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Dysuria in Children

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341. Candidiasis (Overview)

):2816-23. . Maródi L, Johnston RB Jr. Invasive Candida species disease in infants and children: occurrence, risk factors, management, and innate host defense mechanisms. Curr Opin Pediatr . 2007 Dec. 19(6):693-7. . Malani AN, Kauffman CA. Candida urinary tract infections: treatment options. Expert Rev Anti Infect Ther . 2007 Apr. 5(2):277-84. . Guery BP, Arendrup MC, Auzinger G, Azoulay E, Borges Sá M, Johnson EM, et al. Management of invasive candidiasis and candidemia in adult non-neutropenic (...) : Vulvovaginal candidiasis (VVC) - Erythematous vagina and labia; a thick, curdlike discharge; and a normal cervix upon speculum examination [ ] Candida balanitis - Penile pruritus and whitish patches on the penis Candida cystitis - Many patients are asymptomatic, but bladder invasion may result in frequency, urgency, dysuria, hematuria, and suprapubic pain Asymptomatic candiduria - Most catheterized patients with persistent candiduria are asymptomatic Ascending pyelonephritis - Flank pain, abdominal cramps

2014 eMedicine.com

342. HLA-B27 Syndromes (Treatment)

in the treatment of resistant chronic uveitis, including chronic anterior uveitis in children with juvenile rheumatoid uveitis and idiopathic uveitis. This allowed the reduction of both systemic corticosteroids and/or systemic methotrexate. Oral tolerance involves administering an antigen orally to induce a specific peripheral immune tolerance. The mechanisms of oral tolerance are unclear, but it is believed that it involves a specific antigen and the generation of active suppression or clonal anergy dependent (...) in individuals who are HLA-B27 positive; in fact, 60-85% of patients with reactive arthritis are HLA-B27 positive. The disease is most common in persons aged 18-40 years, but it has been known to occur in children and older adults. The sex ratio varies, depending on whether the infection is enteric or venereally acquired. The sex ratio following gastrointestinal infection is 1:1, whereas the genitourinary disease primarily affects males. Prevalence of the disease also is high in homosexual and bisexual men

2014 eMedicine.com

343. Hematopoietic Stem Cell Transplantation (Treatment)

hampered by small numbers. [ ] Patients treated with chemotherapy alone have achieved remission, but overall survival has been poor. [ , ] In a comparison allogeneic transplant versus chemotherapy in children with Phl + ALL (UK Medical Research Council trial for childhood ALL [MRC ALL 97] program from 1997-2002), 3-year survival was reported as 60% compared with 36%, respectively. [ ] Children with induction failure (M2 or M3 bone marrow status at the end of 1 mo of therapy) were found to have very (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine.com

344. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Treatment)

with human papillomavirus (HPV) and Zoon balanitis has been identified. Clinical presentation/diagnosis Although the mean age at presentation is 53 years, patients aged 18-88 years are described in two series, and presentation in children as young as 12 years has been described. The men are uncircumcised in most series. Patients present with a solitary, glistening, sharply demarcated, large (2-3 cm), erythematous, speckled patch on the glans or inner prepuce. Rarely, multiple patches can erode (...) and outcome (5%) cream is recommended, with application to the entire skin surface below the chin. The cream should be left on for 8-14 hours (overnight) and then washed off. Second-line therapy includes the use of 1% lotion/cream or oral . Ivermectin may be repeated in 2 weeks. Lindane is not recommended for pregnant women or children younger than 2 years. Use lindane as a single dose (do not repeat). [ ] Antipruritic agents may be helpful in reducing discomfort related to pruritus. All household members

2014 eMedicine.com

345. Genital Herpes in Pregnancy (Treatment)

of Obstetrics and Gynecologists (Washington, DC) for speaking and teaching; Received honoraria from National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Thi. Chief Editor Ronald M Ramus, MD Professor of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine Ronald M Ramus, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Additional Contributors (...) to herpes simplex virus 2 (HSV-2). Approximately 22% of pregnant women are infected with HSV-2 and 2% of women acquire genital herpes in pregnancy. Approximately 1500-2000 new cases of neonatal HSV infection are diagnosed each year. The incidence of neonatal herpes varies considerably in international studies (about 1:3,200 births in the US and 1:60,000 in the UK). Approximately 80% of infected infants are born to mothers with no reported history of HSV infection. [ ] Untreated neonatal HSV infection

