Prepubertal Dysuria Not as Simple as a UTI
Prepubertal boys who present to the emergency department with dysuria are uncommon. The adult with burning on urination is assumed to have a sexually transmitted disease, but of course that diagnosis should not be high on your list for boys.In fact, infectious urethritis in children is quite uncommon unless there is premature sexual activity or sexual abuse by an adult. Unfortunately, a variety of noninfectious urethral pathologies may mimic infectious urethritis in children. A urinary tract infection in a prepubertal boy is an infectious cause of dysuria. Those infections, however, rarely present with the isolated symptom of burning on urination. There is often evidence of bladder irritability manifested by urgency and frequency. Self-inoculation associated with herpes labialis can also result in an HSV genital infection and painful urination.We should consider noninfectious causes of dysuria when a urinary tract infection, balanoposthitis, a candida infection, or a sexually transmitted disease is not present. Noninfectious irritation of the urethra is most commonly caused by chemical exposures (bubble bath), local trauma, or meatal stenosis. Bubble bath is probably the most common cause of noninfectious dysuria in prepubertal boys. The therapeutic solution for this condition is to stop using bubble bath. See the video of a patient with burning on urination due to bubble bath use.Local trauma is another possible etiology of dysuria. It may be self-induced by the prepubert...
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