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Dysuria in Children

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401. Papillomavirus (Follow-up)

. 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

402. Prostatitis, Tuberculous (Follow-up)

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

403. Prostate Cancer: Brachytherapy (Radioactive Seed Implantation Therapy) (Follow-up)

, 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

404. Reactive Arthritis (Follow-up)

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

405. Reactive Arthritis (Follow-up)

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

406. Lasers in Urology (Follow-up)

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

407. Human Papillomavirus (Follow-up)

. 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

408. HLA-B27 Syndromes (Follow-up)

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

409. Hematopoietic Stem Cell Transplantation (Follow-up)

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

410. Pyelonephritis, Acute (Follow-up)

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

411. Benign Lesions of the Ovaries (Overview)

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

412. Bacterial Infections and Pregnancy (Overview)

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 (...) [ ] 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 than 100.4°F (38°C

2014 eMedicine.com

413. Augmentation Cystoplasty (Overview)

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

414. Nonneoplastic Epithelial Disorders of the Vulva (Follow-up)

, 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

415. Normal and Abnormal Puerperium (Follow-up)

), 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

416. Megaureter and Other Congenital Ureteral Anomalies (Follow-up)

% 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

417. Hypercalciuria (Follow-up)

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

418. Epididymitis

epididymitis from the more ominous testicular torsion. Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in >50% of these patients). In infants with bacteruria and epididymitis, in whom anatomica abnormalities are more common than in older children, a voiding cystourethrogram (VCUG) and abdominal ultrasonography are recommended. Retrograde urethrography is also indicated to evaluate for urethral stricture (...) hemiscrotum. These findings should easily differentiate epididymitis from acute torsion. However, if an abscess or hydrocele formation is present, a photopenic area with a hypervascular rim (halo sign) can be apparent. This finding could potentially mimic late, missed torsion. Problems in examination performance may arise in infants and very small children whose genitalia are small and therefore difficult to image. The unavailability of RNSI equipment in many radiology practices as well as its use

2014 eMedicine Radiology

419. Xanthogranulomatous Pyelonephritis

. Urol Case Rep . 2018 Jul. 19:65-66. . Marinacci LX, Rosales I. Xanthogranulomatous Pyelonephritis. N Engl J Med . 2018 Mar 8. 378 (10):940. . Stoica I, O'Kelly F, McDermott MB, Quinn FMJ. Xanthogranulomatous pyelonephritis in a paediatric cohort (1963-2016): Outcomes from a large single-center series. J Pediatr Urol . 2018 Apr. 14 (2):169.e1-169.e7. . Afgan F, Mumtaz S, Ather MH. Preoperative diagnosis of xanthogranulomatous pyelonephritis. Urol J . 2007 Summer. 4(3):169-73. . Kuo CC, Wu CF, Huang (...) -Paediatric, Royal Liverpool (Alder Hey) Children's Hospital, UK Disclosure: Nothing to disclose. Chief Editor Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine Eugene C Lin, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Acknowledgements John L Haddad, MD Clinical Associate Professor

2014 eMedicine Radiology

420. Bladder, Cystitis

mucosa in the urachus. may be symptomatic or asymptomatic. Patients with bladder may present with symptoms of urgency, frequency, dysuria, hematuria, cloudy and offensive-smelling urine, or suprapubic discomfort. These symptoms may occur singly or in combination. The symptom of urgency results from the stimulation of the afferent arc of the micturition reflex; the offensive smell results from the bacterial conversion of urea to ammonia. Interstitial cystitis (bladder pain syndrome, Hunner ulcer (...) cystitis, also known as pseudotumoral cystitis, is an uncommon inflammatory process seen in children and adults. In children, it is a self-limiting condition that resolves spontaneously and that usually requires no treatment. Therefore, its recognition is important. Predisposing factors for eosinophilic cystitis include asthma, allergies, and eosinophilic gastroenteritis. Bladder biopsy reveals pancystitis and the presence of eosinophils, among other inflammatory cells. Radiographic findings

2014 eMedicine Radiology

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