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URINARY SYMPTOMSRecognise patient with urinary symptoms needing urgent attention:• Unable to pass urine with lower abdominal discomfortManagement:• Insert urethral catheter.• Refer same day.Approach to patient with urinary symptoms not needing urgent attentionBlood in urineHas patient been in bilharzia area 1 ?Yes• Give single dosepraziquantel40mg/kg.• To prevent reinfectionadvisepatient to boilwater beforeuse and avoidswimming incontaminatedwater.NoDoes patient haveburning urine?NoLeucocytesand nitriteson urinedipstick?NoRefer forinvestigationof causeof blood inurine.YesWoman• If patient has a vaginal discharge 23.• If no vaginal discharge, is patientpregnant, catheterised, known withdiabetes or urinary tract problem?NoPatient has a simpleurinary tract infection.• Give ciprofloxacin500mg 12 hourly for3 days.• Encourage patient todrink plenty of fluidsand to empty bladderafter sex.YesBurning urinePatient has acomplicated urinarytract infection.• Give ciprofloxacin 500mg12 hourly for 7 days orif pregnant, amoxicillin/clavulanic acid 2 875/125mg12 hourly for 7 days.• Encourage patient to drinkplenty of fluids.• Educate female patient toempty bladder after sex.ManLook for dischargeNo dischargeAre there leucocytesand nitrites onmidstream urine?YesDo a urine microscopy, culture and sensitivity if symptoms donot resolve or patient has recurrent urinary tract infections.NoPatienthasdischargePatient has an STI 23.Leakageof urine• Check dipstick toexclude urinarytract infection.• Doctor toreview use offurosemide.• Look for vaginalatrophy 98.• Ask aboutconstipation22.• Advise patient tocut down alcoholand caffeineand to do Kegalexercises.• Refer tophysiotherapist ifavailable.• Refer if patienthas vaginalprolapse or noresponse toabove measures.Flow ProblemPoor stream ordifficulty passingurine• Doctor toreview use ofamitriptyline.• Refer forassessment,same weekif patient hasweight lossor hard andnodular prostateon rectalexamination.1Bilharzia areas include Limpopo, North West, Mpumalanga, KwaZulu-natal and isolated areas in Eastern Cape (Transkei) 2 If penicillin allergic, give erythromycin 500mg 6 hourly for 7 days.31