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Dysuria in Children

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361. 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

362. 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

363. 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

364. Warts, Genital (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

365. Urinary Tract Infection, Females (Treatment)

genitourinary tract; who have no history of recent instrumentation; and whose symptoms are confined to the lower urinary tract. Uncomplicated cystitis is most common in young, sexually active women. Patients usually present with dysuria, urinary frequency, urinary urgency, and/or suprapubic pain. Treatment regimens for uncomplicated cystitis in nonpregnant women are provided in Table 1, below. Table 1. Treatment Regimens for Uncomplicated Cystitis in Nonpregnant Women [ ] First-line therapy trimethoprim (...) these agents have relatively poor efficacy and high rates of resistance. [ ] Previous Next: Adjunctive Therapy Patients with intense dysuria may obtain symptomatic relief from a bladder analgesic, such as phenazopyridine, to be used for 1-2 days. Avoid long-term use, as this agent may mask symptoms of therapeutic failure or recurrence. Many authors advise stressing the intake of plenty of fluids to promote a dilute urine flow. Previous Next: Fungal Infection In catheterized patients, removal

2014 eMedicine.com

366. Urinary Tract Infection, Males (Treatment)

filtration rate < 50). Treat the symptom of dysuria with phenazopyridine. [ , , , ] Unfortunately, the prevalence of uropathogens resistant to TMP-SMZ, nitrofurantoin, and first-generation cephalosporins has continued to rise. There are data that suggest overall resistance to TMP-SMZ is approximately 25% (range, 10-45%), based on the area of the country, and resistance to nitrofurantoin is slightly higher. Although studies have indicated that resistance to fluoroquinolones has been acceptably low, more (...) in childhood and repeated in late adolescence. Cystitis For the few men with uncomplicated cystitis, TMP-SMZ can be used in areas where resistant E coli number less than 20%; alternatively, a fluoroquinolone can be used. The length of treatment should be 7-10 days. Urethritis For urethritis, ceftriaxone (125mg IM as a single dose) treats penicillinase-producing N gonorrhoeae. Treatment for nongonococcal urethritis (NGU) should also be given (doxycycline 100mg PO bid for 7 days). Sexual partners should also

2014 eMedicine.com

367. Megaureter and Other Congenital Ureteral Anomalies (Treatment)

% of common sheath reimplants, with a mean follow-up of 29.6 months. No postoperative obstructions, urinary leaks, or wound infections occurred. [ ] Previous Next: Follow-up Follow-up care may include renal ultrasound to assess renal growth and the presence of renal scarring or hydronephrosis. Suppressive antibiotics are discontinued during the postoperative period. Parents are counseled that urinalysis and urine culture are still indicated if their child becomes symptomatic (eg, dysuria, flank pain (...) . The best approach to the initial treatment of an ecoptic ureterocele without reflux by endoscopic decompression or upper pole heminephrectomy continues to be debated. Previous References Anderson CB, Tanaka ST, Pope JC 4th, Adams MC, Brock JW 3rd, Thomas JC. Acute pain crisis as a presentation of primary megaureter in children. J Pediatr Urol . 2011 Jun 21. . Renjen P, Bellah R, Hellinger JC, Darge K. Pediatric urologic advanced imaging: techniques and applications. Urol Clin North Am . 2010 May. 37(2

2014 eMedicine.com

368. Tuberculosis of the Genitourinary System (Treatment)

, 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

369. Nonneoplastic Epithelial Disorders of the Vulva (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

370. Normal and Abnormal Puerperium (Treatment)

), 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

2014 eMedicine.com

371. Prostatitis, Tuberculous (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

372. Prostate Cancer: Brachytherapy (Radioactive Seed Implantation Therapy) (Overview)

, 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

373. Perinephric Abscess (Overview)

before hospitalization, whereas most patients with perinephric abscesses are symptomatic for more than 5 days. The most common symptoms include fever (66-90%), flank or abdominal pain (40-50%), chills (40%), dysuria (40%), weight loss, lethargy, and gastrointestinal symptoms (25%). Pleuritic pain may occur due to diaphragmatic irritation. If the abscess is pressing the adjacent nerves, the referred pain may be felt in the groin, thighs, or knees. Physical findings include flank or costovertebral (...) to surgery. Previous References Jacobson D, Gilleland J, Cameron B, Rosenbloom E. Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol . 2014 May. 29 (5):919-25. . Wickre CG, Major JL, Wolfson M. Perinephric abscess: an unusual late infectious complication of renal biopsy. Ann Clin Lab Sci . 1982 Nov-Dec. 12(6):453-4. . Edelstein HE, McCabe RE, Lieberman E. Perinephric abscess in renal transplant recipients: report of seven cases and review

2014 eMedicine.com

374. Reactive Arthritis (Overview)

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

375. Reactive Arthritis (Overview)

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

376. Reactive Arthritis (Overview)

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

377. Surgical Treatment of Vaginal Cancer (Treatment)

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

2014 eMedicine.com

378. Nephrolithiasis: Acute Renal Colic (Overview)

in people aged 35-45 years, but the disease can affect anyone at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life. An initial stone attack after age 50 years is relatively uncommon. Nephrolithiasis in children has historically been rare, with approximately 5-10 children aged 10 months to 16 years being seen annually for the condition at a typical US pediatric referral center. Over the last 25 years, however (...) . Pyonephrosis: diagnosis and treatment. Br J Urol . 1992 Oct. 70(4):360-3. . Jeffrey RB, Laing FC, Wing VW, Hoddick W. Sensitivity of sonography in pyonephrosis: a reevaluation. AJR Am J Roentgenol . 1985 Jan. 144(1):71-3. . Schneider K, Helmig FJ, Eife R, Belohradsky BH, Kohn MM, Devens K, et al. Pyonephrosis in childhood--is ultrasound sufficient for diagnosis?. Pediatr Radiol . 1989. 19(5):302-7. . Fultz PJ, Hampton WR, Totterman SM. Computed tomography of pyonephrosis. Abdom Imaging . 1993. 18(1):82-7

2014 eMedicine.com

379. Nephrolithiasis (Overview)

at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life. An initial stone attack after age 50 years is relatively uncommon. Nephrolithiasis in children has historically been rare, with approximately 5-10 children aged 10 months to 16 years being seen annually for the condition at a typical US pediatric referral center. Over the last 25 years, however, the incidence of nephrolithiasis in children has increased (...) , Laing FC, Wing VW, Hoddick W. Sensitivity of sonography in pyonephrosis: a reevaluation. AJR Am J Roentgenol . 1985 Jan. 144(1):71-3. . Schneider K, Helmig FJ, Eife R, Belohradsky BH, Kohn MM, Devens K, et al. Pyonephrosis in childhood--is ultrasound sufficient for diagnosis?. Pediatr Radiol . 1989. 19(5):302-7. . Fultz PJ, Hampton WR, Totterman SM. Computed tomography of pyonephrosis. Abdom Imaging . 1993. 18(1):82-7. . Wu TT, Lee YH, Tzeng WS, Chen WC, Yu CC, Huang JK. The role of C-reactive

2014 eMedicine.com

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

(UTI). Reprinted with permission from Elsevier. of 3 Tables Contributor Information and Disclosures Author Pamela I Ellsworth, MD Chief, Division of Pediatric Urology, Nemours Children's Hospital; Professor of Urology, University of Central Florida College of Medicine Pamela I Ellsworth, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Wellman W Cheung, MD, FACS Clinical Professor, Department of Urology and Department of Obstetrics and Gynecology (...) 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

2014 eMedicine.com

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