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DEFINITION

Dysuria is defined as pain or burning associated with urination. The sensation is produced by pain fibers in the inflamed and edematous genitourinary mucosa triggered by muscular contraction of the bladder and peristaltic activity of the urethra.1 Pain fibers can also be directly triggered by exposure of urine to inflamed mucosa.2 Other sensations of discomfort, such as pruritus, can be interpreted as dysuria, especially in young children who are unable to verbalize their perineal or genitourinary symptoms.3

DIFFERENTIAL DIAGNOSIS

There are many diagnoses to consider when a child presents with dysuria. Children presenting with dysuria most commonly have a primary disorder of the genitourinary tract; however, children with systemic conditions may also present with dysuria as the chief complaint. When encountering the broad differential diagnosis of dysuria, it can be helpful to categorize potential etiologies as infectious, noninfectious, systemic, or local conditions (Table 13-1). The patient’s age, history, exam, and laboratory findings will further guide the differential.

TABLE 13-1Infectious and Noninfectious Causes of Dysuria

INFECTIOUS CAUSES OF DYSURIA

Urinary tract infection (UTI) is the most prevalent cause of genitourinary tract infections, accounting for more than 1 million visits to pediatrician’s offices every year.4 The presence of dysuria, fever, back pain, urinary frequency, new-onset urinary incontinence, and suprapubic tenderness increase the probability of UTI.5 UTI should be suspected in any nonverbal child presenting with fever without an identifiable source. A UTI can involve the urethra (urethritis), bladder (cystitis), and/or kidney parenchyma (pyelonephritis). The presence of flank pain, costovertebral angle tenderness, and systemic signs, such as fever and vomiting, raise suspicion for pyelonephritis. These signs are more reliable in older children. If not detected and appropriately treated, a UTI may lead to renal scarring, hypertension, and end-stage renal disease.6

The most common organism associated with UTI is Escherichia coli, but other common organisms include Klebsiella species and Enterococcus species, Proteus mirabilis, and Staphylococcus saprophyticus.7 Pseudomonas aeruginosa occurs more commonly among those who require routine bladder catheterization. Viral causes of cystitis are less common. Specifically, ...

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