A 28 year young female Katrina present to your OPD with complaints of suprapubic pain, urinary frequency and dysuria. She also passed blood in last voided urine about 30 minutes ago. Her urinanalysis demonstrate the presence of pyuria but no white cell casts. On physical examination, she has suprapubic tenderness on palpation. Which of the following is the likely diagnosis in this patient?

**Core Concept**
The patient's symptoms of suprapubic pain, urinary frequency, dysuria, and hematuria, along with pyuria but no white cell casts, are suggestive of a urinary tract infection (UTI) involving the lower urinary tract. This condition is often caused by bacterial infection of the bladder (cystitis) or the urethra.

**Why the Correct Answer is Right**
The presence of pyuria (pus in the urine) indicates an inflammatory response, which is typically seen in bacterial infections. The absence of white cell casts suggests that the infection is limited to the lower urinary tract (bladder or urethra) and has not extended to the kidneys. The patient's symptoms and urinalysis results are consistent with cystitis, which is an infection of the bladder.

**Why Each Wrong Option is Incorrect**
**Option A:** Pyelonephritis is a more severe infection of the upper urinary tract (kidneys), typically characterized by flank pain, fever, and white cell casts in the urine. This patient's symptoms and urinalysis do not support this diagnosis.
**Option B:** Urethritis refers to an infection of the urethra, which can cause dysuria and pyuria, but it is less likely to cause suprapubic pain and hematuria. This patient's symptoms are more consistent with cystitis.
**Option C:** Prostatitis is an infection of the prostate gland, typically seen in men, and is characterized by symptoms such as pelvic pain, urinary obstruction, and a palpable prostate gland. This patient is a young female, making prostatitis an unlikely diagnosis.

**Clinical Pearl / High-Yield Fact**
Cystitis is often caused by E. coli, a common urinary tract pathogen. Patients with cystitis may also experience frequency, urgency, and nocturia due to bladder irritation.

**Correct Answer:** B. Cystitis

✓ Correct Answer: C. Cystitis