Approach to dysuria

• Frequency, urgency, suprapubic pain (lower tract) versus fever, flank pain, vomiting (upper tract)
• Discharge or genital ulceration moves the diagnosis to urethritis and the sexual history earns its place
• Pregnancy status: asymptomatic bacteriuria matters there and almost nowhere else
• Catheter in place? Then dysuria rules change entirely; cloudy catheter urine alone is not infection
• Recurrence pattern: relapses versus reinfection, and anything suggesting obstruction or stones

• Temperature; flank tenderness at the renal angle
• Suprapubic tenderness and a bladder scan where retention is possible
• Genital examination where the story points there; prostate tenderness in men with fever

Two days of burning frequency without fever in a healthy young woman (points at simple cystitis, treated on the story alone) versus fever, rigors, vomiting and left flank pain with colic in a man with a known stone (points at obstructed infected kidney needing drainage).

• Simple cystitis in a healthy non-pregnant woman: treat the story; a dipstick adds little and a culture less
• Culture BEFORE antibiotics for men, pregnancy, pyelonephritis, recurrence, or catheters
• Blood cultures, CBC, creatinine, and lactate for the febrile flanks
• Ultrasound or CT for obstruction whenever colic and fever share a sentence, or recovery stalls at 48-72 hours

• The catheter dipstick is a trap: colonization is universal; treat the patient, not the bag
• Sterile pyuria has its own list: urethritis, TB, stones, interstitial nephritis, partially treated infection
• Failure to defervesce by 72 hours on right antibiotics means obstruction or abscess until imaged

• Short-course antibiotics for cystitis per local resistance; longer, source-directed therapy for pyelonephritis
• Urology tonight for the obstructed infected kidney: nephrostomy or stent, antibiotics alone will not do
• Recurrent infection earns a cause hunt, not a rolling prescription