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Dysuria in Children

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101. British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae

of gonorrhoea in people aged 16 years and older. For individuals under the age of 16 years please see the BASHH guideline on STI and Related Conditions in Children and Young People. The guidelines are primarily aimed at level 3 sexual health services within the United Kingdom (UK) although the principles of the recommendations could be adopted at all levels. EDITORIAL INDEPENDENCE This guideline was commissioned and edited by the Clinical Effectiveness Group (CEG) of the British Association for Sexual (...) , on the site of infection. Co-existing infections and conditions such as Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans and bacterial vaginosis, are not uncommon and these should be considered as a possible cause for an individual’s symptoms. 2.1 Penile urethral infection Symptoms occur in over 90% of individuals, with discharge and/or dysuria appearing two to five days following exposure. A mucopurulent urethral discharge is often present on examination. Rarely

2019 British Association for Sexual Health and HIV

102. 34m with fever, headache and myalgias

with a UTI and prescribed doxycycline. But he discontinues this after four days as his symptoms remained unchanged. Of note, the patient denied any dysuria, urgency, abdominal pain, or flank pain at the time of this diagnosis. Two days later, he has an episode of epistaxis while blowing his nose and presents to the same outside ER for evaluation. At that point, he is found to have multiple lab abnormalities, prompting his transfer to for further care. The patient is a sanitation worker in NYC. He stays (...) in an apartment in Brooklyn during the week and travels to Long Island on the weekends to be with his wife and children. He denies any travel outside of NY. He smokes one pack per day and drinks a 6-pack of beer on weekends. Shira Based on the history so far, take a few minutes to organize your thoughts and we’ll meet back up after the break! ♫ Musical Interlude ♫ Shira Welcome back! I sat down with my friend and mentor Dr. Stephanie Sherman, an academic hospitalist at Baylor College of Medicine in Houston

2019 Clinical Correlations

103. Asymptomatic Bacteriuria

, background, and evidence summaries that sup- port each recommendation can be found in the full text of the guideline. RECOMMENDATIONS FOR ASYMPTOMATIC BACTERIURIA I. Should Asymptomatic Bacteriuria Be Screened for and Treated in Pediatric Patients? Recommendation 1. In infants and children, we recommend against screening for or treating asymptomatic bacteriuria (ASB) (strong recom- mendation, low-quality evidence). II. Should ASB Be Screened for or Treated in Healthy Nonpregnant Women? Recommendation 1 (...) , University of Manitoba, Winnipeg, Canada; 2 Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts; 3 Division of Infectious Diseases, University of Michigan, Ann Arbor; 4 Department of Family and Community Medicine, University of Maryland, Baltimore; 5 Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison; 6 Division of Infectious

2019 Infectious Diseases Society of America

104. Bladder Stones

of 652 cases. Irish Med J, 1975. 68: 85. 19. Childs, M.A., et al. Pathogenesis of bladder calculi in the presence of urinary stasis. J Urol, 2013. 189: 1347. 20. Türk, C., et al., EAU Guidelines on Urolithiasis, in European Association of Urology Guidelines. 2019, EAU Guidelines Office: Arnhem, The Netherlands. 21. Soliman, N.A., et al. Endemic bladder calculi in children. Pediatr Nephrol, 2017. 32: 1489. 22. Millan-Rodriguez, F., et al. Urodynamic findings before and after noninvasive management (...) stone disease in children: clinical studies. J Pak Med Assoc, 1984. 34: 94. 15. Philippou, P., et al. The management of bladder lithiasis in the modern era of endourology. Urology, 2012. 79: 980. 16. Lal, B., et al. Childhood bladder stones-An endemic disease of developing countries. J Ayub Med Coll Abbottabad, 2015. 27: 17. 17. Douenias, R., et al. Predisposing factors in bladder calculi: Review of 100 cases. Urology, 1991. 37: 240. 18. Smith, J.M., et al. Vesical stone: the clinical features

2019 European Association of Urology

105. Neuro-urology

, 2008. Dev Med Child Neurol, 2014. 56: 59. 27. Samijn, B., et al. Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review. Neurourol Urodyn, 2017. 36: 541. 28. Tagliaferri, F., et al. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien), 2006. 148: 255. 29. Kulakli, F., et al. Relationship between urinary dysfunction and clinical factors in patients with traumatic brain injury. Brain Inj, 2014. 28: 323. 30 (...) , etiology and prevention. Int J Urol, 2009. 16: 49. 34. Sawin, K.J., et al. The National Spina Bifida Patient Registry: profile of a large cohort of participants from the first 10 clinics. J Pediatr, 2015. 166: 444. 35. Bartolin, Z., et al. Relationship between clinical data and urodynamic findings in patients with lumbar intervertebral disk protrusion. Urol Res, 2002. 30: 219. 36. Lange, M.M., et al. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol, 2011. 8: 51. 37. Int

