{
"topic": "Urethritis",
"slug": "urethritis",
"category_id": 15106,
"passage_count": 14,
"source_chars": 13077,
"enough_material": true,
"references": [
{
"title": "Signs and Symptoms in Pediatrics",
"author": "Henry M. Adam,Jane Meschan Foy",
"pages": [
275,
276
]
},
{
"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)",
"author": "CamScanner",
"pages": [
484,
486
]
},
{
"title": "Update in Pediatrics",
"author": null,
"pages": [
510
]
},
{
"title": "Algorithms in Pediatrics",
"author": null,
"pages": [
510
]
},
{
"title": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition",
"author": "American Academy of Pediatrics",
"pages": [
448
]
},
{
"title": "Pediatric Clinical Practice Guidelines and Policies",
"author": "American Academy of Pediatrics (AAP);",
"pages": [
546,
1271
]
},
{
"title": "Berkowitz's Pediatrics",
"author": "Berkowitz, Carol D.;",
"pages": [
864
]
},
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
3992
]
}
],
"passages": [
{
"source": "Signs and Symptoms in Pediatrics, p. 275",
"text": "**Figure 21-2** Algorithmic approach to dysuria in prepubertal males and females. _(Adapted with permission from Fleisher GR. Evaluation of dysuria in children. In: Bassow DS (ed);_ UpToDate, _Waltham MA. Copyright \u00a9 2013 UpToDate, Inc. Available at: www.uptodate.com .)_ tenderness with pyelonephritis. All children younger than 2 years and boys of all ages should be evaluated for congenital anatomic abnormalities, such as vesicoureteral refl ux,[3] ## **Urethritis** Urethritis can present with dysuria accompanied by discharge or blood spotting on the child\u2019s underwear. Causes of urethritis include infection, trauma, chemical irritation, and foreign body. Infectious causes in children are uncommon. Patients suspected of having infectious urethritis should have a urethral smear and urine culture included as part of their laboratory evaluation. Sexually transmitted infections are the major cause of urethritis in adults and Dysuria"
},
{
"source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 484",
"text": "stoppage of the offending drug; treatment with corticos. teroids is beneficial. The treatment of chronic interstitia) nephritis is symptomatic. Suggested Reading \u00ab Ulinski T, Sellier-Leclerc AL, Tudorache E, et al. Acute tubulointerstitial nephritis. Pediatr Nephrol 2012; 27:1051-7, URINARY TRACT INFECTIONS Urinary tract infection (UTI) isa common medical problem in children, affecting 3-10% girls and 1-3% boys. They are an important cause of morbidity and might result in renal damage, often in association with vesicoureteric reflux (VUR). During infancy, UTIs are equally common in boys and girls because the route of infection is often hematogenous and boys have a higher incidence of urinary tract anomalies. Beyond infancy, the incidence is higher in girls. Microblology UTIs are chiefly caused by E. coli the predominant periurethral flora, others include Klebsiella, Enterobacter and Staphylococcus saprophyticus. Proteus and Pseudomonas infections occur following obstruction or instrumentation;"
},
{
"source": "Signs and Symptoms in Pediatrics, p. 276",
"text": "## **Urethral Strictures** Urethral strictures in children can be congenital or acquired. Congenital strictures are rare. Acquired strictures occur after instrumentation, trauma, or processes accompanied by infl ammation with production of an exudate and secondary sclerosis. Th e child pre sents with dysuria, infection, or a weak urinary stream. Th e diagnosis is made by voiding cystourethrogram or cystoscopy.[5] ## **Urethral Prolapse** Urethral prolapse is the complete protrusion of the urethral mucosa beyond the meatus in girls. Although it is rare in the general population, there is an association with young age, black race or Hispanic ethnicity, and low socioeconomic status. Th e cause is unclear. Patients present with dysuria, gross hematuria, or blood spotting on the underwear. Treatment includes sitz baths, antibiotics, topical estrogens, or surgical repair. Left untreated, the prolapsed mucosa can become necrotic.[7] Signs and Symptoms in Pediatrics ## **Pelvic Infl ammatory Disease**"
},
{
"source": "Update in Pediatrics, p. 510",
"text": "Urinary tract infections (UTI) are now one of the most common causes of serious bacterial infection in children, accounting for about 7% of children ages 2\u201324 months of age with fever without a clinically apparent focus (Shaikh et al. 2008). Throughout childhood the cumulative incidence is approximately 10% in girls and 3% in boys, with a recurrence risk of 8\u201330% (Conway et al. 2007). Febrile UTIs have the highest incidence during the first year of life in girls and uncircumcised boys. UTIs in infants and young children generally present as unilateral or bilateral (febrile) pyelonephritis. Infections limited to the bladder (cystitis) are typically seen in teenage girls, are afebrile, and are easily treated with a short course of oral antibiotics. Concern about serious longterm consequences, renal scarring, hypertension, and progressive chronic kidney disease, have historically led to intensive evaluation and treatment of children with UTIs. Children with UTIs were routinely exposed to invasive diagnostic"
},
{
"source": "Algorithms in Pediatrics, p. 510",
"text": "## **DEFINITION** Urinary tract infection in children is based on the presence of a positive urine culture in a symptomatic child. There are several parts to this statement. Firstly, the child has to be symptomatic, either in the form of urinary symptoms or have a fever without an identifiable source. Secondly, urine culture being positive would vary according to the method of collection of urine (clean catch, catheter, suprapubic, etc.). As you will realize, the common test used for diagnosing UTI is not included in the pure definition of UTI. Pyuria (presence of leukocytes in the urine) is only an indicator of inflammation and not always the sign of UTI in children."
