Urethral syndromes in children.

Abstract

1. Walid Farhat, MD* 2. Gordon McLorie, MD* 1. 2. *Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Objectives After completing this article, readers should be able to: 1. Describe the evaluation of a child suspected of having urethritis. 2. Delineate the screening tests that have the highest yield for urethritis in young children. 3. List components of a behavioral modification approach to treating dysfunctional voiding. 4. Compare and contrast physical findings in gonococcal and nongonococcal urethritis. Inflammation of the urethra (urethritis) may be due to infection, trauma, allergy, foreign body, or an undetermined factor. Certain characteristics distinguish urethritis in the pediatric population from that in adults. First, urethritis in adults and adolescents has an infectious etiology and always is the result of sexual contact; infectious urethritis in the pediatric age group is uncommon, except in sexually active adolescents or children who have been sexually abused by an adult who has the disease. Second, the variability and nonspecificity of a variety of noninfectious urethral pathologies may mimic infectious urethritis in children. Children who have urethritis may present with irritative voiding symptoms, such as dysuria, urgency, or frequency; possible urethral discharge; initial hematuria; or blood spotting on the underwear. Patients suspected of having urethritis are evaluated with a detailed history, physical examination, urethral smear, or urine culture. In girls, examination may show evidence of vaginitis, which is a common cause of dysuria after urinary tract infection, labial adhesions, or even sexual abuse; in males, results of the examination frequently are inconclusive. In infants, young children, and sexually inactive adolescents, screening tests that have the highest yield include urinalysis and abdominal ultrasonography (US); uroflow is reserved for toilet-trained children. The urine should be examined for evidence of infection or hematuria. Abdominal US can diagnose a variety of abnormalities, including bladder stone or inflammation, ureterocele, foreign body, or tumor. Uroflow is a noninvasive urodynamics test that assesses the ability to initiate voiding on command, quantitates …