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Dysuria in Children

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121. British Association of Dermatologists' guidelines for the management of lichen sclerosus

. Further referral to a specialist urologist and bariatric services may be required. Children and young people-female R23 (GPP) Refer female children and young people with LS to specialized vulval services (vulval clinic, paediatric derma- tologist or urologist experienced in managing LS). R24 (GPP) Consider referral to a specialist vulval clinic in female patients (also adults) with LS not responding to topical steroids, or if surgical management is being considered. R25 ( ) Offer* all female patients (...) activeLSdisease despitegoodcompliance. Children and young people – male R28 ( ) Offer* a trial of an ultrapotent topical steroid applied once daily for 1–3 months combined with emollients and barrier preparations to all male children and young people with phimosis caused by LS. R29 ( ) Offer all male children with phimosis caused by LS who do not respond to topical steroids after 1–3 months referral to a paediatric urologist for circumcision. Disease of the glans unmasked by circumcision should be treated

2018 British Association of Dermatologists

122. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

community-dwelling adult women with symptoms of UI Subpopulations: • women engaging in athletic activity, • older women • women in the military or veterans • racial and ethnic minorities If >10% of study participants are from ineligible groups (children or adolescents, men, pregnant women, institutionalized or hospitalized participants, or have surgically-treated UI) Interventions Nonpharmacological interventions: Behavioral interventions, neuromodulation, intravesical pressure release devices

2018 Effective Health Care Program (AHRQ)

123. CRACKCast E174 – Genitourinary and Renal Tract Disorders

the condition is secondary to an STI. Patients present with a painful edematous scrotum and tenderness at the epididymis. Nausea, vomiting, fever, and lower abdominal, scrotal, or testicular pain may be present. Infants and young children may present with isolated fever. Diagnosis: U/A +/- culture Capture first void and wait for results if suspicious of STI Management: Scrotal elevation, ice packs to the scrotal area, and pain medications are useful to control pain and inflammation. Sexually active (...) acquired epididymitis without evidence of a urinary tract infection may be managed expectantly without antibiotics. Infants with or without positive findings on urinalysis and young children with positive urinalysis findings may be treated with cephalexin tid if a bacterial urinary tract infection is suspected. Orchitis: Usually viral or bacterial testicular infection Symptoms: Tenderness, edema, swelling, discolouration of the scrotum If there is urethral discharge think of epididymo-orchitis Causes

2018 CandiEM

125. 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

126. 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

127. 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

128. 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

130. 2018 United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease

occurs in most patients with appendicitis but only 50% of those with PID. Cervical movement pain will occur in about a quarter of women with appendicitis 29,30 . ? endometriosis – the relationship between symptoms and the menstrual cycle may be helpful in establishing a diagnosis ? complications of an ovarian cyst e.g. torsion or rupture – symptoms are often of sudden onset 8 ? urinary tract infection – often associated with dysuria and/or urinary frequency ? irritable bowel syndrome – disturbance (...) identified although use of clinical tests in guideline may improve diagnostic accuracy in non verbalising patients Dept of Health Low 21 Age - Older people - Children and young people - Young adults Young woman are disproportionately at greater risk of this condition in common with other sexually transmitted infections Accurate diagnosis and better tolerated treatments should improve the burden of disease in the community. Dept of Health Medium Sexual orientation and gender identity - Lesbians - Gay men

2018 British Association for Sexual Health and HIV

131. Suspected cancer: recognition and referral

Introduction 6 Safeguarding children 7 Patient-centred care 8 T erms used in this guideline 9 1 Recommendations organised by site of cancer 11 1.1 Lung and pleural cancers 11 1.2 Upper gastrointestinal tract cancers 13 1.3 Lower gastrointestinal tract cancers 16 1.4 Breast cancer 17 1.5 Gynaecological cancers 18 1.6 Urological cancers 20 1.7 Skin cancers 22 1.8 Head and neck cancers 24 1.9 Brain and central nervous system cancers 25 1.10 Haematological cancers 25 1.11 Sarcomas 28 1.12 Childhood cancers 29 (...) are in a section organised by symptoms and investigation findings. Safeguarding children Remember that child maltreatment: is common can present anywhere may co-exist with other health problems, including suspected cancer. See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment. Suspected cancer: recognition and referral (NG12) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