},
{
"source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 448",
"text": "- Urethra (called urethritis) - Bladder (called cystitis) - Kidneys (called pyelonephritis) UTIs are common in infants and young children. The frequency of UTIs in girls is much greater than in boys. About 3% of girls and 1% of boys will have a UTI by 11 years of age. A young child with a high fever and no other symptoms has a 1 in 20 chance of having a UTI. Uncircumcised boys have more UTIs than those who have been circumcised. ## **Symptoms** Symptoms of UTIs may include the following: - Fever - Pain or burning during urination - Need to urinate more often, or difficulty getting urine out - Urgent need to urinate, or wetting of underwear or bedding by a child who knows how to use the toilet - Vomiting, refusal to eat - Abdominal pain - Side or back pain - Foul-smelling urine - Cloudy or bloody urine - Unexplained and persistent irritability in an infant - Poor growth in an infant ## **Diagnosis**"
},
{
"source": "Pediatric Clinical Practice Guidelines and Policies, p. 546",
"text": "- Urethra (called urethritis) - Bladder (called cystitis) - Kidneys (called pyelonephritis) UTIs are common in infants and young children. The frequency of UTIs in girls is much greater than in boys. About 3% of girls and 1% of boys will have a UTI by 11 years of age. A young child with a high fever and no other symptoms has a 1 in 20 chance of having a UTI. Uncircumcised boys have more UTIs than those who have been circumcised. ## **Symptoms** Symptoms of UTIs may include the following: - Fever - Pain or burning during urination - Need to urinate more often, or difficulty getting urine out - Urgent need to urinate, or wetting of underwear or bedding by a child who knows how to use the toilet - Vomiting, refusal to eat - Abdominal pain - Side or back pain - Foul-smelling urine - Cloudy or bloody urine - Unexplained and persistent irritability in an infant - Poor growth in an infant ## **Diagnosis**"
},
{
"source": "Berkowitz's Pediatrics, p. 864",
"text": "Urinary tract infection (UTI) is among the most common bacterial infections affecting infants and children. Children with UTI frequently present with urinary symptoms such as dysuria, frequency, and urgency. Young infants and toddlers may present with nonspecific symptoms, as with other types of bacterial infection. Further, because of the subtle nature of the symptoms at the early stages of disease, medical intervention may be delayed, resulting in overwhelming sepsis. In most children, UTIs resolve completely with appropriate antibiotic therapy. In the child with an underlying anatomic or functional abnormality of the genitourinary system, such as vesicoureteral reflux (VUR) or bowel-bladder elimination dysfunction, respectively, or with delayed or inadequate antibiotic treatment, however, UTI may result in renal scarring that can sometimes cause hypertension or, rarely, end-stage renal disease."
},
{
"source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 486",
"text": "the diagnosis and management of the initial UTI in febrile infants and young children 2 to 24 months. Pediatrics 2011;128:593-610. * Garcia-Roig ML, Kirsch AJ. Urinary tract infection in the setting of vesicoureteral reflux. F1000Res. 2016 June 30;5. * Indian Society of Pediatric Nephrology. Revised statement on management of urinary tract infections. Indian Pediatr 2011; 48:709-17. + Okarska-Napierala M, Wasilewska A, Kuchar E. Urinary trag infection in children: Diagnosis, treatment, imaging\u2014comparig,,, of current guidelines. J Pediatr Urol 2017:51477-5131:30353-, + Traisman ES. Clinical management of urinary tract infection, Pediatr Ann 2016;45:e108-11. VESICOURETERIC REFLUX _ Vesicoureteric reflux (VUR) refers to the retrograde flow ofurine from bladder to ureters and pelvis at rest or during micturition. Pathogenic organisms that might be presentin the bladder can gain access to the renal parenchyma, inj- tiate inflammation and renal scarring (reflux nephropathy)."
