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Lopes Mendes AL, Innocenzi M, Spicchiale CF, Collura G, Mele E, Del Prete L, Castagnetti M. Acute urinary retention in children: causes and the role of bladder catheterization and ultrasonogram. Minerva Urol Nephrol 2024; 76:499-504. [PMID: 38618703 DOI: 10.23736/s2724-6051.24.05696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Acute urinary retention in children is uncommon and can be related to several causes. The role of abdominal ultrasound and catheterization is controversial. We aimed to identify the most common causes of acute urinary retention in children, focusing, particularly on the role of bladder catheterization and the diagnostic value of acute ultrasound. METHODS We retrospectively analyzed all consecutive children admitted to our emergency department with acute urinary retention from 2010 to 2020. Post-operative acute urinary retention, neonatal age, and known urological or neurological disorders were excluded. Diagnostic workup and management were adopted in each patient. Results were compared in patients with more and less than 5 years old. RESULTS 193 patients were included. Median age was 3 (2-16) years; 53.4% were girls. Ultrasound evaluation was performed in (129/193; 66.8%) patients, more commonly <5-year-old (74% vs. 26%, P<0.01). A previously unknown urological condition was detected in (16/129; 12%). The majority of patients (124/193; 64%) were managed without bladder catheterization. These patients were significantly younger than the remainder (3- vs. 4-year-old, P<0.01) and the most common diagnosis was external genitalia inflammation (53%). Of the remaining patients, (34/69; 49%) restored spontaneous micturition after a single catheterization, whereas 35 required admission. The latter were more commonly males (32%, P=0.01), with higher incidence of abnormal ultrasound (33% vs. 7%, P<0.001). CONCLUSIONS Acute urinary retention in commonly due to external genitalia inflammation, particularly in patients <5-year-old, and can be generally managed, without bladder catheterization. Abdominal ultrasound is an important diagnostic tool, that should be performed only in selected cases.
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Affiliation(s)
- Ana L Lopes Mendes
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy -
| | - Michele Innocenzi
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudia F Spicchiale
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Tor Vergata University, Rome, Italy
| | - Giuseppe Collura
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ermelinda Mele
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Del Prete
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Castagnetti
- Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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2
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Diantini A, Alfaqeeh M, Permatasari LI, Nurfitriani M, Durotulailah L, Wulandari W, Sitorus TDR, Wilar G, Levita J. Clinical Toxicology of OTC Cough and Cold Pediatric Medications: A Narrative Review. Pediatric Health Med Ther 2024; 15:243-255. [PMID: 39011322 PMCID: PMC11249067 DOI: 10.2147/phmt.s468314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024] Open
Abstract
Cough and cold symptoms (CCS) are common pediatric conditions often treated with over-the-counter (OTC) medications. However, the available knowledge regarding the safety and toxicity of these medications in children is inadequate. Therefore, understanding their clinical toxicology is crucial for safeguarding children's well-being. This narrative review highlights the importance of clinical toxicology in evaluating the safety and toxicity profile of OTC medications for treating CCS in pediatric patients. The pharmacology, clinical features, and adverse effects of various drug classes commonly found in cough and cold medications are briefly discussed. Pharmacokinetic and pharmacodynamic parameters are also examined to understand the interactions between these drugs and the body. OTC cough and cold medications often contain active ingredients such as antihistamines, decongestants, antitussives, expectorants, and analgesics-antipyretics. The combination of multiple ingredients in these products significantly increases the risk of adverse effects and unintentional overdoses. Several case studies have reported significant toxicity and even fatalities associated with the use of these medications in children. This review underscores the critical importance of clinical toxicology in evaluating the safety and toxicity profile of OTC medications employed for treating CCS in pediatric patients. The findings highlight the significance of informed clinical practice and public health policies to ensure the well-being of children using OTC cough and cold medications.
