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Dysuria in Children

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321. Pyelonephritis, Acute (Overview)

but may not occur at the same time. If the patient is male, elderly, or a child or has had symptoms for more than 7 days, the infection should be considered complicated until proven otherwise. The classic manifestations of acute pyelonephritis observed in adults are often absent in children, particularly neonates and infants. In children aged 2 years or younger, the most common signs and symptoms of urinary tract infection (UTI) are as follows: Failure to thrive Feeding difficulty Fever Vomiting (...) scarring In children, renal scarring can be detected in 6-15% after a febrile UTI. Of these patients, almost all males and some females have demonstrable renal scarring and a globally small kidney with smooth renal outlines in infancy, usually associated with vesicoureteral reflux (VUR) and thought to be congenital. Most female infants do not have demonstrable scarring on initial imaging, but they subsequently develop it. Delay in treatment of cystitis or pyelonephritis, recurrent UTIs, urinary


322. Nonneoplastic Epithelial Disorders of the Vulva (Overview)

, diaphragms Fixed drug eruption A fixed drug eruption is a cell-mediated allergic drug reaction typically recurring in the same site upon reexposure. Common causative agents include oral drugs such as nonsteroidal anti-inflammatory agents, acetaminophen, sulfonamides, tetracycline, and barbiturates. Fluconazole as a possible causative agent has also been recently reported. [ ] Atopic dermatitis Atopic dermatitis usually occurs in patients with a personal or family history of asthma, hay fever, childhood (...) 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


323. 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 (...) by the ovaries is highly variable and is greatly influenced by breastfeeding the infant. The woman who breastfeeds her infant has a longer period of amenorrhea and anovulation than the mother who chooses to use formula. The mother who does not breastfeed may ovulate as early as 27 days after delivery. Most women have a menstrual period by 12 weeks; the mean time to first menses is 7-9 weeks. In the breastfeeding woman, the resumption of menses is highly variable and depends on a number of factors, including


324. Incontinence, Urinary: Nonsurgical Therapies (Overview)

. In addition, trauma can result in secondary structural incontinence. Neurogenic lesions make up the next category of pediatric incontinence disorders. These include spinal dysraphism, tethered spinal cord, and spinal cord tumors. Nonstructural causes account for most cases of pediatric incontinence. [ ] Infection and inflammation may be the source. Dysfunctional voiding habits can develop even at a young age. Some children may become so preoccupied with activities that voiding is delayed until capacity (...) , which may result from voiding with the legs held too tightly together. The impeded flow of urine may fill the vagina. The vagina empties when the child stands. Nocturnal enuresis is the most common pediatric incontinence disorder. For discussion of this topic, see . Previous Next: Etiology Even in an individual patient, urinary incontinence may have multiple etiologies, with varying degrees of contribution to the overall disorder. Structural and functional disorders involving the bladder, urethra


325. Hypercalciuria (Overview)

al. Prevalence and spot urine risk factors for renal stones in children taking topiramate. J Pediatr Urol . 2013 Jan 31. . . Vachvanichsanong P, Malagon M, Moore ES. Recurrent abdominal and flank pain in children with idiopathic hypercalciuria. Acta Paediatr . 2001 Jun. 90(6):643-8. . Alon US, Berenbom A. Idiopathic hypercalciuria of childhood: 4- to 11-year outcome. Pediatr Nephrol . 2000 Sep. 14(10-11):1011-5. . Escribano J, Balaguer A, Martin R, Feliu A, Espax R. Childhood idiopathic (...) degree of hematuria and back or abdominal pain and is also sometimes associated with voiding symptoms. Microcrystallization of calcium with urinary anions has been suggested to lead to injury of the uroepithelium in children with hypercalciuria. Consequently, when taking the history of the illness, attempt to identify symptoms relating to the urinary tract, paying special attention to the following signs and symptoms: Dysuria Abdominal pain Irritability (infants) Urinary frequency Urinary urgency