132. Complicated urinary tract infections: ceftolozane/tazobactam

such as people with complicated lower urinary tract infection, older people or people with moderate renal impairment. Ceftolozane/tazobactam has not been studied in people with severe neutropenia, or those who are immunocompromised or who have severe renal impairment. It is not indicated for use in children (summary of product characteristics). Ceftolozane/tazobactam is administered by IV infusion. Resource implications Resource implications A vial of ceftolozane/tazobactam costs £67.03 excluding VAT (MIMS (...) to be complicated in people with increased susceptibility, Complicated urinary tract infections: ceftolozane/tazobactam (ESNM74) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 27for example children or older people; people with functional or structural abnormalities of the genitourinary tract or people who are immunocompromised, so that the infection will likely be severe (Frassetto 2015). Complicated urinary tract

2016 National Institute for Health and Clinical Excellence - Advice

133. Orthostatic hypotension due to autonomic dysfunction: midodrine

mg 3 times daily increased standing blood pressure statistically significantly more than placebo, 1 hour after the dose was taken. Improvements in patient- and investigator-rated symptoms were seen with midodrine compared with placebo in both RCTs. However, the symptom measurement scales were not reported to have been validated. Safety Safety According to the summary of product characteristics, the most common adverse effects of midodrine are piloerection, pruritus of the scalp and dysuria (...) of the scalp and dysuria, which lead to discontinuation of treatment in some people. Patients should be monitored for supine hypertension, which occurs in between 1 in 10 and 1 in 100 people. Reducing the dose of midodrine may resolve supine hypertension but, if it does not, treatment must be stopped. See the summary of product characteristics for more information. The main limitation of the 2 RCTs is the focus on disease-oriented outcomes (changes in standing blood pressure), as opposed to patient

2015 National Institute for Health and Clinical Excellence - Advice

134. Interstitial cystitis: oral pentosan polysulfate sodium

to participants. Three of the studies asked people to report their level of 'pain' (Parsons and Mulholland 1987, Mulholland et al. 1990, Parsons et al. 1993), and one study assessed 'pain' and 'dysuria' as separate symptoms (Holm-Bentzen et al. 1987). Data was available from all 4 studies on pain (n=398), with 76 out of 204 people in the pentosan group reporting improvement in pain scores of 50% or more, compared with 41 out of 194 people taking placebo (percentage difference 16.6%, 95% confidence interval (...) , Placebo Controlled Study. The Journal of Urology 193: 857–862 Parsons CL, Benson G, Childs SJ et al. (1993) A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosanpolysulfate. The Journal of Urology 150; 3: 845–848 Parsons CL, Mulholland SG (1987) Successful therapy of interstitial cystitis with pentosanpolysulfate. The Journal of Urology 138; 3: 513–516 Sairanen J, T ammela TL, Leppilahti M et al. (2005) Cyclosporine A and pentosan

2015 National Institute for Health and Clinical Excellence - Advice

135. Neutropenic sepsis: When should I suspect neutropenic sepsis?

to identify in people who are neutropenic, as there may be minimal or a typical symptoms and/or signs of infection or sepsis. Suspect a diagnosis of in any person with known neutropenia or with (such as undergoing chemotherapy), and/or with , who has any of the following features: Symptoms or signs indicating possible infection such as dysuria, diarrhoea, or productive cough. This includes people who are deteriorating unexpectedly, or failing to improve as expected. Note: sepsis may result from infection (...) in a review article notes that if a child undergoing anticancer treatment is unwell, sepsis should be considered early, even if they do not have a fever [ ]. When to suspect neutropenic sepsis The recommendations on when to suspect neutropenic sepsis are based on the NICE clinical guideline [ ], the ESMO clinical guidelines [ ], the German Society of Hematology and Medical Oncology guidelines [ ], and expert opinion in review articles [ ; ; ]. The information that sepsis can present with a wide variety

2017 NICE Clinical Knowledge Summaries

136. Neutropenic sepsis: How should I assess a person with suspected neutropenic sepsis?

/carers about: Any known . Any recent fever or rigors. Be aware that people with neutropenic sepsis may not present with fever, and may present with hypothermia. Any symptoms suggesting a focus of infection, such as dysuria, diarrhoea, or productive cough. Clinical features suggesting dehydration, such as reduced urine output in the past 18 hours. Any altered behaviour, mental state, or cognition. See the CKS topic on for more information. If the person is known to have cancer, the type of cancer (...) exanthems in people who are immunosuppressed may present atypically. Weak high-pitched or continuous cry (in children under 5 years of age). Any breach of skin integrity (for example cuts, burns, or skin infections) or other skin signs suggesting infection or mucositis. See the CKS topics on and for more information. Dry mucous membranes or other signs of dehydration. See the CKS topic on for more information on assessment. The possible underlying source of infection. Be aware that people who