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Affiliation(s)
- Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran. University, Sumedang, West Java, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Mohammed Alfaqeeh
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Lanny Indah Permatasari
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Mirna Nurfitriani
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Lela Durotulailah
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Wening Wulandari
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Truly Deti Rose Sitorus
- Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Gofarana Wilar
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran. University, Sumedang, West Java, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran. University, Sumedang, West Java, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
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Hekmati P, Arshadi H, Kamran H, Kajbafzadeh A, Zahir M, Amirzargar H, Ghahestani SM. Three rare etiologies of urinary retention in pediatrics: A case series and review of the literature. Clin Case Rep 2023; 11:e8125. [PMID: 37927982 PMCID: PMC10622406 DOI: 10.1002/ccr3.8125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Etiology of urinary retention in pediatric age differs significantly from adults and the elderly. Therefore, a comprehensive diagnosis is crucial before specific treatment. Every effort must be made to minimize invasive procedures as far as possible in children.
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Affiliation(s)
- Pooya Hekmati
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
| | - Hamid Arshadi
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
| | - Hooman Kamran
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Abdol‐Mohammad Kajbafzadeh
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
| | - Mazyar Zahir
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
- Urology and Nephrology Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Hossein Amirzargar
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
| | - Seyyed Mohammad Ghahestani
- Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Pediatrics Center of ExcellenceTehran University of Medical SciencesTehranIran
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4
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Smith T, Kritzmire S, Tejada JG, Martinez ML. Urinary bladder retention secondary to intranasal administration of oxymetazoline "Afrin" for intra-arterial chemotherapy. Interv Neuroradiol 2023:15910199231204924. [PMID: 37787170 DOI: 10.1177/15910199231204924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Selective ophthalmic artery infusion of chemotherapy (SOAIC) has emerged as the standard of care for retinoblastoma (RB). Intranasal oxymetazoline (INO), Afrin, is often intraoperatively administered adjunctively to optimize flow to the orbit. There has been one report to date that suggests the adjunctive use of INO has led to systemic side effects. To our knowledge, this is the first documented case of INO causing urinary retention in a patient undergoing SOAIC, and the recommended treatment.
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Affiliation(s)
- Taylor Smith
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stacy Kritzmire
- Department of Pediatric Anesthesia, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Juan G Tejada
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Eskenazi Hospital, Indianapolis, IN, USA
| | - Mesha L Martinez
- Department Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
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Karava V, Chainoglou A, Stefanidis C, Tsikopoulos G, Zafeiriou D, Stabouli S. Sacrococcygeal Teratoma in an Infant with Acute Urinary Retention. J Pediatr 2022; 247:170-171.e1. [PMID: 35427691 DOI: 10.1016/j.jpeds.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Vasiliki Karava
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasia Chainoglou
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Stefanidis
- Pediatric Surgery Department, Hippokratio General Hospital, Thessaloniki, Greece
| | - Georgios Tsikopoulos
- Pediatric Surgery Department, Hippokratio General Hospital, Thessaloniki, Greece
| | - Dimitrios Zafeiriou
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Stabouli
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Suchovsky SB, Reiter PD, Lewis HE, Clevenger AC. Methylnaltrexone in the Management of Opioid-Associated Urinary Retention in Children. J Pediatr Pharmacol Ther 2022; 27:373-378. [DOI: 10.5863/1551-6776-27.4.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
To evaluate the association between methylnaltrexone and urine output (UOP) in critically ill children with opioid-associated urinary retention.
METHODS
This retrospective study included patients admitted to the pediatric intensive care unit between December 1, 2019, and November 30, 2020, who received methylnaltrexone for opioid-associated oliguria (spontaneous UOP below 1 mL/kg/hr and at least 1 dose of an opioid within the preceding 6 hours).