326. Cystectomy, Radical (Overview)

accumulation of TP53 have been correlated with an increased grade, stage, and recurrence risk. The risk of progression to muscle-invasive disease is associated with tumor grade, stage (Ta vs T1), size, number of lesions (solitary vs multiple lesions), previous tumor recurrence, and presence of CIS. Previous Next: Presentation Gross or microscopic hematuria is the initial presenting sign in 80%-90% of patients. Approximately 20% of patients have irritative symptoms such as urinary urgency, dysuria (...) . 93(1):64-6. . deKernion JB, Trapasso JG. Urinary Diversion and Continent Reservoir. Adult and Pediatric Urology . 1996. 2:1465-97. Dreicer R. Chemotherapy for muscle-invasive bladder cancer in the perioperative setting: current standards. Urol Oncol . 2007 Jan-Feb. 25(1):72-5. . El-Gabry EA, Strup SE, Gomella LG. Superficial Bladder Cancer: Current Treatment Modalities and Future Directions: Part II. AUA Update Series . 2000. 20:154-9. El-Gabry EA, Strup SE, Gomella LG. Superficial Bladder Cancer


327. Cystitis, Nonbacterial (Overview)

> Nonbacterial and Noninfectious Cystitis Updated: Mar 09, 2018 Author: Lynda A Frassetto, MD; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Nonbacterial and Noninfectious Cystitis Overview Practice Essentials Nonbacterial is a catchall term that encompasses various medical disorders, including infectious and , as well as painful bladder syndrome/ (PBS/IC). PBS/IC describes a syndrome of pain and genitourinary symptoms (eg, frequency, urgency, pain, dysuria (...) the following forms of the disease: Chemical Autoimmune Hypersensitivity General symptoms of cystitis include urgency, frequency, dysuria, and, occasionally, hematuria, dyspareunia, abdominal cramps, and/or bladder pain and spasms. Establishing or excluding a specific diagnosis often requires repeated cultures and various urologic procedures, including cystoscopy with bladder biopsies, various bladder tests, and immune system function examinations. Some conditions, such as , , and urethral foreign bodies


328. Cystectomy, Partial (Overview)

, and dysuria is the second most common symptom. These symptoms rarely occur without hematuria (microscopic or gross). Flank pain due to ureteral obstruction, lower-extremity edema, and pelvic masses are other presenting symptoms. Symptoms of advanced disease, such as weight loss and abdominal or bone pain, are rare because patients usually seek medical attention before these develop. Previous Next: Indications Indications for partial cystectomy in malignancy Urothelial carcinoma (also called transitional (...) consecutive cases. Eur Urol . 2000 Jan. 37(1):85-9. . Dandekar NP, Dalal AV, Tongaonkar HB, Kamat MR. Adenocarcinoma of bladder. Eur J Surg Oncol . 1997 Apr. 23(2):157-60. . Herr HW. Urachal carcinoma: the case for extended partial cystectomy. J Urol . 1994 Feb. 151(2):365-6. . Hays DM, Raney RB, Wharam MD, Wiener E, Lobe TE, Andrassy RJ, et al. Children with vesical rhabdomyosarcoma (RMS) treated by partial cystectomy with neoadjuvant or adjuvant chemotherapy, with or without radiotherapy. A report from


329. Cutaneous Tuberculosis (Overview)

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


330. Condyloma Acuminatum (Treatment)

. In more than one half of children with anogenital warts, the lesions are a manifestation either of viral inoculation at birth or of incidental spread of cutaneous warts. Such cases often are caused by nongenital HPV types. The diagnosis of genital warts in a child requires that the clinician report suspected abuse to begin an evaluation process that may or may not confirm sexual abuse. [ , ] Neonates and infants with laryngeal papillomatosis Pregnant women with genital warts can transmit the virus (...) . Patients with perianal warts, those who are HIV positive, and those with a history of receptive anal intercourse are at increased risk for anal HGSIL. There is no direct evidence to suggest that this would progress to invasive anal cancer, as lesions of the cervix are capable of doing. Nonetheless, penile, vulvar, vaginal, anal carcinomas, and head and neck cancers have been linked to HPV infection. [ ] Children with anogenital warts Anogenital warts are rare in the general pediatric population


