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Dysuria in Children

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121. 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

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. Pentosan polysulfate sodium (Elmiron) - Interstitial Cystitis

on Paediatric requirements Not applicable Information relating to orphan market exclusivity Similarity Pursuant to Article 8 of Regulation (EC) No. 141/2000 and Article 3 of Commission Regulation (EC) No 847/2000, the applicant did not submit a critical report addressing the possible similarity with authorised orphan medicinal products because there is no authorised orphan medicinal product for a condition related to the proposed indication. Protocol Assistance The applicant received protocol Assistance (...) . Introduction The finished product is presented as hard capsules containing 100 mg of pentosan polysulfate sodium as active substance. Other ingredients of the capsule contents are microcrystalline cellulose and magnesium stearate. Ingredients of the capsule shell are gelatin and titanium dioxide (E171). The product is available in HDPE bottle with a tamper-evident PP child resistant closure and PVC/Aclar- Aluminium blisters, as described in section 6.5 of the SmPC. 2.2.2. Active Substance General

2017 European Medicines Agency - EPARs

124. Padeliporfin (Tookad) - prostate cancer / Prostatic Neoplasms

refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The applicant indicated that padeliporfin was considered to be a new active substance. The application submitted is composed of administrative information, complete quality data, non-clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain tests or studies. Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC

2017 European Medicines Agency - EPARs

126. 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

127. 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

128. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium

malformations. Paediatr Perinat Epidemiol, 2009. 23(1): p. 18-28. 87. Briggs, G.G., Drug effects on the fetus and breast-fed infant. Clin Obstet Gynecol, 2002. 45(1): p. 6-21. 88. Horne, H.W., Jr. and R.B. Kundsin, The role of mycoplasma among 81 consecutive pregnancies: a prospective study. Int J Fertil, 1980. 25(4): p. 315-7. 89. Czeizel, A.E. and M. Rockenbauer, Teratogenic study of doxycycline. Obstet Gynecol, 1997. 89(4): p. 524-8. 90. Kelsey, J.J., et al., Presence of azithromycin breast milk (...) sexual contact and risk of reinfection) of individuals with disease caused by M. genitalium infection should be tested and/or offered epidemiological treatment (using the same antimicrobial regimen as used in the index patient). This is to reduce the risk of re-infection in the index case. 8 3. Clinical Features 3.1 Signs and symptoms in males: [3] None – the majority are asymptomatic [27] Urethral discharge Dysuria Penile irritation Urethral discomfort Urethritis (acute, persistent, recurrent

2018 British Association for Sexual Health and HIV

129. Balanitis: How should I assess suspected balanitis?

Balanitis: How should I assess suspected balanitis? Assessment | Diagnosis | Balanitis | CKS | NICE Search CKS… Menu Assessment Balanitis: How should I assess suspected balanitis? Last revised in October 2018 How should I assess suspected balanitis? Assess for clinical features which may suggest specific of balanitis. Ask about: and their onset and duration, including dysuria, pain, itch, bleeding, splitting, dyspareunia, sexual dysfunction, urethral discharge or exudate. Additional symptoms (...) such as joint problems or eye involvement (may suggest Reiter's syndrome or infection). Hygiene practices, for example, how often nappies are changed in children, or how often the penis is cleaned. Exposure to potential irritants or allergens, such as soaps, bubble bath, detergents, or creams; latex condoms or lubricants. Exposure to new drugs (may suggest a drug eruption) and any over-the-counter treatments tried. Trauma, for example from 'foreskin fiddling' in children; or during sexual intercourse

2018 NICE Clinical Knowledge Summaries

130. 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

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. 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

136. 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

137. 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

138. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

incontinence and concomitant neurologic disease affecting lower urinary tract function (neurogenic bladder) surgical treatment of stress urinary incontinence after appropriate evaluation and counseling have been performed. (Expert Opinion) Physicians may offer synthetic midurethral slings, in addition to other sling types, to the following patient populations after appropriate evaluation and counseling have been performed: (Expert Opinion) Patients planning to bear children Diabetes Obesity Geriatric (...) from the history, bladder diary, questionnaires, and/or pad testing. Characterization of incontinence (stress, urgency, mixed, continuous, without sensory awareness) Chronicity of symptoms Frequency, bother, and severity of incontinence episodes Patient’s expectations of treatment (patient-centered goals) Pad or protection use Concomitant urinary tract symptoms (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) Concomitant pelvic symptoms (e.g

2017 American Urological Association

139. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

, to the following patient populations after appropriate evaluation and counseling have been performed: (Expert Opinion) ? Patients planning to bear children ? Diabetes ? Obesity ? Geriatric OUTCOMES ASSESSMENT 23. Physicians or their designees should communicate with patients within the early postoperative period to assess if patients are having any significant voiding problems, pain, or other unanticipated events. If patients are experiencing any of these outcomes, they should be seen and examined. (Expert (...) , and severity of incontinence episodes ? Patient’s expectations of treatment (patient- centered goals) ? Pad or protection use ? Concomitant urinary tract symptoms (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) ? Concomitant pelvic symptoms (e.g., pelvic pain, pressure, bulging, dyspareunia) ? Concomitant gastrointestinal symptoms (e.g., constipation, diarrhea, splinting to defecate) ? Obstetric history (e.g., gravity, parity, method of delivery

2017 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

140. 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

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