RESULTS
Twenty-five patients (median age = 5.5 years, IQR 1.7–16.4; median weight = 19 kg, IQR 9–45) were included. Mean methylnaltrexone dose was 0.15 ± 0.006 mg/kg. A statistically significant increase in UOP from baseline to 6 hours following methylnaltrexone was observed (p = 0.001), but not all patients responded. Fourteen patients (56%) had no UOP following methylnaltrexone administration, while 11 (44%) demonstrated a robust increase (median = 0 mL/kg/hr at baseline [IQR 0–0] to 1.96 mL/kg/hr [IQR 1.08–2.22; p = 0.001]) within 6 hours following methylnaltrexone administration. Younger patients responded better than older patients (responder age = 2.5 years [IQR 0.8–7]) versus 11.4 years [IQR 1.75–17.5] for non-responders) (p = 0.04). Both intravenous (IV) and subcutaneous (SQ) routes were associated with an increase in UOP (IV, p = 0.04; SQ, p = 0.02). The effect persisted for up to 24 hours after administration. Sixty-four percent of patients required urinary catheter placement. Pain scores (averaged 6 hours before and after methylnaltrexone) remained unchanged (p = 0.44).
CONCLUSIONS
Methylnaltrexone may increase spontaneous UOP in some children with opioid-associated urinary retention, but urinary catheterization rates remain high.
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Affiliation(s)
- Skyler B. Suchovsky
- Department of Pharmacy (SBS, HEL), Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Pamela D. Reiter
- Department of Pharmacy and Division of Pediatric Critical Care (PDR), Children's Hospital Colorado
| | - Hannah E. Lewis
- Department of Pharmacy (SBS, HEL), Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Amy C. Clevenger
- Clinical Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences (Anschutz Medical Campus), Aurora, CO; Department of Pediatrics and Division of Pediatric Critical Care (ACC), Children's Hospital Colorado and University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
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Cornwell LB, Ewing E, Algra J, Chiang GJ. Acute urinary retention in pediatric cerebral palsy: Is there an optimal management strategy? J Pediatr Urol 2021; 17:527.e1-527.e7. [PMID: 34162517 DOI: 10.1016/j.jpurol.2021.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cerebral palsy (CP) patients commonly have lower urinary tract dysfunction. Urinary retention (UR), which has been associated with dysfunctional voiding in CP can correlate to chronic upper tract dysfunction. We sought to provide insight into the pediatric presentation of acute UR in patients with CP and subsequent outcomes in this at-risk population. STUDY DESIGN All children with perinatally acquired CP presenting to a regional health network were identified from 2009 to 2019. Retrospective analysis of a hospitalized subset concurrently diagnosed with a first episode of acute UR was performed. Factors associated with new-onset UR are described, as well as management. Using follow-up data, we also assessed the risk for recurrent UR and/or abnormal renal imaging after an initial UR presentation. RESULTS 3404 CP patients were analyzed with only 33 fulfilling inclusion criteria. Median age was 10(IQR 7.5-16; range 1-22) years, 87.9% were GMFCS-V. 39.4% had a reported history of decreased urinary frequency. At presentation, median maximal time without void prior to catheterization was 13 h, and catheterized volume was a median 120% expected capacity-for-age. 84.8% of presentations were associated with a known transient/reversible etiology. 51.5% were post-anesthesia at median 3.5 days, 33.3% had associated constipation, 30.3% had received exacerbating medications. 11/33 were taught clean intermittent catheterization (CIC) after the initial presentation (all pro re nata [PRN] except one). At a median follow-up of 37 months: 50% of those without a CIC PRN no void plan had a repeat episode, at a median of 10.8 months later. Of the patients who had follow-up renal imaging at a median 22.0 months after presentation, 45% had abnormalities: 7 with debris or suspected stones and 2 with collecting system dilation. No factors associated with the initial UR presentation were found to be significantly predictive of recurrence or abnormal follow-up imaging. DISCUSSION Patients with CP presenting with acute UR are often those with the most severe limitations and have a history of decreased urinary frequency. They usually have transient or reversible factors associated with UR presentation, however UR recurrence and abnormal imaging in this population subset is common. CONCLUSIONS Pediatric patients with CP who present with acute UR usually present in the context of recent anesthesia and in the setting of exacerbating factors. They are at risk for recurrence and may be best managed with caretaker education of CIC PRN no void to address recurrent episodes. Providers should consider surveillance of these patients for the development of abnormal renal imaging.
