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Dysuria in Children

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181. Late Effects of Treatment for Childhood Cancer

Late Effects of Treatment for Childhood Cancer Late Effects of Treatment for Childhood Cancer (PDQ®)—Health Professional Version - National Cancer Institute Menu Search Search Search General Information About Late Effects of Treatment for Childhood Cancer During the past five decades, dramatic progress has been made in the development of curative therapy for pediatric malignancies. Long-term survival into adulthood is the expectation for more than 80% of children with access to contemporary (...) , the Children’s Oncology Group (COG), and the Institute of Medicine. A risk-based medical follow-up is recommended, which includes a systematic plan for lifelong screening, surveillance, and prevention that incorporates risk estimates based on the following:[ ] Previous cancer. Cancer therapy. Genetic predisposition. Lifestyle behaviors. Comorbid conditions. Sex. Part of long-term follow-up is also focused on appropriate screening of educational and vocational progress. Specific treatments for childhood

2012 PDQ - NCI's Comprehensive Cancer Database

182. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

use RCTs 76 Figure 22. RR Number of Children With Adverse Events 82 Figure 23. RR Number of Adults With Adverse Events 83 Figure 24. RR Number of Elderly Participants With Adverse Events 85 Figure 25. RR Number of Critically Ill or High-Risk Participants With Adverse Events 88 Figure 26. Number of Participants With Serious Adverse Events 94 Appendixes Appendix A. Exact Search Strings and List of Manufacturers Appendix B. Sample Data Abstraction Forms Appendix C. Evidence Tables Appendix D (...) no evidence that a particular mechanism or route of administration of probiotic organisms was associated with an increased risk of an adverse event in intervention participants relative to control group participants. Stratified analyses and meta-regressions showed no increased risk of adverse events for children (RR 0.96; 95% CI: 0.88, 1.04; p=0.296, 35 RCTs), adults (RR 0.97; 95% CI: 0.79, 1.19; p=0.745, 40 RCTs), or elderly (RR 0.94; 95% CI: 0.82, 1.08; p=0.367, 4 RCTs) participants compared

2011 EvidenceUpdates

183. Overactive Bladder: Etiology, Diagnosis, and Impact (Overview)

and Drug Administration (FDA) to expand the number and types of patients eligible for clinical trials. As noted, OAB may include not only urgency urinary incontinence but also urgency, frequency, dysuria, and nocturia. Other terms used include detrusor overactivity, detrusor instability, detrusor hyperreflexia, and involuntary bladder contractions. A preliminary diagnosis of OAB can be made on the basis of the history and physical examination (see ), in conjunction with a few simple office (...) modulators. [ ] These prospective therapies are currently at different stages of clinical development. Among other investigational therapies, neurokinin receptor antagonists, alpha-adrenoceptor antagonists, nerve growth factor inhibitors, gene therapy, and stem cell–based therapies are of considerable interest. The future development of new modalities in OAB treatment appears promising. OAB affects children as well as adults. For more information, see and . Previous Next: Anatomy A normal bladder

2014 eMedicine.com

184. Nephrolithiasis (Overview)

in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate to flank or lumbar areas (...) surgery and in all children. [ ] Calcium stones Calcium stones account for 75% of renal calculi. Recent data suggest that a low-protein, low-salt diet may be preferable to a low-calcium diet in hypercalciuric stone formers for preventing stone recurrences. [ ] Epidemiological studies have shown that the incidence of stone disease is inversely related to the magnitude of dietary calcium intake in first-time stone formers. There is a trend in the urology community not to restrict dietary intake

2014 eMedicine.com

185. Nephrolithiasis: Acute Renal Colic (Overview)

and characteristics of pain in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate (...) kidney or stone surgery and in all children. [ ] Calcium stones Calcium stones account for 75% of renal calculi. Recent data suggest that a low-protein, low-salt diet may be preferable to a low-calcium diet in hypercalciuric stone formers for preventing stone recurrences. [ ] Epidemiological studies have shown that the incidence of stone disease is inversely related to the magnitude of dietary calcium intake in first-time stone formers. There is a trend in the urology community not to restrict