331. Cystectomy, Radical (Treatment)

. Advantages and Disadvantages of Intestinal Segments Used for Urinary Diversion Segment Advantages Disadvantages Stomach Can be used in patients with renal failure, hepatic failure, acidosis, and pelvic radiation; no mucus production Hypokalemic hypochloremic metabolic alkalosis, hematuria dysuria syndrome due to acid irritation of the urothelium, concern for increased secondary malignancy Jejunum N/A Hyperkalemic hypochloremic metabolic acidosis, hyponatremia, osteomalacia (Avoid if at all possible


332. Surgical Treatment of Vaginal Cancer (Overview)

botryoides (embryonal rhabdomyosarcoma) Rare 3y Local, blood, lymphatic Most common vaginal cancer among children, grapelike mass, strap cells Endodermal sinus tumor (yolk sac tumor) Very rare 10mo Local Aggressive, alpha-fetoprotein (AFP) as marker Leiomyosarcoma < 2% Wide range Local, blood, lymphatic Grade is most important prognostic factor, can be secondary to pelvic irradiation HPV and other infectious agents The identification of HPV deoxyribonucleic acid (DNA) in squamous cell cancer cells (...) report urinary symptoms, which are caused by an anterior lesion compressing or invading the bladder, the urethra, or both. This causes bladder pain, dysuria, urgency, and hematuria. About 15-30% of patients present with pelvic pain. Posterior lesions compress or invade the rectosigmoid, which causes tenesmus or constipation. Only 10% of patients report a vaginal mass or vaginal prolapse. In 2000, Eltabbakh and coworkers reported a single patient who presented with a cystic pelvic mass arising from


333. Streptococcus Group B Infections (Overview)

bacteruria to cystitis and pyelonephritis with bacteremia): Fever, dysuria, flank pain, or pelvic pain See for more detail. Diagnosis Examination in patients with GBS infection may demonstrate the following findings: Lung consolidation, pleural effusion Tachypnea Tachycardia, murmur, evidence of heart failure Hypotension Headache, nuchal rigidity Confusion, altered mental status, neurologic dysfunction Evidence of an embolic event, phlebitis, Splenomegaly Vascular insufficiency of the lower extremity (...) B streptococcal disease from that caused by other pathogens. Pneumonia with bacteremia is common, while meningitis is less likely. Late group B streptococcal neonatal sepsis is defined as infection that presents between one week postpartum and age 3 months. Late disease commonly involves group B Streptococcus serotype III, typically characterized by bacteremia and meningitis. The absence of antibody to group B streptococci in infants is a risk factor for infection. Because antibodies to group B


334. Cervical Cancer (Overview)

cancer is an abnormal Papanicolaou (Pap) test result. Physical symptoms of cervical cancer may include the following: Abnormal vaginal bleeding Vaginal discomfort Malodorous discharge Dysuria See for more detail. Diagnosis ( ) infection must be present for cervical cancer to occur. Complete evaluation starts with . Screening recommendations Current screening recommendations for specific age groups, based on guidelines from the American Cancer Society (ACS), the American Society for Colposcopy (...) at the -308-promoter position of the tumor necrosis factor-alpha (TNF-alpha) gene and cervical cancer. Int J Gynecol Cancer . 2003 Mar-Apr. 13(2):148-53. . Govan VA, Constant D, Hoffman M, Williamson AL. The allelic distribution of -308 Tumor Necrosis Factor-alpha gene polymorphism in South African women with cervical cancer and control women. BMC Cancer . 2006 Jan 26. 6:24. . . Abrahamsson J, Carlsson B, Mellander L. Tumor necrosis factor-alpha in malignant disease. Am J Pediatr Hematol Oncol . 1993 Nov