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Affiliation(s)
- Laura B Cornwell
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA.
| | - Emily Ewing
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - Jeffrey Algra
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - George J Chiang
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
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Crigger C, Kuzbel J, Al-Omar O. Choosing the Right Catheter for Pediatric Procedures: Patient Considerations and Preference. Res Rep Urol 2021; 13:185-195. [PMID: 33954151 PMCID: PMC8092428 DOI: 10.2147/rru.s282654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Determining the need for bladder decompression and urinary diversion in the perioperative pediatric surgical patient can cause a clinical conundrum for the surgical team. Add in the several different types of urinary diversion devices possible, and the various materials associated therein and the process can suddenly seem unnecessarily daunting given the lack of concise recommendations and broad consensus. The decision to divert urine, though seemingly trivial, is associated with inherent risks. Managing and mitigating certain risks are best approached through proper education, selection, and technique. We provide a broad overview of pediatric catheter selection, indications, and pitfalls to streamline the process so that energy and attention can best be focused on the planned intervention at hand.
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Affiliation(s)
- Chad Crigger
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
| | - Jake Kuzbel
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
| | - Osama Al-Omar
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
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9
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Rai O, Lama S, Wazir Pandita S. The importance of a thorough clinical examination in adolescent girls presenting with acute urinary retention. BMJ Case Rep 2021; 14:14/2/e240378. [PMID: 33563679 PMCID: PMC7875276 DOI: 10.1136/bcr-2020-240378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present an adolescent girl with a 1-day history of acute urinary retention and lower abdominal pain. She was admitted to the paediatric ward for ongoing treatment and investigations. Due to a myriad of factors including pain and anxiety, challenges posed included an incomplete initial abdominal and external genital examination. This case report highlights the importance of a focused history and performing an appropriate sensitive examination at the time of presentation. Furthermore, we explore the common causes of new onset urinary retention and unravel the case as it unfolds. We also highlight differential diagnoses (however, uncommon), which must be considered and not overlooked to avoid unnecessary investigations and to ensure timely management.
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Affiliation(s)
- Oman Rai
- Paediatric Department, William Harvey Hospital, Ashford, UK
| | - Sanju Lama
- Paediatric Department, William Harvey Hospital, Ashford, UK
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de Jong AC, Maaskant JM, Groen LA, van Woensel JBM. Monitoring of micturition and bladder volumes can replace routine indwelling urinary catheters in children receiving intravenous opioids: a prospective cohort study. Eur J Pediatr 2021; 180:47-56. [PMID: 32529397 PMCID: PMC7782390 DOI: 10.1007/s00431-020-03703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/03/2022]
Abstract
In this prospective observational study, the incidence, risk factors and the time to event of urinary retention in children receiving intravenous opioids were evaluated. Urinary retention was confirmed by ultrasound following the inability to void for 8 h or earlier in patients experiencing discomfort. In total, 207 opioid episodes were evaluated, of which 199 (96.1%) concerned morphine, in 187 children admitted to the pediatric ward or pediatric intensive care unit. The median age was 7.6 years (IQR 0.9-13.8), and 123 (59.4%) were male. The incidence of urinary retention was 31/207 (15.0%) opioid episodes, in which 14/32 (43.8%) patients received continuous sedation for mechanical ventilation and 17/175 (9.7%) received no sedation. Multivariable logistic regression analysis showed a significant association with continuous sedation (OR 6.8, 95% CI 2.7-17.4, p 0.001) and highest daily fluid intake (OR 0.8 per 10% deviation of normal intake, 95% CI 0.7-0.9, p 0.01). Opioid dosage, age and gender were not significantly associated. Most events (28/31, 90.3%) occurred within 24 h.Conclusion: The incidence of urinary retention in children receiving intravenous opioids is low, indicating that placement of urinary catheters is not routinely necessary in these patients. However, micturition and bladder volumes must be monitored, especially in sedated children and during the first 24 h of opioid administration. What is Known: • Great variation exists in the routine placement of urinary catheters in children receiving IV opioids. What is New: • Confirmed by ultrasound, the incidence of urinary retention in children receiving intravenous opioids in this study was 15%, indicating that placement of urinary catheters is not routinely necessary in these patients. • Children receiving continuous sedation for invasive mechanical ventilation showed a sevenfold greater risk of developing urinary retention than non-sedated patients.
