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Dysuria in Children

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401. Urinary Tract Obstruction (Overview)

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 (...) . 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 of the cause

2014 eMedicine.com

402. Urinary Tract Infections in Pregnancy (Overview)

mucosal vaccine for urinary tract infections. J Urol . 2003 Sep. 170(3):867-9. . Mann JR, McDermott S. Are Maternal Genitourinary Infection and Pre-Eclampsia Associated With ADHD in School Aged Children?. J Atten Disord . 2010 Sep 13. . Sun Y, Vestergaard M, Christensen J, Nahmias AJ, Olsen J. Prenatal exposure to maternal infections and epilepsy in childhood: a population-based cohort study. Pediatrics . 2008 May. 121(5):e1100-7. . Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de (...) and childhood neurologic consequences. For patient education information, see the and , as well as , , , and . Definitions of key terms Urinary tract infection UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/mL of urine with accompanying pyuria (> 7 white blood cells [WBCs]/mL) in a symptomatic patient. A diagnosis of UTI should be supported by a positive culture for a uropathogen, particularly in patients

2014 eMedicine.com

403. Urethritis (Overview)

, 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 worse (...) 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

404. Urinary Tract Infection, Females (Overview)

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 (...) 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

2014 eMedicine.com

405. Uric Acid Nephropathy (Overview)

practice, the prognosis for persons with acute renal failure from acute urate nephropathy is excellent. The morbidity of uric acid nephrolithiasis arises from the manifestations of stones, obstruction, and crystalluria and is often accompanied by dysuria and hematuria. [ ] Secondary bacteriuria and pyelonephritis also can occur. However, life-threatening complications are rare. Race See the list below: A number of different malignancies cause a predisposition to acute uric acid nephropathy, making (...) demographics for this entity difficult to characterize. Sex See the list below: Uric acid nephrolithiasis occurs most frequently in those with underlying hyperuricemia or gout, which occurs in men more frequently than women by a male-to-female ratio of 4:1. In the United States, the prevalence rate is 4-9% in men and 1.7-4.1% in women. Age See the list below: Uric acid nephropathy has been well documented in the pediatric and adult populations. It may occur more often in pediatric patients because

2014 eMedicine.com

406. Urinary Tract Infection, Males (Overview)

to the normal male urinary tract’s many natural defenses to infection, many experts consider UTIs in males, by definition, to be complicated (ie, more likely to be associated with anatomic abnormalities, requiring surgical intervention to prevent sequelae). Signs and symptoms Dysuria is the most frequent chief complaint in men with UTI. The combination of dysuria, urinary frequency, and urinary urgency is about 75% predictive for UTI, whereas the acute onset of hesitancy, urinary dribbling, and slow stream (...) organisms can retard ureteral peristalsis. E coli is responsible for approximately 25% of cases in males, with and causing many remaining infections; , Pseudomonas , , and are less frequent. Bacterial cystitis Bacterial cystitis without concomitant infection in other portions of the genitourinary tract is believed to be a rare event in males. The abrupt onset of irritative voiding symptoms (eg, frequency, urgency, nocturia, dysuria) and suprapubic pain are clinically diagnostic. Most cases of bacterial

2014 eMedicine.com

407. Urethral Syndrome (Overview)

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

408. Urethral Prolapse (Overview)

is predominantly asymptomatic. Often, urethral prolapse is an incidental finding during routine examination. The most common presentation is vaginal bleeding associated with a periurethral mass. [ ] Symptomatic children present with bloody spotting on their underwear or diapers. is uncommon. Until urethral prolapse is definitively diagnosed, the presence of blood in the genital area should raise suspicion of and warrant ruling out this possibility. Voiding disturbances are typically rare in the pediatric (...) population, but when they are present, patients may report dysuria, urinary frequency, or introital pain. Again, hematuria is uncommon. Children may report genital pain if the prolapsed mucosa becomes very large or if thrombosis and necrosis have developed. Furthermore, although reportedly a nonobstructive lesion, acute urinary retention secondary to urethral prolapse has been reported. [ ] In contrast, patients with postmenopausal urethral prolapse are often symptomatic. Vaginal bleeding associated

2014 eMedicine.com

409. Urethral Diverticula (Overview)

been identified with increasing frequency over the past several decades because of increased physician awareness of the condition. The most common symptoms associated with urethral diverticula include urinary frequency, urgency, and dysuria. In some cases, and calculi are also present. Despite the increased awareness in recent years, this entity continues to be overlooked during routine evaluation of women with voiding problems. Accurate diagnosis and treatment of urethral diverticula require (...) . Congenital urethral diverticula are rare; however, urethral diverticula in children have been used to support the congenital origin theory. Congenital urethral diverticula have been postulated to arise from the following: Remnant of Gartner duct Faulty union of primordial folds Cell rests Vaginal wall cysts of müllerian origin Congenital dilatation of periurethral cysts Association with blind-ending ureters Acquired diverticula may originate from repeated urinary tract infections obstructing

2014 eMedicine.com

410. Urethral Caruncle (Overview)

. Cases of urethral melanoma, [ ] , [ , ] intestinal ectopia, lymphoma, [ , ] and urethral leiomyoma [ ] masquerading as urethral caruncle have been reported; however, reports of these associations are rare. Intraepithelial squamous cell carcinoma arising within a urethral caruncle has been reported in two patients. [ ] Additionally, urethral caruncles have been reported to occur rarely in the premenopausal patient and may enlarge during pregnancy. Urethral polyps are the pediatric equivalent (...) of urethral caruncles and manifest in a similar fashion. Previous Next: Presentation Most urethral caruncles are asymptomatic and are incidentally noted on pelvic examination; however, some may be painful and others may be associated with dysuria. Many individuals with a urethral caruncle present with bleeding or, more commonly, with the patient noticing blood on undergarments. Urethral caruncles are unlikely to explain voiding or storage symptoms in women. In fact, a comparison of lower urinary tract

2014 eMedicine.com

411. Tuberculosis of the Genitourinary System (Overview)

, 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

412. Benign Vulvar Lesions (Overview)

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 eczema, or dry skin and is related (...) ), 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 pemphigoid is an autoimmune condition

2014 eMedicine.com

413. 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

414. 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

415. 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

416. 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

417. 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

418. 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

419. 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

420. 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

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