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Dysuria, defined as painful urination, indicates irritation of either the bladder, urethra, or prostate gland.1 It may be associated with urinary frequency and urgency or may be used to describe the discomfort associated with these symptoms. A complaint of dysuria can be difficult to elicit in younger children who may have difficulty distinguishing between dysuria and perineal or genital irritation.2

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Overall, the most common conditions associated with dysuria are urinary tract infections (UTIs), urethritis, and local irritation. However, there are many other causes to consider (Table 9–1).24 The patient's age and the presence of specific clinical or laboratory findings can help focus the differential diagnosis. Additionally, sexual abuse and pruritis associated with pinworm infestation can mimic dysuria.

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Table 9–1. Infectious and Noninfectious Causes of Dysuria*
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Infection

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Prepubertal Children

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A complaint of dysuria can be difficult to ascertain in younger children, but the presence of fever, increased fussiness, decreased appetite, lower abdominal pain, or suprapubic or flank tenderness may signal the presence of a UTI. Among febrile infants and children of age 2 months to 2 years with no other source of fever, the prevalence of a UTI is about 5% with an overall predominance of girls. Male neonates are five to eight times more likely to have a UTI than girls during the neonatal period but after 3 months of age, female infants are two times more likely to be infected and 1–5-year-old girls are 10–20 times more likely to be compared with boys.5

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A UTI can affect either the upper or lower genitourinary tract. The presence of fever and other signs such as flank pain point to pyelonephritis rather than cystitis. These signs, however, are more reliable in older children. The most common organisms associated with UTI are enterobacteria. Escherichia coli is associated with 70–90% of infections....

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