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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

Symptoms of IU patients in our series as per the IU Grade noted on cystourethroscopy
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Figure 2: Symptoms of IU patients in our series as per the IU Grade noted on cystourethroscopy

Mentions: 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 nine, loin pain in six, and scrotal pain in two patients [Figure 2]. The two patients with unilateral scrotal pain had previous scrotal exploration and were treated as epididymitis with antibiotics, however the scrotal pain persisted. These two patients were subsequently diagnosed to have posterior urethritis on cystourethroscopy. Past medical history included circumcision in two patients for religious reasons and in two patients for foreskin pathology. Two patients had treatment for suspected urinary tract infection in the past; however, both patients had a negative urine culture at the time of presentation. Serum C-reactive protein (CRP) and full blood count was tested in 15 patients and was within normal limits in all of them. Renal ultrasound scan (USS) was performed in 17 patients and was normal in 12, debris seen within the bladder in two, thickened bladder wall seen in two, and renal pelvis dilatation/hydronephrosis noted in three patients. None of our patients gave history of being sexually active at the time of presentation. But we did chlamydial studies in the adolescent age group and all of them were negative.


Idiopathic urethritis in children: Classification and treatment with steroids.

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

Symptoms of IU patients in our series as per the IU Grade noted on cystourethroscopy
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Symptoms of IU patients in our series as per the IU Grade noted on cystourethroscopy
Mentions: 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 nine, loin pain in six, and scrotal pain in two patients [Figure 2]. The two patients with unilateral scrotal pain had previous scrotal exploration and were treated as epididymitis with antibiotics, however the scrotal pain persisted. These two patients were subsequently diagnosed to have posterior urethritis on cystourethroscopy. Past medical history included circumcision in two patients for religious reasons and in two patients for foreskin pathology. Two patients had treatment for suspected urinary tract infection in the past; however, both patients had a negative urine culture at the time of presentation. Serum C-reactive protein (CRP) and full blood count was tested in 15 patients and was within normal limits in all of them. Renal ultrasound scan (USS) was performed in 17 patients and was normal in 12, debris seen within the bladder in two, thickened bladder wall seen in two, and renal pelvis dilatation/hydronephrosis noted in three patients. None of our patients gave history of being sexually active at the time of presentation. But we did chlamydial studies in the adolescent age group and all of them were negative.

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