfek I, Uygun N, Solok V, Yazici H (January 1999). “Bladder involvement in Behçet’s syndrome”. J. Urol. 161 (1): 52–6. PMID 10037367.
  5. ↑ Grover S, Srivastava A, Lee R, Tewari AK, Te AE (February 2011). “Role of inflammation in bladder function and interstitial cystitis”. Ther Adv Urol. 3 (1): 19–33. doi:10.1177/1756287211398255. PMC 3126088. PMID 21789096.
  6. ↑ Eken A, Alma E (2013). “Emphysematous cystitis: The role of CT imaging and appropriate treatment”. Can Urol Assoc J. 7 (11–12): E754–6. doi:10.5489/cuaj.472. PMC 3840514. PMID 24282470.
  7. ↑ Glicksman, Joseph M. (1967). “Gonococcal Skin Lesions”. Archives of Dermatology. 96 (1): 74. doi:10.1001/archderm.1967.01610010080015. ISSN 0003-987X.
  8. ↑ Siboulet, A. (1955). “Inclusion Bodies in Non-Gonococcal Urethritis, also Skin Lesions with Inclusions”. Sexually Transmitted Infections. 31 (4): 235–237. doi:10.1136/sti.31.4.235. ISSN 1368-4973.
  9. ↑ Tsai, Chia-Chun; Li, Ching-Chia (2013). “Nonchlamydial nongonococcal urethritis in men”. Urological Science. 24 (3): 73–77. doi:10.1016/j.urols.2013.06.001. ISSN 1879-5226.
  10. ↑ Gil-Ruiz MA, Alcaraz AJ, Marañón RJ, Navarro N, Huidobro B, Luque A (March 2012). “Electrolyte disturbances in acute pyelonephritis”. Pediatr. Nephrol. 27 (3): 429–33. doi:10.1007/s00467-011-2020-9. PMID 21983846.
  11. ↑ Edell SL, Bonavita JA (September 1979). “The sonographic appearance of acute pyelonephritis”. Radiology. 132 (3): 683–5. doi:10.1148/132.3.683. PMID 472247.
  12. ↑ Esim Buyukbayrak E, Kars B, Karsidag AY, Karadeniz BI, Kaymaz O, Gencer S, Pirimoglu ZM, Unal O, Turan MC (November 2010). “Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis”. Arch. Gynecol. Obstet. 282 (5): 515–9. doi:10.1007/s00404-010-1498-x. PMID 20461391.
  13. ↑ Trojian TH, Lishnak TS, Heiman D (April 2009). “Epididymitis and orchitis: an overview”. Am Fam Physician. 79 (7): 583–7. PMID 19378875.
  14. ↑ Foo KT (August 2015). “Diagnosis and treatment of benign prostate hyperplasia in Asia”. Transl Androl Urol. 4 (4): 478–83. doi:10.3978/j.issn.2223-4683.2015.08.07. PMC 4708589. PMID 26816845.
  15. ↑ Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B; et al. (2016). “Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management”. Am J Obstet Gynecol. 215 (6): 704–711. doi:10.1016/j.ajog.2016.07.045. PMID 27472999.
  16. ↑ Kim, Kyung Won; Shinagare, Atul B.; Krajewski, Katherine M.; Howard, Stephanie A.; Jagannathan, Jyothi P.; Zukotynski, Katherine; Ramaiya, Nikhil H. (2013). “Update on Imaging of Vulvar Squamous Cell Carcinoma”. American Journal of Roentgenology. 201 (1): W147–W157. doi:10.2214/AJR.12.9594. ISSN 0361-803X.

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