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Dysuria in Children

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461. Meatal Stenosis (Overview)

. [ ] Meatal stenosis is typically characterized by an upward-deflected, difficult-to-aim urinary stream and, rarely, by dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy or meatoplasty is normally curative. For patient education resources, see the , as well as and . Next: Pathophysiology After circumcision, a child who is not toilet-trained persistently exposes the meatus to urine, which results in inflammation (ammoniac dermatitis) and mechanical trauma as the meatus rubs against (...) of meatal stenosis may not alleviate them. Previous References Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) . 2006 Jan-Feb. 45 (1):49-54. . Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol . 2011 Oct. 7 (5):526-8. . Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture

2014 eMedicine Pediatrics

462. Arthritis, Conjunctivitis, Urethritis Syndrome (Treatment)

). Rheumatol Int . 2009 Jul. 29(9):1097-9. . Rueda JC, Crepy MF, Mantilla RD. Clinical features 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 (...) findings of enthesitis in reactive arthritis. Clin Nucl Med . 2011 Feb. 36(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

2014 eMedicine Pediatrics

463. Hematuria (Overview)

Nephrol . 2009 Oct. 24(10):1951-8. . Expert Panel on Pediatric Imaging:., Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria ® Hematuria-Child. J Am Coll Radiol . 2018 May. 15 (5S):S91-S103. . Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol . 2000 Jan. 14(1):65-72. . Dodge WF, West EF, Smith EH, Bruce Harvey 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr (...) . . Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr . 1981 Nov. 99(5):716-9. . Kincaid-Smith P, Fairley K. The investigation of hematuria. Semin Nephrol . 2005 May. 25(3):127-35. . Krieger I, Sargent DA. A postural sign in the sensory deprivation syndrome in infants. J Pediatr . 1967 Mar. 70(3):332-9. . Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G, et al. Stratifying risk of urinary tract

2014 eMedicine Pediatrics

464. Hemorrhagic Cystitis (Overview)

stem cell transplantation. Biol Blood Marrow Transplant . 2011 Oct. 17(10):1512-9. . Hatakeyama N, Suzuki N, Yamamoto M, Kuroiwa Y, Hori T, Mizue N, et al. Detection of BK virus and adenovirus in the urine from children after allogeneic stem cell transplantation. Pediatr Infect Dis J . 2006 Jan. 25(1):84-5. . Hoffman JA, Shah AJ, Ross LA, Kapoor N. Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant . 2001. 7 (...) , Choi Y, et al. Isolation of adenovirus type 7 from the urine of children with acute hemorrhagic cystitis. Pediatr Infect Dis J . 1996 Jul. 15(7):633-4. . Mori T, Aisa Y, Shimizu T, Ikeda Y, Okamoto S, Okada K, et al. Hemorrhagic cystitis caused by adenovirus type 34 after allogeneic bone marrow transplantation. Transplantation . 2005 Mar 15. 79(5):624. . Umekawa T, Kurita T. Acute hemorrhagic cystitis by adenovirus type 11 with and without type 37 after kidney transplantation. Urol Int . 1996. 56(2

2014 eMedicine Pediatrics

465. Gonorrhea (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine Pediatrics

466. Meatal Stenosis (Treatment)

of up to 8 weeks. In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and Smith found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only one patient had recurrent meatal stenosis). [ ] Mild dysuria may be present for 1-2 days after meatotomy. If dysuria results in urinary retention, placing the child (...) and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation; their presence seemed to have a calming effect. In a retrospective study of 55 boys who underwent clinic meatotomy (CM) under topical lidocaine and prilocaine (EMLA) anesthesia, Fronczak et al found that although their success rate was lower than that reported in earlier studies and the incidence

2014 eMedicine Pediatrics

467. 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 Pediatrics

468. Meatal Stenosis (Follow-up)

of up to 8 weeks. In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and Smith found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only one patient had recurrent meatal stenosis). [ ] Mild dysuria may be present for 1-2 days after meatotomy. If dysuria results in urinary retention, placing the child (...) and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation; their presence seemed to have a calming effect. In a retrospective study of 55 boys who underwent clinic meatotomy (CM) under topical lidocaine and prilocaine (EMLA) anesthesia, Fronczak et al found that although their success rate was lower than that reported in earlier studies and the incidence

2014 eMedicine Pediatrics

469. 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 Pediatrics

470. Congenital Adrenal Hyperplasia (Treatment)

. Complications of excessive administration of glucocorticoids include growth failure, obesity, striae, hypertension, hyperglycemia, and cataracts. The complications of excess mineralocorticoid administration include hypertension and hypokalemia. A study by Maccabee-Ryaboy et al of 180 pediatric patients indicated that children with CAH are more likely to experience hypertension than are children in the general population, with the incidence of hypertension varying according to sex and the type of CAH (...) MA, Prakash D, et al. Spontaneous adrenal hemorrhage associated with transient antiphospholipid antibody in a child. Clin Pediatr (Phila) . 2001 Jun. 40(6):347-50. . Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab . 2010 Sep. 95(9):4133-60. . Poppas DP. Clitoroplasty in congenital adrenal hyperplasia: description of technique. Adv Exp

2014 eMedicine Pediatrics

471. Arthritis, Conjunctivitis, Urethritis Syndrome (Follow-up)

). Rheumatol Int . 2009 Jul. 29(9):1097-9. . Rueda JC, Crepy MF, Mantilla RD. Clinical features 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 (...) findings of enthesitis in reactive arthritis. Clin Nucl Med . 2011 Feb. 36(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

