Pediatric emergency medicine trisk 1118 1118
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FIGURE 57.1 Prepubertal children pathway. (Adapted from: Fleisher GR. Etiology and
evaluation of dysuria in children and adolescents. In: UpToDate, Post TW (Ed), UpToDate ,
Waltham, MA. Available at www.uptodate.com .)
Labial adhesions in the prepubertal age may be a potential cause for painful
urination (see Table 57.4 ). Since most girls with labial adhesions are
asymptomatic, evaluation for infection or other cause for dysuria should be
considered.
A few patients with a normal examination and negative cultures may complain
of dysuria persistently. In this setting, dysfunctional voiding and idiopathic
hypercalciuria represent potential diagnoses. If suspected, the diagnosis of
hypercalciuria/uricosuria can be confirmed by measurement of calcium excretion
in the urine. Another possible explanation in a female is that the patient is
experiencing vaginal pruritus secondary to pinworms. Confirmation of this
