Painful urination or “dysuria” has not been considered a prominent part of the Painful Bladder Syndrome/IC syndrome complex, and is more often associated with urinary tract infection or recent urethral instrumentation.
Warren and colleagues at the University of Maryland are conducting an ongoing case-control study to identify risk factors for the disease. As a part of this study, subjects with recent onset disease were asked to recall antecedent events. They report that a small majority of patients indicate that pain or burning on urination began at the onset of PBS/IC.
54% of 138 recent-onset PBS/IC patients indicated that at their onset date they had started to experience symptoms of dysuria. Of note, the characteristic symptoms of pelvic pain and urgency were similar in groups with and without dysuria as a presenting complaint. Frequency was a presenting symptom in 93% of dysuria patients compared with 81% of those with no dysuria on presentation.
A further study may explain the dysuria in many of the patients. While only a minority of patients had urine sample cultured, 34% of those with dysuria had a positive culture as compared with 5% of those without dysuria. All but one pathogen grew out at greater than 10,000 colonies per milliliter. 43% of dysuria patients had pyuria compared with only 8% of those without dysuria. The authors conclude based on this and other data that at the onset of PBS/IC, significantly more of those with dysuria had evidence of urinary tract infection that those without pain during urination.
Warren comments on 3 other epidemiologic studies that addressed the question of dysuria as a presenting complaint, and concludes that all studies, using different methodology in different patient populations, reported 46% – 60% of patients at the onset of disease had dysuria or patient reported “UTI”.
I suppose the message here is not to discount the possibility of PBS/IC in the patient presenting with dysuria in the absence of a positive urine culture.