2014 eMedicine.com

346. Cervical Cancer (Treatment)

to alleviate symptoms from proctitis. Cystourethritis also can occur, leading to dysuria, frequency, and nocturia. Antispasmodics often are helpful for symptom relief. Urine should be examined for possible infection. If urinary tract infection (UTI) is diagnosed, therapy should be instituted without delay. Proper skin hygiene should be maintained for the perineum. Topical lotion should be used if erythema or desquamation occurs. Late sequelae of radiation therapy usually appear 1-4 years after treatment (...) series can be started as young as age 9 years. Catch-up vaccination is recommended for females aged 13-26 years who have not been previously vaccinated or who have not completed the full series. [ ] The 9vHPV vaccine may be offered as a 2-dose series for children and young adolescents aged 9-14 years. [ ] In the Costa Rica Vaccine Trial, researchers documented durable antibody responses after 1 dose (as opposed to the standard 3 doses) of the bivalent human papillomavirus (HPV) 16/18 L1 viruslike

2014 eMedicine.com

347. Benign Vulvar Lesions (Treatment)

, 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

2014 eMedicine.com

348. Bacterial Infections and Pregnancy (Treatment)

with microabscesses. Twenty-two percent of perinatal infections result in neonatal death or stillbirth. [ ] Among women who have listeriosis during pregnancy, two thirds of surviving infants develop clinical neonatal listeriosis. Early diagnosis and antimicrobial treatment of infected women during pregnancy can lead to the birth of a healthy child. In neonates, the mortality rate is approximately 50%. Mortality is more likely in early-onset neonatal sepsis. Late-onset listeriosis typically manifests as meningitis (...) collection [ ] If the culture result is positive, the woman should be treated during labor If culture results are unknown at the time of delivery, a risk-based approach can be used, in which patients are deemed at high risk and receive treatment if they meet any of the following criteria: Previously delivered infant with invasive GBS infection GBS bacteriuria during current pregnancy Delivery before 37 weeks' gestation Duration of ruptured membranes longer than 18 hours Intrapartum temperature of more

2014 eMedicine.com

349. Benign Lesions of the Ovaries (Treatment)

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

350. Augmentation Cystoplasty (Treatment)

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 (...) pressure and improves continence. Adult patients should have good manual dexterity, proven by performing self-catheterization in front of the physician. In pediatric patients, the parents must be committed to catheterizing the child at least every 4-6 hours. Parents must be taught catheterization before surgery. Intermittent catheterization and anticholinergic management are usually used in combination to accomplish symptom-management goals, to create continence, to eliminate vesicoureteral reflux

2014 eMedicine.com

351. Epididymal Tuberculosis (Treatment)

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

352. Human Papillomavirus (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

2014 eMedicine.com

353. Lasers in Urology (Treatment)

transurethrally or perineally directly into the prostate. This can cause large-volume necrosis with atrophy while preserving the urethral mucosa. In several studies these coagulative procedures have proven to have unacceptably high adverse events, namely irritative voiding, dysuria, and other storage symptoms, as well as high reoperation rates. Additionally, more efficient and improved laser applications such as Ho:LEP and photo-vaporization (PVP) techniques have shown to be more effective largely replacing (...) and patient an immediate watertight seal with a tensile strength that exceeds conventional closures. This application is in its clinical infancy; however, the future may bring a ubiquitous, mature technology. Autofluorescence The ability to ablate and weld increases the laser's use as a diagnostic tool. In this capacity, light of a specific wavelength is used to differentiate healthy from dysplastic or malignant tissue. This may involve the use of dyes that are metabolized differentially by normal