2014 eMedicine.com

186. Nonneoplastic Epithelial Disorders of the Vulva (Overview)

of 180 kd now thought to be collagen XVII), located in the basement membrane of the skin. [ ] Mucosal lesions of the vulva occur less frequently and are less severe than other blistering disorders. [ ] A juvenile localized subtype of immunoglobulin G (IgG)–mediated bullous pemphigoid occurring in children in the first year of life and characterized by a self-limited nonscarring bullous pemphigoid–like process involving only the vulva has been described. [ ] Cicatricial pemphigoid Cicatricial (...) , and irritation occur and may be responsible for dyspareunia and dysuria. [ ] The rare hypertrophic form, clinically resembling lichen sclerosus, manifests with extensive white scarring of the periclitoral area with variable degrees of hyperkeratosis. [ ] It may be very itchy. Extensive vaginal involvement may result in a malodorous discharge. Large denuded areas may become adherent, causing stenosis of the vaginal introitus and dyspareunia. Marked atrophy may develop with time. Malignancy is possible in long

2014 eMedicine.com

187. Normal and Abnormal Puerperium (Overview)

), the American College of Obstetricians and Gynecologists (ACOG), and the United States Preventive Services Task Force recommend exclusive breastfeeding for the first six months of life. In 1991 The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched a global program called The Baby-Friendly Hospital Initiation (BFHI) that aims to increase the numbers of infants who are exclusively breastfed worldwide. The BFHI program developed “Ten Steps to Successful Breastfeeding (...) ) are options for those who are certain they do not desire more children. The CDC has published “The United Stated Medical Eligibility Criteria for Contraceptive Use (US MEC)” which are evidence-based guidelines that assist health care providers in recommending a safe of contraceptive method for an individual based on medical comorbidities [ ] Recommendations are provided using a 4-point categorical grading system which takes into account an individual’s risks of using certain contraceptive agents depending

2014 eMedicine.com

188. Epididymitis (Overview)

demonstrates increased blood flow in the epididymis resulting from the active inflammation. Signs and symptoms The following history findings are associated with acute epididymitis and orchitis: Gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days (as opposed to hours for testicular torsion) Dysuria, frequency, or urgency Fever and chills (in only 25% of adults with acute epididymitis but in up to 71% of children with the condition) Usually, no nausea (...) prostatitis or seminal vesiculitis (in postpubertal individuals) With tuberculosis, focal epididymitis, a draining sinus, or beading of the vas deferens In children, an underlying congenital anomaly of the urogenital tract Findings associated with orchitis may include the following: Testicular enlargement, induration, and a reactive hydrocele (common) Nontender epididymis In 20-40% of cases, association with acute epididymitis See for more detail. Diagnosis The following laboratory studies may

2014 eMedicine.com

189. Epididymal Tuberculosis (Overview)

appearance) with . Severe cases involve the entire bladder wall, where deep layers of muscle are eventually replaced by fibrous tissue, thus producing a thick fibrous bladder. Tubercles are rare in the bladder; if present, they usually appear at the ureteral orifice. Malignancy should be considered with any isolated tubercles away from the ureteral orifices. Epididymal and testicular TB The higher frequency of isolated epididymal TB lesions in children favors the possibility of hematologic spread (...) increased frequency of urination (during the day initially but at night later in the disease course), dysuria, frank pain, suprapubic pain, blood or pus in the urine, and fever. Urinary urgency is relatively uncommon unless the bladder is extensively involved. Patients with GUTB may also present with a painful testicular swelling, perianal sinus, or genital ulcer. Unexplained infertility in both men and women is sometimes attributable to GUTB. [ ] Physicians have also diagnosed endometrial TB while

2014 eMedicine.com

190. Augmentation Cystoplasty (Follow-up)

Updated: Nov 23, 2016 Author: Pravin K Rao, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS Share Email Print Feedback Close Sections Sections Augmentation Cystoplasty Overview Background Bladder augmentation, also called augmentation cystoplasty, is a surgical procedure used in adults and children who lack adequate bladder capacity or detrusor compliance. [ , , ] For many patients, augmentation cystoplasty can provide a safe, functional reservoir that allows for urinary continence and prevention (...) for an embryologic urinary defect as a child seek a healthier cosmetic and functional state. In other cases, adults have an acquired condition that is causing bladder dysfunction. Adults may present with symptoms very similar to those of children with congenital abnormalities. Again, surgery is indicated for adults with refractory symptoms and those with risk or progression of upper tract deterioration. Previous Next: Contraindications Patients who are unable or unwilling to perform life-long intermittent