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Affiliation(s)
- Anita C. de Jong
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Jolanda M. Maaskant
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luitzen A. Groen
- Department of Pediatric Urology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Job B. M. van Woensel
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
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11
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Schmidt AM, Hirsch K, Schroth M, Stehr M, Schäfer FM. Acute urinary retention in children. J Pediatr Urol 2020; 16:842.e1-842.e6. [PMID: 32900634 DOI: 10.1016/j.jpurol.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/15/2020] [Accepted: 08/15/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Acute urinary retention is a common emergency in adult patients, foremost in older men. In childhood urinary retention is a rare entity with only sparse literature on the etiology. OBJECTIVE To assess the etiology and treatment of acute urinary retention in the pediatric population and assess age and sex distribution. STUDY DESIGN A retrospective analysis of all patients admitted to our emergency department with acute urinary retention between 2005 and 2019 was performed. Exclusion criteria were newborns (because of physiologic postnatal oliguria) and postoperative urinary retention during the same hospital stay. RESULTS 113 children with acute urinary retention (ICD: R33) meeting the above criteria were identified. 16 Patients were excluded because of incomplete medical charts. 97 children were included into the study (age 0.5-18.3 years, mean age 5.3 years). 89 patients had one episode, 8 patients two episodes. A peak around the third year of age was observed. Sex ratio showed a 2:1 male to female distribution. Most common etiology was balanoposthitis (15.5%) and acute constipation/fecal impaction (15.5%). Traumatic urinary retention was found in 11.4% of the cases. Urinary tract infection were found 7.2%. No underlying reason could be found in 12.4% (idiopathic urinary retention). Other causes included febrile non-urinary infection (8.2%), subvesical obstruction (4.1%), vulvovaginitis (3.1%) and urethritis (2.1%). In 50% of the cases of urinary retention under 1 year of age (2 out of 4) an underlying tumor (rhabdomyosarcoma, sacral teratoma) was identified. DISCUSSION Age and sex distribution were similar to previously published series; however, this study shows a marked difference concerning the etiology: e. g. we identified a significantly higher proportion of functional disorders as a reason for acute urinary retention in childhood. It is hypothesized that this is partly because previously published studies originate from areas (USA, Israel, Iran) with different socio-demographic and cultural background. CONCLUSION AUR in children is a rare condition with very heterogeneous causes. Although the majority of cases exhibit mild underlying conditions, serious reasons, such as malignant diseases especially in the first year of life, must be excluded. AUR relief without catheterization is a child-friendly approach in cases of mild inflammatory or functional disorders and can help to minimize traumatization.
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Affiliation(s)
- Ana-Marija Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Karin Hirsch
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Michael Schroth
- Department of Pediatrics and Pediatric Emergency Care, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany.
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Snelling PJ. Getting started in paediatric emergency medicine point-of-care ultrasound: Five fundamental applications. Australas J Ultrasound Med 2020; 23:5-9. [PMID: 34760576 PMCID: PMC8411752 DOI: 10.1002/ajum.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Point-of-care ultrasound is a valuable tool in the Paediatric Emergency Medicine department. It can be utilised at the patient bedside to augment the physical examination, improving clinical accuracy. Alternatively, it can safeguard needle guided procedures and improve their success rate. It allows real-time information to be gathered without exposing the child to ionising radiation. This article outlines five fundamental applications and how it can be incorporated into clinical practice.
