Pain on urination, called dysuria, is frequently described as ''burning.'' Dysuria is evidence of inflammation of the lower urinary tract. The patient may describe discomfort in the penis or in the suprapubic area. Dysuria also implies difficulty in urination. This may result from external meatal stenosis or from a urethral stricture. Painful urination is usually associated with urinary frequency and urgency. When the patient describes pain or difficulty in urination, ask the following questions:

How long have you noticed a burning sensation on urination?''

How often do you urinate each day?''

How does your urination feel different?''

Is your urine clear?''

Does the urine smell bad?''

Do you have a discharge from your penis?''

Does the urine seem to have gas bubbles in it?''

Have you noticed any solid particles in your urine?''

Have you noticed pus in your urine?''

Pneumaturia is the passage of air in the urine, producing what the patient describes as ''bubbles of gas'' in the urine. The air or gas is usually emitted at the end of urination. Normally, there is no gas in the urinary tract. The symptom of pneumaturia indicates the introduction of air by instrumentation, a fistula to the bowel, or a urinary tract infection by gas-forming bacteria, such as Escherichia coli or clostridia.

Fecaluria is the presence of fecal material in the urine and is rare. The passage of feculent-smelling material results from either an intestinovesicular fistula or a urethrorectal fistula.

These fistulas occur as a consequence of ulceration from the bowel to the urinary tract. Diverticulitis, carcinoma, and Crohn's disease are frequent causes.

Pus in the urine, or pyuria, is the body's response to inflammation of the urinary tract. Bacteria are the most common cause of inflammation resulting in pyuria, although pyuria is also seen in patients with neoplasms and kidney stones. Cystitis and prostatitis are common causes of pyuria.

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