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Dysuria in Children

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441. 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

2014 eMedicine.com

442. 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

2014 eMedicine.com

443. 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

2014 eMedicine.com

444. Epididymal Tuberculosis (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

445. Augmentation Cystoplasty (Follow-up)

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

446. Surgical Treatment of Vaginal Cancer (Diagnosis)

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

447. Streptococcus Group B Infections (Diagnosis)

bacteruria to cystitis and pyelonephritis with bacteremia): Fever, dysuria, flank pain, or pelvic pain See for more detail. Diagnosis Examination in patients with GBS infection may demonstrate the following findings: Lung consolidation, pleural effusion Tachypnea Tachycardia, murmur, evidence of heart failure Hypotension Headache, nuchal rigidity Confusion, altered mental status, neurologic dysfunction Evidence of an embolic event, phlebitis, Splenomegaly Vascular insufficiency of the lower extremity (...) B streptococcal disease from that caused by other pathogens. Pneumonia with bacteremia is common, while meningitis is less likely. Late group B streptococcal neonatal sepsis is defined as infection that presents between one week postpartum and age 3 months. Late disease commonly involves group B Streptococcus serotype III, typically characterized by bacteremia and meningitis. The absence of antibody to group B streptococci in infants is a risk factor for infection. Because antibodies to group B

2014 eMedicine.com

448. Urinary Tract Infection, Females (Follow-up)

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

449. Urinary Tract Infection, Males (Follow-up)

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

450. Condyloma Acuminatum (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

451. 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 Emergency Medicine

452. Schistosomiasis (Treatment)

endemic 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 (...) . [ ] 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 Emergency Medicine

453. Candidiasis (Diagnosis)

):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

454. Cervical Cancer (Diagnosis)

cancer is an abnormal Papanicolaou (Pap) test result. Physical symptoms of cervical cancer may include the following: Abnormal vaginal bleeding Vaginal discomfort Malodorous discharge Dysuria See for more detail. Diagnosis ( ) infection must be present for cervical cancer to occur. Complete evaluation starts with . Screening recommendations Current screening recommendations for specific age groups, based on guidelines from the American Cancer Society (ACS), the American Society for Colposcopy (...) at the -308-promoter position of the tumor necrosis factor-alpha (TNF-alpha) gene and cervical cancer. Int J Gynecol Cancer . 2003 Mar-Apr. 13(2):148-53. . Govan VA, Constant D, Hoffman M, Williamson AL. The allelic distribution of -308 Tumor Necrosis Factor-alpha gene polymorphism in South African women with cervical cancer and control women. BMC Cancer . 2006 Jan 26. 6:24. . . Abrahamsson J, Carlsson B, Mellander L. Tumor necrosis factor-alpha in malignant disease. Am J Pediatr Hematol Oncol . 1993 Nov

2014 eMedicine.com

455. Colovesical Fistula (Diagnosis)

. Although rare, fistulae due to cytotoxic therapy have been reported. One case involved a patient undergoing a CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) regimen for non-Hodgkin lymphoma. [ ] Another involved enterovesical fistula as a result of neutropenic enterocolitis (a complication of chemotherapy) in a pediatric patient with acute leukemia. [ ] Traumatic pathophysiology Urethral disruption caused by blunt trauma or a penetrating injury can result in fistulae (...) laparoscopic cholecystectomy) have been reported as a cause of colovesical fistulae. [ , , , , ] Previous Next: Presentation The presenting symptoms and signs of enterovesical fistulae occur primarily in the urinary tract. Symptoms include suprapubic pain, irritative voiding symptoms, and symptoms associated with chronic urinary tract infection (UTI). The hallmark of enterovesical fistulae may be described as Gouverneur syndrome, namely, suprapubic pain, frequency, dysuria, and tenesmus. Other signs

2014 eMedicine.com

456. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Diagnosis)

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

457. Cystectomy, Radical (Diagnosis)

accumulation of TP53 have been correlated with an increased grade, stage, and recurrence risk. The risk of progression to muscle-invasive disease is associated with tumor grade, stage (Ta vs T1), size, number of lesions (solitary vs multiple lesions), previous tumor recurrence, and presence of CIS. Previous Next: Presentation Gross or microscopic hematuria is the initial presenting sign in 80%-90% of patients. Approximately 20% of patients have irritative symptoms such as urinary urgency, dysuria (...) . 93(1):64-6. . deKernion JB, Trapasso JG. Urinary Diversion and Continent Reservoir. Adult and Pediatric Urology . 1996. 2:1465-97. Dreicer R. Chemotherapy for muscle-invasive bladder cancer in the perioperative setting: current standards. Urol Oncol . 2007 Jan-Feb. 25(1):72-5. . El-Gabry EA, Strup SE, Gomella LG. Superficial Bladder Cancer: Current Treatment Modalities and Future Directions: Part II. AUA Update Series . 2000. 20:154-9. El-Gabry EA, Strup SE, Gomella LG. Superficial Bladder Cancer

2014 eMedicine.com

458. Cystectomy, Partial (Diagnosis)

, and dysuria is the second most common symptom. These symptoms rarely occur without hematuria (microscopic or gross). Flank pain due to ureteral obstruction, lower-extremity edema, and pelvic masses are other presenting symptoms. Symptoms of advanced disease, such as weight loss and abdominal or bone pain, are rare because patients usually seek medical attention before these develop. Previous Next: Indications Indications for partial cystectomy in malignancy Urothelial carcinoma (also called transitional (...) consecutive cases. Eur Urol . 2000 Jan. 37(1):85-9. . Dandekar NP, Dalal AV, Tongaonkar HB, Kamat MR. Adenocarcinoma of bladder. Eur J Surg Oncol . 1997 Apr. 23(2):157-60. . Herr HW. Urachal carcinoma: the case for extended partial cystectomy. J Urol . 1994 Feb. 151(2):365-6. . Hays DM, Raney RB, Wharam MD, Wiener E, Lobe TE, Andrassy RJ, et al. Children with vesical rhabdomyosarcoma (RMS) treated by partial cystectomy with neoadjuvant or adjuvant chemotherapy, with or without radiotherapy. A report from

2014 eMedicine.com

459. Cystitis, Nonbacterial (Diagnosis)

> Nonbacterial and Noninfectious Cystitis Updated: Mar 09, 2018 Author: Lynda A Frassetto, MD; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Nonbacterial and Noninfectious Cystitis Overview Practice Essentials Nonbacterial is a catchall term that encompasses various medical disorders, including infectious and , as well as painful bladder syndrome/ (PBS/IC). PBS/IC describes a syndrome of pain and genitourinary symptoms (eg, frequency, urgency, pain, dysuria (...) the following forms of the disease: Chemical Autoimmune Hypersensitivity General symptoms of cystitis include urgency, frequency, dysuria, and, occasionally, hematuria, dyspareunia, abdominal cramps, and/or bladder pain and spasms. Establishing or excluding a specific diagnosis often requires repeated cultures and various urologic procedures, including cystoscopy with bladder biopsies, various bladder tests, and immune system function examinations. Some conditions, such as , , and urethral foreign bodies

2014 eMedicine.com

460. Cutaneous Tuberculosis (Diagnosis)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin

2014 eMedicine.com

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