Genitourinary Complaints#

Approach to common genitourinary complaints in primary care. GU presentations range from straightforward UTIs to complex chronic pelvic pain—the key is identifying who needs urgent evaluation, appropriate workup, and when to refer.

Key Principles#

  • UTI vs STI: Dysuria workup differs by age, sex, and risk factors; don’t miss chlamydia in young patients
  • Hematuria always needs workup: Even one episode of gross hematuria or persistent microscopic hematuria requires evaluation
  • Red flags: Testicular torsion (acute scrotal pain <6 hours), pyelonephritis (fever + flank pain), urinary retention
  • Medication review: Anticholinergics (retention), alpha-blockers (incontinence), diuretics (frequency)
  • Sexual history: Essential for dysuria, discharge, and pelvic pain—ask routinely and non-judgmentally

Topics#

Lower Urinary Tract#

  • Dysuria — UTI vs STI vs vaginitis; when to culture vs empiric treatment
  • Urinary Frequency/Urgency — OAB vs UTI vs BPH vs diabetes; behavioral vs pharmacologic management
  • Hematuria — microscopic vs gross; malignancy workup; when to refer urology

Flank and Kidney#

  • Flank Pain — nephrolithiasis vs pyelonephritis vs MSK; imaging choices; stone management

Male GU#

  • Scrotal Pain — torsion (emergency) vs epididymitis vs hernia; when ultrasound is urgent
  • Erectile Dysfunction — vascular vs psychogenic vs medication-induced; PDE5 inhibitor prescribing

Female GU/Gynecologic#

When to Refer#

Urology (Routine)#

  • Microscopic hematuria with negative initial workup (cystoscopy needed)
  • Recurrent UTIs (>3/year) for anatomic evaluation
  • BPH failing medical management or with retention
  • Erectile dysfunction not responding to PDE5 inhibitors
  • Chronic prostatitis/pelvic pain syndrome
  • Kidney stones >10mm or not passing

Urology (Urgent)#

  • Gross hematuria with clots (may need bladder irrigation)
  • Suspected bladder or renal mass on imaging
  • Urinary retention not relieved by catheterization
  • Fournier’s gangrene (ED first, then urology)

Urology (Emergent—ED)#

  • Testicular torsion (acute scrotal pain, high-riding testis)
  • Priapism >4 hours
  • Obstructing stone with infection (pyonephrosis)

Gynecology#

  • Pelvic pain with suspected endometriosis or adenomyosis
  • Recurrent vaginal infections not responding to treatment
  • Abnormal uterine bleeding requiring further evaluation
  • Chronic pelvic pain failing conservative management
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