Background
- New onset dysuria is one of the best indicators of a UTI
- In older patients, urinary studies should only be performed if a patient's urinary symptoms worsen acutely and there is no other identifiable cause
- Non-specific symptoms should not be the only reason for obtaining urinary studies
| If fever >37.9°C and 1 or more of the following, order a urine culture: - Dysuria - Urgency - Flank pain - Rigors - Urinary incontinence - Frequency - Frank haematuria - Suprapubic pain |
or, if no fever, request M,C&S if there is new onset burning on urination, or 2 or more of the following: - urgency - Flank pain - Rigors - Urinary incontinence - Frequency, suprapubic pain - Frank haematuria |
Or If fever >37.9°C but 2 or more symptoms of non-UTI infection, do not order a urine. |
Causes of smelly urine
- Asparagus, garlic, onions, coffee
- Dehydration
- Vitamin B6 supplements
- Incontinence
- UTI
Urinary incontinence is NEVER normal
Causes incontinence
D - Delirium
I - Infection
A - Atrophic Vaginitis / Urethritis
P - Pharmaceuticals
P - Psychological (rare)
E - Excessive Urine Output
R - Restricted Mobility
S - Stool Impaction
Incontinence drugs
- Diuretics
- Anticholinergics
- Psychotropics:
- Antidepressants
- Antipsychotics
- Sedative hypnotics
- Narcotic analgesics
- Ca++ channel blockers
- Alcohol
Investigations
| Patient Hx | Symptoms | Signs | Urine dip |
|---|---|---|---|
Clear and unambiguous |
New onset of frequency, dysuria | Abdo. pain, Haematuria, Smelly urine, Fever | Negative – seek other cause. Do not send MSU |
Clear & unambiguous |
New onset of frequency, dysuria | Abdo. pain, Haematuria, Smelly urine, Fever | Positive for leucocytes and nitrites – likely UTI, send MSU and treat |
Clear & unambiguous |
No urinary symptoms | Do not dip urine, do not send MSU | |
Lacking - communication |
↑confusion, apathy, irritability, (delirium), ↓mobility, off food | Abdo. pain, Haematuria, Offensive smelling urine, Fever | Negative – seek other cause. Do not send MSU |
Lacking - communication |
↑confusion, apathy, irritability, (delirium), ↓mobility, off food | Abdo. pain, Haematuria, Offensive smelling urine, Fever | Positive for leucocytes & nitrites – likely UTI - send MSU and treat |
Lacking - communication |
↑confusion, apathy, irritability, (delirium), ↓mobility, off food | Abdo. pain, Haematuria, Offensive smelling urine, Fever | Leucocyte positive only – seek alternative diagnosis Nitrite positive only – send MSU and start treatment |