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Dysuria in Children

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102. The Irish Maternity Early Warning System (IMEWS) National Clinical Guideline

National Perinatal Epidemiology Centre NSP National Service Plan NWIHP National Women and Infants Health Programme ONMSD Office of the Nursing and Midwifery Services Director PEWS Paediatric Early Warning System QC-M Quality Care-Metrics QI Quality Improvement SAFE Situation Awareness for Everyone SMM Severe Maternal Morbidity TYC Test Your Care WHO World Health Organization9 | A National Clinical Guideline | Irish Maternity Early Warning System V2 1 National Clinical Guideline recommendations 1.1 (...) and the National Women and Infants Health Programme. Membership nominations were sought from a variety of clinical and non-clinical backgrounds to represent stakeholders within the maternity services. GDG members included those involved in obstetrics, midwifery, anaesthetics, neonatology, clinical risk, quality assurance, Clinical Indemnity Scheme, education, the National Women and Infants Programme and two representatives of maternity service users (Table 1). Table 1: Members of the Childbirth GDG Name Job

2019 HIQA Guidelines

103. 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

104. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease (2019 Interim Update)

PID guideline V4 page 7 • urinary tract infection – often associated with dysuria and/or urinary frequency • irritable bowel syndrome – disturbance in bowel habit and persistence of symptoms over a prolonged time period are common. Acute bowel infection or diverticular disease can also cause lower abdominal pain usually in association with other gastrointestinal symptoms. • functional pain (pain of unknown aetiology) – may be associated with longstanding symptoms Management It is likely (...) - Cognitive - Mobility - Other impairment There are no data to suggest any link between this condition and disability status, although people with mental health problems are at disproportionate risk of STIs in general None identified although use of clinical tests in guideline may improve diagnostic accuracy in non verbalising patients Dept of Health Low PID guideline V4 page 20 Age - Older people - Children and young people - Young adults Young woman are disproportionately at greater risk

2019 British Association for Sexual Health and HIV

105. 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

106. 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

107. 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

108. 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

109. 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

110. 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

111. 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

112. 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

113. 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

114. Lichen Sclerosus

), especially in children, causing constipation.(Marren 2005) Soft stools after a fiber rich diet may help. Lichen sclerosus in men and boys usually occurs on the glans penis and/or foreskin, with a predilection in the perifrenular aerea, and may cause phimosis in a previously retractable foreskin or adhesions of the foreskin to the glans causing dysuria or painful erection. Perineal involvement in men is rarely observed. Meatal stenosis may lead to problems passing urine and urinary obstruction; urethral (...) be superimposed, and these should be treated. Histological features A biopsy is not necessary in all patients in particular if the clinical picture is diagnostic. In children a vulval biopsy is not usually performed, because it may be very traumatic for the child. It should be reserved for cases with an uncertain diagnosis and thosewho fail to respond to treatments.(Neill 2010) Typical histological features of LS are orthohyperkeratosis, epidermal atrophy, basal cell degeneration, dermal hyalinisation

2018 European Dermatology Forum

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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