Mr. Jones presents to the primary care office with complaints of sudden urgency to urinate, back pain, and frequent urination. The patient had a UA performed in the office that is positive for a urinary tract infection. Further assessment of the patient should include ruling out obstruction to the normal flow, does the patient have trouble starting a stream upon urination? Any fevers or chills? Any other past medical history? History of frequent UTI’s? Sexual history? Any pelvic pain? Penile discharge?
Differential Diagnosis
Urinary Tract Infection
Prostatitis
- Pyelonephritis
- The patient should have a physical exam with a focused genitourinary assessment. Including the patient’s general appearance and vital signs. Palpation and percussion of the abdomen provides information regarding the kidneys, ureter, or possible bladder inflammation (Michaels, 2020). In a male with suspected prostatitis a gentle digital rectal exam is advised to exam the prostate gland. Enlargement of the prostate can cause obstruction leading to dysuria in males (Rowe & Juthani-Mehta, 2019).
- The patient presenting with dysuria, frequency and back pain has already completed a urine dipstick, the urine should also be sent to the lab for culture due to suspected urinary tract infection. A plain film x-ray of the kidneys, ureters, and bladder will rule out possible pyelonephritis. In the primary care setting this patient does not seem to have an indication for additional laboratory studies, if the patient is febrile and showing signs of sepsis additional testing should be ordered.
This patient is showing to have an uncomplicated urinary tract infection. This patient should be started on Macrobid 100 mg 1 tablet twice daily for 5 days (Aliaga, 2019). Educating the patient that hydration is important in order to clear the bacteremia from the urinary tract. The patient can also take phenazopyridine as needed for dysuria this may provide symptomatic relief. The patient would not require a follow up UA unless symptoms are not resolving or further complications arise.
Reference
Aliaga, L. (2019). Treatment of acute uncomplicated cystitis. a clinical review. International Journal of Family & Community Medicine, 1(2). https://doi.org/10.15406/ijfcm.2017.01.00009
Micheals, T. (2020). Dysuria: Evaluation and Differential Diagnosis in Adults. American Family Physician , 92(9), 778-788.
Rowe, T. A., & Juthani-Mehta, M. (2019). Urinary tract infection in older adults. Aging health, 9(5), 10.2217/ahe.13.38. https://doi.org/10.2217/ahe.13.38