2014 eMedicine.com

354. Hypercalciuria (Treatment)

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

2014 eMedicine.com

355. Reactive Arthritis (Treatment)

of Poncet's disease. From the description of 198 cases found in the literature. Clin Rheumatol . 2013 Jul. 32(7):929-35. . Prati C, Bertolini E, Toussirot E, Wendling D. Reactive arthritis due to Clostridium difficile. Joint Bone Spine . 2010 Mar. 77(2):190-2. . Durand CL, Miller PF. Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child. Pediatr Infect Dis J . 2009 Aug. 28(8):750-1. . Macía Villa C, Sifuentes Giraldo W, Boteanu A, González Lanza M, Bachiller Corral J (...) (2):121-3. . Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum . 2009 Nov. 60(11):3516-8; author reply 3518-9. . Moorthy LN, Gaur S, Peterson MG, Landa YF, Tandon M, Lehman TJ. Poststreptococcal reactive arthritis in children: a retrospective study. Clin Pediatr (Phila) . 2009 Mar. 48(2):174-82. . Siala M, Gdoura R, Younes M, Fourati H, Cheour I

2014 eMedicine.com

356. Reactive Arthritis (Treatment)

of Poncet's disease. From the description of 198 cases found in the literature. Clin Rheumatol . 2013 Jul. 32(7):929-35. . Prati C, Bertolini E, Toussirot E, Wendling D. Reactive arthritis due to Clostridium difficile. Joint Bone Spine . 2010 Mar. 77(2):190-2. . Durand CL, Miller PF. Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child. Pediatr Infect Dis J . 2009 Aug. 28(8):750-1. . Macía Villa C, Sifuentes Giraldo W, Boteanu A, González Lanza M, Bachiller Corral J (...) (2):121-3. . Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum . 2009 Nov. 60(11):3516-8; author reply 3518-9. . Moorthy LN, Gaur S, Peterson MG, Landa YF, Tandon M, Lehman TJ. Poststreptococcal reactive arthritis in children: a retrospective study. Clin Pediatr (Phila) . 2009 Mar. 48(2):174-82. . Siala M, Gdoura R, Younes M, Fourati H, Cheour I

2014 eMedicine.com

357. Papillomavirus (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

2014 eMedicine.com

358. Prostate Cancer: Brachytherapy (Radioactive Seed Implantation Therapy) (Treatment)

, acute urinary retention and dysuria were actually greater in the hormone ablation group. [ ] Clinicians often compromise and use a 5-alpha reductase inhibitor for downsizing instead of true androgen ablation. Nonetheless, brachytherapy is not advisable in patients with glands larger than 60 g. In morbidly obese patients, the equipment often cannot sustain the patient’s weight or is not long enough to reach the prostate. Previous Next: Outcomes When compared with historical series using classic EBRT (...) to treat prostate cancer, brachytherapy series appear to offer equivalent or better disease-specific survival as measured by biochemical failure rates. Patients must be appropriately selected and treated at an accredited institution. Although brachytherapy is still in its infancy, 5-, 7-, and 12-year follow-up studies suggest that brachytherapy is equal to surgery in terms of biochemical recurrence. A 12-year study by Ragde et al, which reported on patients treated with I-125 seeds with or without

2014 eMedicine.com

359. Prostatitis, Tuberculous (Treatment)

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

360. Pyelonephritis, Acute (Treatment)

associated obstruction. The groups at greatest risk are infants and preschool-aged children. Initial management varies with patient age and presentation. Close follow-up examination, regardless of whether the patient is initially admitted, is essential to ensure recovery. Immediate reevaluation is encouraged for any recurrence of symptoms, because neither treatment of asymptomatic bacteriuria nor long-term suppressive therapy has been found to be effective. Urologic evaluation is necessary to establish (...) the presence of any urologic abnormality. The preferred imaging study for the diagnosis of acute pyelonephritis is technetium-99m dimercaptosuccinic acid ( 99m Tc-DMSA) scintigraphy. Ultrasonography is the imaging study of choice for the diagnosis of urinary tract structural abnormalities. Age-related data adapted from Harwood-Nuss and colleagues and Hansson and colleagues are presented below in Table 5. [ , ] Table 5. Pediatric Urinary Tract Infections Neonates Infants 6 weeks to 3 years of age Children 3

2014 eMedicine.com

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