2017 NICE Clinical Knowledge Summaries

137. Chilblains: Nifedipine

dihydropyridines (theoretical risk of cross-reactivity) or any of the excipients. To people with unstable angina, cardiogenic shock, significant aortic stenosis, unstable angina, or within 1 month of myocardial infarction. To women who are pregnant or breastfeeding — seek specialist advice if these women require treatment. To children under the age of 18 years — safety in children has not been established. To people taking rifampicin. Rifampicin induces the cytochrome P450 system —bioavailability of nifedipine (...) formulations may be associated with large variations in blood pressure and reflex tachycardia. Uncommon — angioedema; anxiety; chills; dyspnoea; dysuria; epistaxis; erectile dysfunction; hypersensitivity reactions; jaundice; joint swelling; migraine; myalgia; nasal congestion; nocturia; paraesthesia; polyuria; pruritus; rash; sleep disturbance; sweating; syncope; tachycardia; tremor; urticaria; vertigo; visual disturbance. Cardiac ischaemic pain has been reported, in a small proportion of people, after

2017 NICE Clinical Knowledge Summaries

138. CRACKCast E099 – Urological Disorders

of the ipsilateral testicle is considered evidence of a normal reflex. This reflex normally is absent in 50% of male infants younger than 30 months.” [1] List causes of acute scrotal swelling by age groups (infant, child, adolescent, adult) Infant Child Adolescent Adult Hernia Hydrocele Hernia Torsion Epididymitis Epididymitis Torsion Trauma Epididymitis Hernia Trauma Tumor Torsion Fournier’s gangrene [2] Describe the physiology, diagnosis and management of testicular torsion Bimodal onset: <1 yr and at puberty (...) Hematuria UTIs in Adults – Rosens in Perspective Most frequent bacterial infection in adults, one of the most common causes of sepsis Diagnosis is made by: Urinary specific symptoms (dysuria, frequency, urgency, hematuria, suprapubic/CVA discomfort) Bacteriuria (note this alone does not equal UTI! – unless patient Is pregnant or immunocompromised) No other source of infection Classified as: Lower (bladder only) vs. upper (ureters and kidney) Uncomplicated or complicated How is UTI diagnosed? What

2017 CandiEM

139. CRACKCast E095 – Large Intestine

in children and adolescents, delayed sexual maturation Thromboembolic disease **Thromboembolic disease risk – 60% increased DVT PE Cerebral sinus thrombosis Ischemic heart disease Mesenteric ischemia Peripheral neuropathy 5) How does adult intussusception differ from peds Adults: Vague, undifferentiated presentations – age 65 yrs Usually cause by a mass (60% benign neoplasms, 30% malignant) CT diagnosis Need surgery usually Not so happy endings Kids: Vague, undifferentiated presentations, but second most (...) : Bloating Crampy pain Excessive gas Change in bowel habits 10-30% of people progress to diverticulitis (West = left side, Japan = right side) ITIS presentation: LLQ pain (referred to groin or suprapubic) RLQ pain in some! Peritonitis (if perforation) Dysuria / pneumaturia (colovesical fistula) Vomiting / distension (if obstructed) Feces / gas from vagina (colovaginal fistula) A tentative diagnosis can be made clinically, but a CT scan is routinely performed to exclude alternative dx, or complicated

2017 CandiEM

140. CRACKCast E093 – Appendicitis

of urinary frequency and dysuria or rectal symptoms, such as tenesmus and diarrhea. Children “ Appendicitis is uncommon in neonates, infants and preschool children . Mortality from neonatal appendicitis approaches 28 percent and reflects the difficulty in establishing the diagnosis prior to advanced disease with bowel perforation and sepsis. Case reports indicate that abdominal distension, vomiting, and decreased feeding are the most commonly reported findings in neonates with appendicitis ….. Fever (...) from 8-20 cm in length – which is why the pain can be almost anywhere! 1) List 8 DDx for this condition ALL PATIENTS FEMALE PATIENTS PEDIATRIC PATIENTS Nonspecific abdominal pain Gastroenteritis Epiploic appendagitis Ureterolithiasis, nephrolithiasis Inflammatory bowel disease Ileus or bowel obstruction Intestinal perforation Testicular torsion (males) Ectopic pregnancy Ovarian torsion Pelvic inflammatory disease Ovarian cyst Henoch-Schönlein purpura Mesenteric lymphadenitis Meckel’s diverticulum 2

2017 CandiEM

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