2019 European Association of Urology

106. Urological Infections

Guidelines on Paediatric Urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 2. Blok, B., et al. EAU Guidelines on Neuro-urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 3. Guyatt, G.H., et al. What is “quality of evidence” and why is it important to clinicians? BMJ, 2008. 336: 995. 4. Phillips B, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated (...) . Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents, 2009. 33: 111. 128. Bauer, H.W., et al. A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol, 2005. 47: 542. 129. Schwenger, E.M., et al. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev, 2015: CD008772. 130. Kontiokari, T., et al. Randomised trial

2019 European Association of Urology

107. Diagnosis and Management of Hymenal Variants

of thin hymenaltissuewithadarkorbluishhuecausedbythehematocolposbehindit.Otherfindingsthatmaybepresent include an abdominal mass, urinary retention, dysuria, constipation, and dyschezia. On evaluation, the goal is to differentiateanimperforatehymenfromotherobstructinganatomicetiologies,suchaslabialadhesions,urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Surgical intervention is necessary only in symptomatic prepubertal patients. After confirmation of the diagnosis, surgical (...) ,dysuria,constipation,anddyschezia. Microperforateor Septate Hymen It is important to note that a microperforate hymen or septate hymen may not present as an obstruction. Often there will be menstrual efflux; however, depending on the degree of perforation or efflux, there may be retained menstrual blood with malodorous discharge, particularly withamicroperforatehymen.Mostoften,thepatientwith a microperforate or septate hymen will present when she has difficulty placing tampons, has a retained tampon

2019 American College of Obstetricians and Gynecologists

108. Sepsis: How should I assess a person with suspected sepsis?

symptoms suggesting specific infection, such as dysuria or productive cough. Clinical features suggesting dehydration, such as reduced urine output in the past 18 hours. Any altered behaviour, mental state, or cognition, such as not responding normally to social cues or waking only with prolonged stimulation, or new irritability (in children); new-onset confusion (in adults). See the CKS topic on for more information. Any sudden change or deterioration in functional ability. Possible for sepsis (...) , including co-morbidities and drug treatments. Possible risk factors for antibiotic resistance, such as recent or previous antibiotic therapy, previous hospital admissions, and residency in a care home, for example. Immunization status (particularly in infants and young children). Examine the person to assess for: General appearance, level of consciousness and cognition. Cognitive assessment should include recognition of new-onset confusion, disorientation, and/or agitation. See the CKS topic

2019 NICE Clinical Knowledge Summaries

109. Complications after bladder augmentation or substitution in children: a prospective study of 86 patients. Full Text available with Trip Pro

Complications after bladder augmentation or substitution in children: a prospective study of 86 patients. • To evaluate complications after urinary bladder augmentation or substitution in a prospective study in children.• Data of 86 patients who underwent urinary bladder augmentation (80 patients) or substitution (6 patients) between 1988 and 2008 at the authors' institute were analysed. • Ileocystoplasty occurred in 32, colocystoplasty in 30 and gastrocystoplasty in 18. Urinary bladder (...) , there were a total of 105 complications (39 bladder stones, 16 stoma complications, 11 bowel obstructions, 5 reservoir perforations, 7 VUR recurrences, 1 ureteral obstruction, 4 vesico-urethral fistulae, 4 orchido-epididymitis, 4 haematuria-dysuria syndrome, 3 decreased bladder capacity/compliance, 3 pre-malignant histological changes, 1 small bowel bacterial overgrowth and 7 miscellaneous). • In 25 patients, more than one complication occurred and required 91 subsequent surgical interventions. Patients

2011 BJU international

110. Meatotomy using local anesthesia and sedation or general anesthesia with or without penile block in children: a prospective randomized study. (Abstract)

