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Idiopathic urethritis in children: Classification and treatment with steroids.

Jayakumar S, Pringle K, Ninan GK - J Indian Assoc Pediatr Surg (2014)

Bottom Line: IU in male children can be successfully managed with steroid instillation, especially in grade I and II.Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment.In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Urology, University Hospitals of Leicester, Leicester, United Kingdom.

ABSTRACT

Background: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 - 4) and report our experience with use of topical and oral steroids in IU.

Materials and methods: Retrospective data collection of all male children (0-16 years) diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes.

Results: A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16) years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV). Mean follow up was 18.9(1-74) months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone) in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7%) patients. Significant improvement in symptoms and signs was noted in 1(5.3%) patient who is still undergoing treatment.

Conclusions: IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required.

No MeSH data available.


Related in: MedlinePlus

Ninan classification of Idiopathic urethritis in male children, (Grade-I) Inflammation involving urethra distal to external urethral sphincter, (Grade-II) Inflammation extending into urethra proximal to external urethral sphincter, (Grade-III) Inflammation of urethra with stricture formation or scarring, (Grade-IV) Inflammation of urethra with retrograde extension to the upper tracts or epididymis with systemic symptoms
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Figure 1: Ninan classification of Idiopathic urethritis in male children, (Grade-I) Inflammation involving urethra distal to external urethral sphincter, (Grade-II) Inflammation extending into urethra proximal to external urethral sphincter, (Grade-III) Inflammation of urethra with stricture formation or scarring, (Grade-IV) Inflammation of urethra with retrograde extension to the upper tracts or epididymis with systemic symptoms

Mentions: Data was collected retrospectively on all male children (< 16 years of age) diagnosed with IU and managed by a single surgeon at our institution over a period of 8 years (2005–2012). Patients with balanitis xerotica obliterans (BXO) and positive urine culture at presentation were excluded from the study. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management, and outcomes. Data was incorporated into a spreadsheet (Microsoft Excel© 2007) for analysis. A new classification was proposed based on the cystourethroscopy findings and symptoms and this is shown in Figure 1.


Idiopathic urethritis in children: Classification and treatment with steroids.

Jayakumar S, Pringle K, Ninan GK - J Indian Assoc Pediatr Surg (2014)

Ninan classification of Idiopathic urethritis in male children, (Grade-I) Inflammation involving urethra distal to external urethral sphincter, (Grade-II) Inflammation extending into urethra proximal to external urethral sphincter, (Grade-III) Inflammation of urethra with stricture formation or scarring, (Grade-IV) Inflammation of urethra with retrograde extension to the upper tracts or epididymis with systemic symptoms
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4155630&req=5

Figure 1: Ninan classification of Idiopathic urethritis in male children, (Grade-I) Inflammation involving urethra distal to external urethral sphincter, (Grade-II) Inflammation extending into urethra proximal to external urethral sphincter, (Grade-III) Inflammation of urethra with stricture formation or scarring, (Grade-IV) Inflammation of urethra with retrograde extension to the upper tracts or epididymis with systemic symptoms
Mentions: Data was collected retrospectively on all male children (< 16 years of age) diagnosed with IU and managed by a single surgeon at our institution over a period of 8 years (2005–2012). Patients with balanitis xerotica obliterans (BXO) and positive urine culture at presentation were excluded from the study. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management, and outcomes. Data was incorporated into a spreadsheet (Microsoft Excel© 2007) for analysis. A new classification was proposed based on the cystourethroscopy findings and symptoms and this is shown in Figure 1.

Bottom Line: IU in male children can be successfully managed with steroid instillation, especially in grade I and II.Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment.In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Urology, University Hospitals of Leicester, Leicester, United Kingdom.

ABSTRACT

Background: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 - 4) and report our experience with use of topical and oral steroids in IU.

Materials and methods: Retrospective data collection of all male children (0-16 years) diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes.

Results: A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16) years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV). Mean follow up was 18.9(1-74) months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone) in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7%) patients. Significant improvement in symptoms and signs was noted in 1(5.3%) patient who is still undergoing treatment.

Conclusions: IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required.

No MeSH data available.


Related in: MedlinePlus