2014 eMedicine.com

191. Benign Lesions of the Ovaries (Follow-up)

identification of purulent material from the fimbriated ends of the fallopian tubes (salpingitis) noted during diagnostic laparoscopy. The commonly reported symptoms of TOAs are dyspareunia and rectal discomfort, partial intestinal obstruction, dysuria, urinary frequency, and sterility. Occasionally, fever with the symptoms of pelvic peritonitis develops. Pelvic examination findings are characteristic. The uterus is retroverted, and cervical motion produces pain. Lateral to the uterus, enlarged masses (...) . The updated French guidelines indicate that transvaginal pelvic ultrasonography is the first-line modality for evaluating presumed benign ovarian tumors in adult women. [ ] Transvaginal ultrasonography is limited with regard to its role in assessing masses in neonates, children, and virginal adolescents. Color-coded Doppler ultrasonography improves the diagnostic accuracy of B-mode ultrasonography. Ultrasonography is easy, rapid, and able to provide critical information for the evaluation of an adnexal

2014 eMedicine.com

192. Benign Vulvar Lesions (Follow-up)

of 180 kd now thought to be collagen XVII), located in the basement membrane of the skin. [ ] Mucosal lesions of the vulva occur less frequently and are less severe than other blistering disorders. [ ] A juvenile localized subtype of immunoglobulin G (IgG)–mediated bullous pemphigoid occurring in children in the first year of life and characterized by a self-limited nonscarring bullous pemphigoid–like process involving only the vulva has been described. [ ] Cicatricial pemphigoid Cicatricial (...) , and irritation occur and may be responsible for dyspareunia and dysuria. [ ] The rare hypertrophic form, clinically resembling lichen sclerosus, manifests with extensive white scarring of the periclitoral area with variable degrees of hyperkeratosis. [ ] It may be very itchy. Extensive vaginal involvement may result in a malodorous discharge. Large denuded areas may become adherent, causing stenosis of the vaginal introitus and dyspareunia. Marked atrophy may develop with time. Malignancy is possible in long

2014 eMedicine.com

193. Tuberculosis (Diagnosis)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin

2014 eMedicine.com

194. Tuberculosis (Diagnosis)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin

2014 eMedicine.com

195. Tuberculosis of the Genitourinary System (Diagnosis)

, golf-hole appearance) with . Severe cases involve the entire bladder wall, where deep layers of muscle are eventually replaced by fibrous tissue, thus producing a thick fibrous bladder. Tubercles are rare in the bladder; if present, they usually appear at the ureteral orifice. Malignancy should be considered with any isolated tubercles away from the ureteral orifices. Epididymal and testicular TB The higher frequency of isolated epididymal TB lesions in children favors the possibility (...) order of frequency, include increased frequency of urination (during the day initially but at night later in the disease course), dysuria, frank pain, suprapubic pain, blood or pus in the urine, and fever. Urinary urgency is relatively uncommon unless the bladder is extensively involved. Patients with GUTB may also present with a painful testicular swelling, perianal sinus, or genital ulcer. Unexplained infertility in both men and women is sometimes attributable to GUTB. [ ] Physicians have also

2014 eMedicine.com

196. Urinary Tract Obstruction (Diagnosis)

obstruction is usually indolent and may be asymptomatic. When infection is present, the patient may experience fever, chills, and dysuria. Hematuria may also be present. When bilateral obstruction or unilateral obstruction in a solitary kidney is severe and renal failure has occurred, uremia can be present. Uremia symptoms include weakness, peripheral edema, mental status changes, and pallor. If hydronephrosis is severe, the kidney may be palpable on physical examination, especially in children. In cases (...) malignancies. In men, hydronephrosis is most likely after age 60 years secondary to prostatic obstruction. Hydronephrosis is found in 2-2.5% of children. Previous Next: Etiology Obstruction of urinary flow can occur anywhere from the kidneys to the urethral meatus. Dividing the urinary tract into the upper urinary tract, defined as the kidney and ureter to the hiatus with the bladder, and the lower urinary tract, defined as the bladder and urethra to the urethral meatus, allows for further delineation