335. Colovesical Fistula (Overview)

. Although rare, fistulae due to cytotoxic therapy have been reported. One case involved a patient undergoing a CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) regimen for non-Hodgkin lymphoma. [ ] Another involved enterovesical fistula as a result of neutropenic enterocolitis (a complication of chemotherapy) in a pediatric patient with acute leukemia. [ ] Traumatic pathophysiology Urethral disruption caused by blunt trauma or a penetrating injury can result in fistulae (...) laparoscopic cholecystectomy) have been reported as a cause of colovesical fistulae. [ , , , , ] Previous Next: Presentation The presenting symptoms and signs of enterovesical fistulae occur primarily in the urinary tract. Symptoms include suprapubic pain, irritative voiding symptoms, and symptoms associated with chronic urinary tract infection (UTI). The hallmark of enterovesical fistulae may be described as Gouverneur syndrome, namely, suprapubic pain, frequency, dysuria, and tenesmus. Other signs


336. 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


337. 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 (...) resection of the ejaculatory ducts, resulting in epididymitis. It can also be a result of heavy physical activity such as weight lifting. In children, infection is less common an etiology. One study of a pediatric emergency department found only 4 (4.1%) of 97 children diagnosed with epididymitis had a positive urine culture. [ ] Children may have various congenital abnormalities or functional voiding problems that increase the risk of reflux into the ejaculatory ducts. For example, epididymitis may


338. Sepsis, Bacterial (Overview)

, abdominal pain, deranged cell count, and positive PD fluid culture result Urinary tract: Cystitis, pyelonephritis, urethritis, or renal abscess, among others, with urgency, dysuria, pelvic, suprapubic, or back pain; urine microscopy showing pyuria or a positive urine culture result; urosepsis has also been reported after prostatic biopsy [ ] Female genital tract: Pelvic inflammatory disease, cervicitis, or salpingitis, among others, with lower abdominal pain, vaginal discharge, positive results (...) on endocervical and high vaginal swabs Male genital tract: Orchitis, epididymitis, acute prostatitis, balanitis, or prostatic abscess, among others, with dysuria, frequency, urgency, urge incontinence, cloudy urine, prostatic tenderness, and positive urine Gram stain and culture results Bone: Osteomyelitis presenting with pain, warmth, swelling, decreased range of motion, positive blood and/or bone culture results, and MRI changes Joint: Septic arthritis presenting with pain, warmth, swelling, decreased range


339. Septic Shock (Overview)

. (See , , , and .) This article does not cover sepsis of the neonate or infant. Special consideration must be given to neonates, infants, and small children with regard to fluid resuscitation, appropriate antibiotic coverage, intravenous (IV) access, and vasopressor therapy. (See , , , , and .) Shock Classification, Terminology, and Staging Shock is identified in most patients by hypotension and inadequate organ perfusion, which may be caused by either low cardiac output or low systemic vascular (...) and gastrointestinal (GI) infections – Diarrhea, abdominal pain, abdominal distention, guarding or rebound tenderness, rectal tenderness or swelling Pelvic and genitourinary (GU) infections – Pelvic or flank pain, adnexal tenderness or masses, vaginal or urethral discharge, dysuria, frequency, urgency Bone and soft-tissue infections – Localized limb pain or tenderness, focal erythema, edema, swollen joint, crepitus in necrotizing infections, joint effusions Skin infections – Petechiae, purpura, erythema


340. Bladder Cancer (Overview)

, and vagina with squamous cell carcinoma of the bladder infiltrating through the bladder wall into the vaginal wall. Signs and symptoms Clinical manifestations of bladder cancer are as follows: Painless gross hematuria - Approximately 80-90% of patients; classic presentation Irritative bladder symptoms (eg, dysuria, urgency, frequency of urination) - 20-30% of patients Pelvic or bony pain, lower-extremity edema, or flank pain - In patients with advanced disease Palpable mass on physical examination - Rare (...) , rhabdosarcoma, carcinosarcoma, lymphoma, and small cell carcinoma. Leiomyosarcoma is the most common sarcoma of the bladder. most commonly occur in children. Carcinosarcomas are highly malignant tumors that contain a combination of mesenchymal and epithelial elements. Primary bladder lymphomas arise in the submucosa of the bladder. Except for lymphomas, all these rare bladder cancers carry a poor prognosis. Small cell carcinoma of the urinary bladder is a poorly differentiated, malignant neoplasm


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