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3992",
"text": "**Iridocyclitis** that occurs in children with juvenile idiopathic arthritis deserves special mention. Unlike most forms of anterior uveitis, it rarely creates pain, photophobia, or conjunctival hyperemia. Loss of vision may not be noticed until severe and irreversible damage has occurred. Because of the lack of symptoms and the high incidence of uveitis in these children, routine periodic screening is necessary. Ophthalmic screening guidelines are based on 3 factors that predispose children with arthritis to uveitis (Fig. 669.4): 1. Type of arthritis 2. Age of onset of arthritis 3. Antinuclear antibody (ANA) status **Choroiditis,** inflammation of the posterior portion of the uveal tract, invariably also involves the retina; when both are obviously affected, the condition is termed _chorioretinitis_ . The causes of posterior uveitis are numerous; the more common are toxoplasmosis, histoplasmosis, cytomegalovirus, sarcoidosis, syphilis, tuberculosis, and toxocariasis"
},
{
"source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 725",
"text": "and constipation. Signs and symptoms of UTI vary with the child's age. Neonates and infants up to 2 months of age with pyelo- nephritis do not have symptoms localized to the urinary tract, and often UTI is diagnosed as part of a sepsis evalu- ation. Neonates with UTI can have fever, jaundice, failure to thrive, poor feeding, vomiting, and irritability. Older children (2 months to 2 years of age) can additionally have strong-smelling urine or abdominal pain. Preschoolers (2-6 years of age) present more commonly with voiding symptoms, such as dysuria, urgency, and frequency. Older children and adolescents can also display flank and/or back pain, enuresis, and incontinence. On physical exami- nation, patients can have costovertebral angle tenderness, abdominal or suprapubic tenderness, palpable bladder or dribbling, or poor urinary stream. Bacterial infections are the most common etiology of UTI: * Escherichia coli causes the majority of infections (75-90%). * Klebsiellaspp. * Proteus spp. * Enterococcus spp."
},
{
"source": "Pediatrics for Practitioner (Sharad Thora), p. 381",
"text": "- Anatomic abnormalities are more commonly picked up in young children - Children having nonfebrile UTI around or after 5 years of age are more likely to have voiding dysfunction rather than anatomic factor - Urinary tract infection is the most common serious bacterial infection in febrile infants and young children; it includes 10% of all febrile children and 13.6% of febrile infants - About 8% of girls and 2% of boys experience at least one episode of UTI up to the age 7 years - Common uropathogens include _Escherichia coli_ (accounting for approximately 85% of UTI in children), _Klebsiella, Proteus, Enterobacter, Citrobacter_ , _Staphylococcus saprophyticus_ and _Enterococcus_ - Renal parenchymal defects are present in 3\u201315% of children within 1\u20132 years of their first diagnosed UTI. **362** Pediatrics for Practitioner ## **A Simplified and Practical Clinical Approach** - Definition of UTI - How do I suspect UTI? - How do I plan investigation to confirm UTI?"
},
{
"source": "Pediatric Clinical Practice Guidelines and Policies, p. 1271",
"text": " ## **DIAGNOSIS AND MANAGEMENT OF AN INITIAL UTI IN FEBRILE INFANTS AND YOUNG CHILDREN (TECHNICAL REPORT)** - _S. Maria E. Finnell, MD, MS; Aaron E. Carroll, MD, MS; Stephen M. Downs, MD, MS; Steering Committee on Quality Improvement and Management; and Subcommittee on Urinary Tract Infection_ ABSTRACT. _Objectives._ The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection."
},
{
"source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 592",
"text": "## **URINARY RETENTION** Acute urinary retention in infants and children is usually voluntary and associated with severe acute cystitis, urethritis, meatitis (in boys), or vaginitis. Severe constipation may result in urinary retention. In boys, urethral stricture (congenital, traumatic) and meatal stenosis with meatitis (Fig. 14-25, _A_ ) should be considered. Urethral valves are more likely to cause dysuria or straining without complete retention. Retention in girls is unlikely to be caused by even severe labial adhesions, so uncommon lesions such as a prolapsed ureterocele should **14**[|] Urologic Disorders **569** **Figure 14-22** Exstrophy. **A** and **B,** Classic bladder exstrophy in a boy infant with a small bladder. **C** and **D,** Bladder exstrophy in a girl. Note the separate openings to each hemivagina.  **----- Start of picture text -----**
A
**----- End of picture text -----**
"
}
]
}