2014 eMedicine.com

197. Urinary Tract Infections in Pregnancy (Diagnosis)

; it is characterized by inflammation of the bladder as a result of bacterial or nonbacterial causes (eg, radiation or viral infection). Acute cystitis develops in approximately 1% of pregnant patients, of whom 60% have a negative result on initial screening. Signs and symptoms include hematuria, dysuria, suprapubic discomfort, frequency, urgency, and nocturia. These symptoms are often difficult to distinguish from those due to pregnancy itself. Acute cystitis is complicated by upper urinary tract disease (ie (...) , pyelonephritis) in 15-50% of cases. Acute pyelonephritis Pyelonephritis is the most common urinary tract complication in pregnant women, occurring in approximately 2% of all pregnancies. Acute pyelonephritis is characterized by fever, flank pain, and tenderness in addition to significant bacteriuria. Other symptoms may include nausea, vomiting, frequency, urgency, and dysuria. Furthermore, women with additional risk factors (eg, immunosuppression, diabetes, , , recurrent or persistent UTIs before pregnancy

2014 eMedicine.com

198. Urinary Tract Infection, Females (Diagnosis)

infection) represents the majority of these infections (see the image below). Related terms include pyelonephritis, which refers to upper urinary tract infection; bacteriuria, which describes bacteria in the urine; and candiduria, which describes yeast in the urine. Plain radiograph in a 63-year-old patient with poorly controlled type 2 diabetes mellitus shows emphysematous cystitis. Signs and symptoms Symptoms and signs of UTI in the adult are as follows: Dysuria Urinary urgency and frequency (...) of estrogen with attendant changes in vaginal flora (notably, loss of lactobacilli), which allows periurethral colonization with gram-negative aerobes, such as E coli; and higher likelihood of concomitant medical illness, such as diabetes. Of neonates, boys are slightly more likely than girls to present with UTI as part of a gram-negative sepsis syndrome. The incidence in preschool-aged children is approximately 2% and is 10 times more common in girls. UTI occurs in 5% of school-aged girls, but it is rare

2014 eMedicine.com

199. Urethritis (Diagnosis)

with urethritis, including approximately 25% of those with NGU, are asymptomatic and present to a clinician following partner screening. [ ] Up to 75% of women with Chlamydia trachomatis infection are asymptomatic. Signs and symptoms in patients with urethritis may include the following: Urethral discharge: May be yellow, green, brown, or tinged with blood; production unrelated to sexual activity Dysuria (in men): Usually localized to the meatus or distal penis, worst during the first morning void, and made (...) is highest in the summer months. International Worldwide, approximately 62 million new cases of gonococcal urethritis and 89 million new cases of NGU are reported each year. Previous Next: Mortality/Morbidity Approximately 10%-40% of women with urethritis eventually develop (PID), which may subsequently cause and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. Children born to mothers with Chlamydia infection

2014 eMedicine.com

200. Urethral Syndrome (Diagnosis)

Updated: Jun 23, 2017 Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Urethral Syndrome Overview Practice Essentials Urethral syndrome is characterized by urinary frequency, dysuria, and suprapubic discomfort without any objective finding of urological abnormalities. It is also characterized by sterile urine culture results and urinary frequency that is typically worse during the day than during the night. The dysuria (...) syndrome is to relieve the discomfort and urinary frequency. This often involves a trial-and-error approach that uses behavioral, dietary, and medical therapy. See and . Next: Background Urethral syndrome was originally described as urinary frequency and dysuria without demonstrable infection. As a diagnosis, urethral syndrome (also known as frequency-dysuria syndrome) is controversial, and the term (coined by Powell and Powell in 1949) may be outdated, partially because of the lack of consensus

2014 eMedicine.com

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