EpistemisStranguria
Specialty: Nephrology and urology.
Why it occurs
- Acute sexually transmitted urethritis (infection by Neisseria gonorrhoeae or Chlamydia trachomatis with intense mucosal inflammation)
- Impacted urethral lithiasis (stone that mechanically obstructs the urethral lumen causing spasm of the sphincter)
- Acute bacterial prostatitis (bacterial infection of the prostatic parenchyma that compresses the prostatic urethra)
- Hemorrhagic cystitis (caused by radiotherapy or drugs such as cyclophosphamide)
- Minor urethral trauma (due to previous instrumentation or traumatic catheterization)
Initial workup
Urinary sediment and culture; urethral smear or first fraction of urine for nucleic acid amplification (PCR) for STDs (Chlamydia, Gonococcus, Mycoplasma); transrectal or suprapubic ultrasound to rule out prostatic abscess or stone impaction; urethrosonography in selected cases.
red flags
Stranguria associated with the absolute inability to pass urine despite the urgent desire (urinary retention), high fever with shivering (suspected bacteremia or acute prostatitis), or fresh blood leaking from the urethral meatus independent of urination.
Standard management
- Ibuprofen — 400-600 mg every 8 hours orally with food to reduce the inflammatory response and relax urethral spasm
- Ceftriaxone — 500 mg single intramuscular dose to cover Gonococcus) associated with Azithromycin (1 g orally single dose to treat Chlamydia
- Tamsulosin (0.4 mg orally at night to reduce bladder neck resistance and facilitate urination).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Nephrology and urology
- Listed causes
- 5
- Treatment options
- 3