, university affiliated, pediatric medical center in 2008. Children were randomly allocated to undergo surgery with sedation and local anesthesia, or general anesthesia with or without penile block. All procedures were performed with the same method by the same surgeon. For local anesthesia EMLA 5% cream (lidocaine 2.5% and prilocaine 2.5%) covered with an occlusive dressing was applied 1 hour preoperatively, and midazolam (in patients younger than 5 years) or nitrous oxide (older than 5 years) was used (...) Meatotomy using local anesthesia and sedation or general anesthesia with or without penile block in children: a prospective randomized study. Meatotomy is a simple, common procedure for the treatment of meatal stenosis. We compared the outcomes of meatotomy performed using local anesthesia and sedation, and general anesthesia with and without penile block.A prospective comparative design was used. Participants included 76 boys 1.5 to 10 years old treated for meatal stenosis at a tertiary

2011 The Journal of urology Controlled trial quality: uncertain

111. Unusual Presentation of a Mullerian Remnant in an Infant with Recurrent Epididymo-orchitis. (Abstract)

Unusual Presentation of a Mullerian Remnant in an Infant with Recurrent Epididymo-orchitis. Mullerian duct remnants result from incomplete regression, a defect that occurs during sexual differentiation. Ninety percent of patients with mullerian remnants also have an associated disorder of sexual differentiation such as hypospadias. Presenting signs and symptoms are recurrent bladder infection, perineal pain, dysuria, or infertility. The purpose of this case report is to recount an unusual

2011 Urology

112. Urinary Tract Infection (Cystitis) - acute, uncomplicated

of the kidneys. Requires referral Symptoms of uncomplicated UTI: Primary symptoms - dysuria, urinary frequency, urinary urgency May also present with suprapubic pain, mild hematuria, foul-smelling or cloudy urine Symptoms may be subtle or atypical (such as confusion or agitation) in the very young or elderly (<16 or >65). These patients should be referred Signs and symptoms NOT characteristic of UTIs: Systemic symptoms, such as fever, chills, nausea, or vomiting, flank pain (pain in the side or back below (...) the ribs) Vaginal discharge or irritation Urine culture is not recommended except in the following circumstances: Failure to respond to appropriate empiric therapy Relapse (recurrence within 2 to 4 weeks) following therapy Uncertainty about diagnosis Pregnant patient Women can accurately self-diagnose a recurrent UTI based on symptoms 85 to 95% of the time; presumptive diagnosis can be made based on presence of dysuria and urinary frequency and urgency and absence of vaginal symptoms (abnormal

2018 medSask

113. Sexually Transmitted Infections

are present, as friction may delay healing. • Oral to genital transmission of HSV-1 is very common through oral sex. This can happen when ‘cold sores’ are not causing symptoms. • Genital herpes does not affect your fertility or stop you having children. Vaginal delivery is usual for most women with a history of genital herpes. • Genital herpes does not stop you having sex. • Anybody with genital herpes, whether they get symptoms or have never had symptoms, may shed the virus from time to time (...) status unknown and risk factors present e.g. Maori, Pasifika, areas of high endemicity, IDU or incarceration www.hepatitisfoundation.org.nz/ Symptomatic Examination is required for clinical assessment if symptomatic of vaginal discharge, dysuria, lower abdominal pain, abnormal bleeding, anal pain or discharge, or a contact of gonorrhoea: • Examine the inguinal nodes, vulval and perianal skin, vestibule and introitus. • Vulvovaginal NAAT swab for chlamydia & gonorrhoea testing prior to speculum

2017 New Zealand Sexual Health Society

114. Gonorrhoea

check in females • Pre-termination of pregnancy (TOP) • Pre-intrauterine device (IUD) insertion • Routine sexual health check in man who has sex with other men (MSM) • Signs or symptoms suggestive of gonorrhoea – Females: Vaginal discharge/dysuria/lower abdominal pain/abnormal bleeding/anal pain or discharge – Males: Urethral discharge/dysuria/testicular pain or swelling/anal pain or discharge Note: Most laboratories are automatically performing multiplex NAAT testing for chlamydia & gonorrhoea (...) to be symptomatic than females with endocervical infection. Symptoms and signs are non-specific. Females • Often asymptomatic, but may complain of vaginal discharge, dysuria,lower abdominal pain, abnormal bleeding, anal pain or discharge. • There may be signs of purulent urethral discharge, mucopurulent cervicitis with easily induced bleeding and/or signs of PID. Males • Males with urethral infection are usually symptomatic with discharge and dysuria (see Urethritis guideline www.nzshs.org/guidelines

