Painful Hematuria with Dysuria

CLINICAL DIAGNOSTIC MANUAL

Painful hematuria with dysuria is a clinical condition characterized by the presence of blood in the urine accompanied by pain and difficulty in urination. This combination of symptoms typically indicates involvement of the urinary tract, which may range from infections to mechanical injuries or the presence of stones. An appropriate evaluation is crucial to determine the underlying cause and apply the correct treatment.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Painful Hematuria	Blood in urine, pain during urination	Detailed clinical history, physical examination, urinalysis	Urine culture, renal and bladder ultrasound, cystoscopy
Dysuria	Painful or difficult urination, urinary urgency	Detailed clinical history, physical examination, urinalysis	Urine culture, renal and bladder ultrasound, cystoscopy
Urinary Tract Infection with Cystitis	Burning pain during urination, hematuria, urinary urgency and frequency, suprapubic pain	History of urinary symptoms and dysuria, urinalysis showing bacteria and leukocytes	Positive urine culture, bladder ultrasound
Kidney Stones	Severe flank and back pain, hematuria, nausea and vomiting, urinary urgency	History of renal colic, physical exam revealing costovertebral angle tenderness, urinalysis showing crystals	Abdominal and pelvic CT scan, renal ultrasound
Trauma (Urinary Catheter or Traumatic Sexual Activity)	Pain and bleeding during urination, hematuria, pelvic pain	History of recent catheter use or traumatic sexual activity, physical exam revealing genital trauma signs	Renal and bladder ultrasound, cystoscopy
Pyelonephritis	Lumbar pain, fever, chills, hematuria, urinary infection symptoms	History of recent urinary infection, physical exam revealing costovertebral angle tenderness, urinalysis showing leukocytes, nitrites, and bacteria	Positive urine culture, renal ultrasound, blood tests showing leukocytosis
Glomerulonephritis	Hematuria, edema, hypertension, proteinuria	History of prior infections (e.g., streptococcal pharyngitis), urinalysis showing hematuria and proteinuria	Renal biopsy, blood tests showing altered renal function and elevated specific antibodies (e.g., anti-streptolysin O)
Urinary Tract Tumors	Hematuria, pelvic pain, weight loss, obstructive urinary symptoms	History of persistent urinary symptoms and hematuria, physical exam revealing a palpable mass in advanced cases	Cystoscopy, abdominal and pelvic CT scan or MRI, biopsy of the lesion
Benign Prostatic Hyperplasia (BPH)	Dysuria, urinary urgency and frequency, weak urinary stream, hematuria in some cases	History of obstructive urinary symptoms, physical exam including digital rectal exam revealing prostate enlargement	Urinary flow studies, transrectal ultrasound, prostate-specific antigen (PSA) test