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Dysuria in Children

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421. 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


422. 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


423. 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


424. 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


425. 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


426. 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


427. 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

428. 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

429. 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

430. Urinary Tract Infection, Female (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 Emergency Medicine

431. Urinary Tract Infection, Male (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 Emergency Medicine

432. Urogenital Reconstruction, Penile Hypospadias

below: Meatotomy is indicated at any age when the meatus caliber is reduced, causing dysuria. Correction of glanular hypospadias with distal urethra repositioning, creation of a symmetric glans (glanuloplasty), and preputium plasty is indicated in childhood or adolescence at the patient's request for cosmetic or psychological reasons. Correction of penile and penoscrotal hypospadias is indicated in childhood in patients younger than school age for the following reasons: To permit normalization (...) by its erectile tissue. The normal male urethra runs from the bladder through the penile shaft, ventrally to the corpora cavernosa, and sorts with the external urethral meatus at the tip of the glans. Previous Next: Contraindications Reconstruction of the urethra and restoration of the normal appearance of the genitalia is contraindicated in infancy because of the difficulty related to the small dimension of the structures. Previous References Smith ED. The hystory of hypospadias. Pediatr Surg Int

2014 eMedicine Surgery

433. Acute Abdomen and Pregnancy (Diagnosis)

(CT) examination is substantially below this level. [ ] During pregnancy, perform medically indicated diagnostic radiographic procedures when needed; when possible, however, consider other imaging procedures not associated with ionizing radiation instead of radiography. [ ] Because of the possible association of antenatal radiation exposure with childhood cancer, [ ] use ionizing radiation only when medically necessary, and minimize that exposure when possible without compromising patient care (...) for urolithiasis is approximately 1:1600. [ , ] For patient education information, see the , as well as and . History and physical examination Findings in urolithiasis include the following: Pain, usually in the flank - Almost always the presenting complaint Nausea and vomiting Dysuria Urgency Fever Gross hematuria History of a prior episode - In 25% of patients [ , ] Costovertebral angle tenderness - Almost always present Abdominal tenderness - Sometimes observed Workup Patients with urolithiasis may have

2014 eMedicine Surgery

434. Schistosomiasis, Bladder

areas are rising. In the complete absence of routine presymptomatic screening of these groups in developed countries, it is increasingly likely that patients with acute or chronic schistosomiasis will present to emergency departments (EDs) with a variety of complaints in nonendemic areas. [ , ] Pediatric and adolescent patients who have traveled or lived in endemic areas are at the highest risk for exposure to schistosomes and are at risk for serious long-term complications. These patients usually (...) . [ ] Acutely, patients with schistosomiasis may present with the following: Pruritic rash due to cercarial penetration into the skin Nonspecific symptoms such as fever, myalgias, and malaise Right upper quadrant abdominal pain Diarrhea Dysuria or hematuria Important laboratory findings include (1) eosinophilia and (2) hematuria and proteinuria, which is associated with urinary schistosomiasis. Manifestations of chronic schistosomiasis can also months or years after acute infection. Symptoms are nonspecific

2014 eMedicine Radiology

435. Surgical Treatment of Vaginal Cancer (Follow-up)

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


436. Cervical Cancer (Follow-up)

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


437. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Follow-up)

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


438. Cyclospora (Follow-up)

findings returned to normal. These findings suggest, but do not prove, Cyclospora -related reversible gallbladder pathology. Reactive arthritis syndrome (RAS): RAS developed in a 31-year-old man with documented Cyclospora infection 5 months after the exposing event and approximately 2 months after the absence of Cyclospora on intestinal biopsies. He had not received TMP-SMZ because of sulfa allergy, and no other antibiotic was prescribed. At the time of the RAS diagnosis (dysuria, negative urinalysis (...) YR. Cyclospora cayetanensis in a Pediatric Hospital in Morelia, México. Am J Trop Med Hyg . 2014 Sep 3. 91(3):537-40. . . Thima K, Mori H, Praevanit R, Mongkhonmu S, Waikagul J, Watthanakulpanich D. Recovery of Cyclospora cayetanensis among asymptomatic rural Thai schoolchildren. Asian Pac J Trop Med . 2014 Feb. 7(2):119-23. . Liu H, Shen Y, Yin J, Yuan Z, Jiang Y, Xu Y, et al. Prevalence and genetic characterization of Cryptosporidium, Enterocytozoon, Giardia and Cyclospora in diarrheal


439. Cystectomy, Radical (Follow-up)

. 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


440. Genital Herpes in Pregnancy (Follow-up)

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


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