2014 eMedicine Pediatrics

472. Toxicity, Marine - Ciguatera (Treatment)

Painful paresthesias of the extremities Paradoxical temperature reversal (eg, cold objects feel hot and hot objects feel cold; classic symptom) Dental pain (teeth feel loose) Pruritus Arthralgias Myalgias Weakness Ataxia, vertigo Respiratory paralysis Coma In children, irritability may be the only presenting neurologic symptom. Cardiovascular findings may reflect the following: Bradycardia Hypotension Pulmonary edema Other general symptoms include the following: Dysuria Chills Sweating Painful (...) , Harvard Medical School Dana A Stearns, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck Salary Employment John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical

2014 eMedicine Pediatrics

473. Hypercalciuria (Diagnosis)

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 Pediatrics

474. Meatal Stenosis (Diagnosis)

. [ ] Meatal stenosis is typically characterized by an upward-deflected, difficult-to-aim urinary stream and, rarely, by dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy or meatoplasty is normally curative. For patient education resources, see the , as well as and . Next: Pathophysiology After circumcision, a child who is not toilet-trained persistently exposes the meatus to urine, which results in inflammation (ammoniac dermatitis) and mechanical trauma as the meatus rubs against (...) of meatal stenosis may not alleviate them. Previous References Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) . 2006 Jan-Feb. 45 (1):49-54. . Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol . 2011 Oct. 7 (5):526-8. . Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture

2014 eMedicine Pediatrics

475. Arthritis, Conjunctivitis, Urethritis Syndrome (Diagnosis)

). Rheumatol Int . 2009 Jul. 29(9):1097-9. . Rueda JC, Crepy MF, Mantilla RD. Clinical features 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 (...) findings of enthesitis in reactive arthritis. Clin Nucl Med . 2011 Feb. 36(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

2014 eMedicine Pediatrics

476. Somatoform Disorder: Somatization (Overview)

medical outpatient visits. [ ] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [ ] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms. Somatization in children consists of the persistent experience (...) is the major factor in the pain symptom. [ ] Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood. RAP has been defined by intermittent pain with full recovery between episodes lasting more than 3 months. [ ] Epidemiological studies suggest that RAP effects 8-25% of school-age children aged 9-12 years, is more prevalent among girls, and accounts for 2-4% of pediatric office visits. [ ] An estimated 10% of these patients have documented physical illness, with one third

2014 eMedicine Pediatrics

477. Posterior Urethral Valves (Overview)

. Adult care of children from pediatric urology. J Urol . 2012 Apr. 187 (4):1164-71. . Tikkinen KA, Heikkilä J, Rintala RJ, Tammela TL, Taskinen S. Lower urinary tract symptoms in adults treated for posterior urethral valves in childhood: matched cohort study. J Urol . 2011 Aug. 186 (2):660-6. . Heikkilä J, Holmberg C, Kyllönen L, Rintala R, Taskinen S. Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol . 2011 Dec. 186 (6):2392-6. . Narasimhan KL, Mahajan JK (...) reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses?. Prenat Diagn . 2016 Sep. 36 (9):831-7. . Joseph TP, Gopi VK, Babu PR, Satish Kumar KV. Outcome of Antenatally Presenting Posterior Urethral Valves (PUV) in Children. Indian Pediatr . 2017 Apr 15. 54 (4):295-297. . Odeh R, Noone D, Bowlin PR, Braga LH, Lorenzo AJ. Predicting Risk of Chronic Kidney Disease in Infants and Young Children at Diagnosis of Posterior Urethral Valves: Initial Ultrasound Kidney

2014 eMedicine Pediatrics

478. Posterior Urethral Valves (Diagnosis)

. Adult care of children from pediatric urology. J Urol . 2012 Apr. 187 (4):1164-71. . Tikkinen KA, Heikkilä J, Rintala RJ, Tammela TL, Taskinen S. Lower urinary tract symptoms in adults treated for posterior urethral valves in childhood: matched cohort study. J Urol . 2011 Aug. 186 (2):660-6. . Heikkilä J, Holmberg C, Kyllönen L, Rintala R, Taskinen S. Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol . 2011 Dec. 186 (6):2392-6. . Narasimhan KL, Mahajan JK (...) reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses?. Prenat Diagn . 2016 Sep. 36 (9):831-7. . Joseph TP, Gopi VK, Babu PR, Satish Kumar KV. Outcome of Antenatally Presenting Posterior Urethral Valves (PUV) in Children. Indian Pediatr . 2017 Apr 15. 54 (4):295-297. . Odeh R, Noone D, Bowlin PR, Braga LH, Lorenzo AJ. Predicting Risk of Chronic Kidney Disease in Infants and Young Children at Diagnosis of Posterior Urethral Valves: Initial Ultrasound Kidney

2014 eMedicine Pediatrics

479. Acute Abdomen and Pregnancy (Treatment)

(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

480. Epididymitis (Diagnosis)

a selective approach to antibiotic therapy in pediatric epididymitis. They suggest treating all young infants, regardless of urinalysis results, and older boys who have a positive urinalysis or culture. It is also recommended to presumptively treat sexually active adolescents with epididymitis for sexually transmitted infections. This study excluded boys with recent urologic surgery and known lower urinary tract anomalies. [ ] Antibiotics Empiric coverage varies with the patient's age and sexual history (...) between older and younger patients with epididymitis?. Investig Clin Urol . 2017 May. 58 (3):205-209. . Cristoforo TA. Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients: A Literature Review of Retrospective Studies and Data Analysis. Pediatr Emerg Care . 2017 Jan 17. . Boettcher M, Bergholz R, Krebs TF, Wenke K, Treszl A, Aronson DC, et al. Differentiation of Epididymitis and Appendix Testis Torsion by Clinical and Ultrasound Signs in Children

2014 eMedicine Emergency Medicine

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