Pediatric emergency medicine trisk 1112 1112
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CHAPTER 57 ■ PAIN: DYSURIA
JACQUELINE BRYNGIL CORBOY, PATRICIA LOPEZ
INTRODUCTION
Many conditions of the genitourinary tract produce symptoms of pain or burning
associated with urination, or dysuria. This sensation is produced by the muscular
contraction of the bladder and the peristaltic activity of the urethra, both of which
stimulate the pain fibers in the edematous and inflamed mucosa. Young children
may complain of painful urination when they are instead experiencing related
symptoms, such as pruritus. When a child is too young to verbalize his or her
symptoms, parents may interpret various nonspecific statements or behaviors by
their child as indicative of painful urination.
Dysuria is a commonly reported symptom associated with a number of
infectious and noninfectious causes, but it usually stems from one of several
common disorders of childhood and adolescence. Most children presenting with
dysuria as a chief complaint will have primary disorders of the genitourinary
tract. Although patients with urethritis secondary to systemic illnesses may have
dysuria as one of their many symptoms, it is rarely the principal reason for a visit
to an emergency department (ED).
Most diseases causing dysuria are self-limited or easily treated; but systemic
causes of urethritis or the spread of some bacterial pathogens beyond the
genitourinary tract may be life threatening. A differential diagnosis of the many
systemic, infectious, and noninfectious causes most commonly presenting as
dysuria may be found in Tables 57.1 to 57.4 .
EVALUATION AND DECISION
The approach to the child with dysuria must be broad; history and physical
examination will help determine the direction and scope of the workup. Conduct
a thorough investigation of possible causes, including questions about trauma
(both accidental and nonaccidental), exposure to chemicals such as detergents,
fabric softeners, perfumed soaps, bubble baths, and medications that may irritate
the mucosal lining of the urethra or bladder. A negative history for injury does not
rule it out as most traumas are not recalled by young patients. In the case of
masturbation or abuse, such history may be denied. Obtaining a history about the
nature and extent of sexual activity may facilitate the detection of sexually