2017 New Zealand Sexual Health Society

115. Trichomonas

dysuria, urethral irritation or discharge. Complications • Usually no complications. • In pregnancy, trichomoniasis has been associated with low birth weight, premature rupture of membranes, and preterm delivery. However, it is unclear whether treatment of asymptomatic infection in pregnancy reduces these outcomes. • Increased risk of post-surgical and post-partum infections are also associated with concurrent trichomoniasis. • Mother to child transmission during delivery is possible, but usually has (...) Asymptomatic male contacts: • Full sexual health check (see Sexual Health Check guideline www.nzshs.org/guidelines) including first void urine (first 30ml), preferably =1 hour after last void for trichomoniasis testing by NAAT if available locally • Treat empirically for trichomoniasis • Male contacts with dysuria or discharge (see Urethritis in Males guideline www.nzshs.org/guidelines) Symptomatic male contacts: • See Urethritis in Men guideline www.nzshs.org/guidelines TEST IF: • Female with vaginal

2017 New Zealand Sexual Health Society

116. Neuro-urology

Med Child Neurol, 2014. 56: 59. 27. Samijn, B., et al. Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review. Neurourol Urodyn, 2017. 36: 541. 28. Tagliaferri, F., et al. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien), 2006. 148: 255. 29. Kulakli, F., et al. Relationship between urinary dysfunction and clinical factors in patients with traumatic brain injury. Brain Inj, 2014. 28: 323. 30. Aruga, S (...) and prevention. Int J Urol, 2009. 16: 49. 34. Sawin, K.J., et al. The National Spina Bifida Patient Registry: profile of a large cohort of participants from the first 10 clinics. J Pediatr, 2015. 166: 444. 35. Bartolin, Z., et al. Relationship between clinical data and urodynamic findings in patients with lumbar intervertebral disk protrusion. Urol Res, 2002. 30: 219. 36. Lange, M.M., et al. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol, 2011. 8: 51. 37. Int. Diabetes Federation

2018 European Association of Urology

117. Urological Infections

Guidelines on Paediatric Urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 2. Blok, B., et al. EAU Guidelines on Neuro-urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 3. Guyatt, G.H., et al. What is “quality of evidence” and why is it important to clinicians? BMJ, 2008. 336: 995. 4. Phillips B, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated (...) . Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents, 2009. 33: 111. 128. Bauer, H.W., et al. A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol, 2005. 47: 542. 129. Schwenger, E.M., et al. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev, 2015: CD008772. 130. Kontiokari, T., et al. Randomised trial

2018 European Association of Urology

118. Adult Urodynamics

Quality: Grade C ) 19. Clinicians may perform videourodynamics in properly selected patients to localize the level of obstruction, particularly for the diagnosis of primary bladder neck obstruction. (Expert Opinion) Purpose Lower urinary tract symptoms (LUTS), which include urinary incontinence, are a common and significant source of impaired quality of life and comorbidity in large numbers of adults and children. Commonly, patients presenting with LUTS have overlapping symptoms and conditions, making (...) organ prolapse. Studies published after March 10, 2011 were not included as part of the evidence base considered by the Panel from which evidence-based guideline statements (Standards, Recommendations, Options) were derived. Data from studies published after the literature search cut-off will be incorporated into the next version of this guideline. Preclinical studies (e.g., animal models), pediatric studies, meeting abstracts, commentary, editorials, non-English language studies and studies

2018 American Urological Association

119. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units: HAI-Net ICU protocol, version 2.2

Surveillance of HAI and prevention indicators in European intensive care units 7 3.3 Pneumonia (PN 1 –PN 5) X-ray Two or more serial chest X-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease* (in patients without underlying cardiac or pulmonary disease, one definitive chest X- ray or CT-scan is sufficient). Symptoms and at least one of the following: ? fever > 38 °C with no other cause ? leukopenia ( 38 °C), urgency, frequency, dysuria (...) , or suprapubic tenderness and ? Patient has a positive urine culture, i.e. = 10 5 microorganisms per ml of urine with no more than two species of microorganisms. 3.4.2 UTI-B: not microbiologically confirmed symptomatic UTI ? Patient has at least two of the following, with no other recognised cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness; And at least one of the following: ? positive dipstick for leukocyte esterase and/or nitrate ? pyuria urine specimen with = 10 WBC/ml or = 3

2017 European Centre for Disease Prevention and Control - Technical Guidance

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