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Affiliation(s)
- Peter James Snelling
- Emergency DirectorateGold Coast University Hospital1 Hospital BlvdSouthportQueensland4215Australia
- Sonography Innovation and Research Group (Sonar Group)Gold CoastQueensland4215Australia
- Griffith UniversitySouthportQueensland4215Australia
- Child Health Research CentreUniversity of QueenslandSouth BrisbaneQueensland4101Australia
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Ultrasonographic Assessment of Bladder Volumes in Children Undergoing Penile Surgery: Does the Type of Anesthesia Matter? Am J Ther 2019; 26:e314-e320. [PMID: 28767453 DOI: 10.1097/mjt.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are scant data reporting postoperative ultrasonographically measured bladder volumes in children undergoing penile surgery. STUDY QUESTION We studied the effect of various anesthesia techniques on return of micturition after penile surgery in children, using ultrasonographically measured bladder volumes. DATA SOURCES Ultrasonographically measured postvoiding residual bladder volumes indexed to age-appropriate capacity, and time elapsed between the end of surgery and spontaneous voiding after pediatric circumcision, distal hypospadias repair, or repair of urethrocutaneous fistula, were studied. STUDY DESIGN Children between 4 months and 12 years were randomized to caudal block, intravenous (IV) fentanyl or penile block, in association with inhaled general anesthesia. Bladder volumes were measured before surgery and immediately after voiding for the first time. Time to first postsurgery void was also recorded. RESULTS Thirty-one children completed all assessments; 12 underwent caudal block, 9 IV fentanyl anesthesia, and 7 were given penile block. The mean first postvoid bladder residual volumes were highest in the caudal and lowest in the penile block children (27.5 vs. 17.3 mL, P = 0.003). The time elapsing between the end of surgery and first voiding was the longest in the fentanyl group compared with caudal and penile blocks (232, 178, 150 minutes, respectively, P = 0.02). CONCLUSIONS None of the anesthetic techniques provoked postoperative urinary retention after minor penile surgery in children. The penile block appears superior to caudal block or to IV fentanyl-based anesthesia with regard to postoperative recovery of normal micturition.
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Keskinen H, Helenius L, Pajulo O, Helenius IJ. Postoperative urinary retention or difficulties to empty the bladder in young patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Surg 2018; 53:1542-1546. [PMID: 29153469 DOI: 10.1016/j.jpedsurg.2017.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Postoperative urinary retention has been reported to affect up to 27% of adults undergoing degenerative lumbar spine surgery and approximately one-third of children undergoing lower-extremity orthopedic surgery. No data exist on the incidence and risk factors of postoperative urinary tract retention/difficulties to empty the bladder in young patients undergoing instrumented posterior spinal fusion. We aimed to characterize incidence, risk factors and treatment of postoperative urinary retention (POUR) and difficulties to empty the bladder in young patients undergoing posterior spinal fusion (PSF) for idiopathic scoliosis. METHODS One hundred and eleven consecutive patients (mean age 16years [range, 11-21years], 81 females and 30 males) undergoing PSF for adolescent idiopathic scoliosis were screened after removal of urinary catheter postoperatively for inability to void and residual volume of urinary bladder. The latter was measured using ultrasound on two separate occasions. POUR and the need for intermittent catheterization were defined as an inability to void after catheter removal and documented full bladder with ultrasound (a residual of 300mL or more) or a significant residual volume after voiding (>2mL/kg or >100mL). RESULTS Fifty-one (46%) of the patients were either unable to void or had a clinically significant amount of residual volume after voiding. These fifty-one patients required intermittent catheterization for a mean of two days. Thirty patients (27%) had POUR, a residual volume of 300mL or more. Two (1.8%) patients experienced urinary tract infection postoperatively. Patients with urinary retention had a significantly higher mean intraoperative blood loss (mean 626mL vs. 464mL; p=0.020) and longer operation time (mean 3.3h vs. 2.8h; p=0.009) as compared with those not having urinary retention. In multivariate analyses the main risk factor for urinary retention was male gender (odds ratio 3.2 [95% confidence interval 1.1-9.2], p=0.028). CONCLUSIONS Postoperative voiding difficulties affect almost half of the patients with age under 21years undergoing PSF for idiopathic scoliosis. The main risk factors were increased intraoperative blood loss, longer length of surgery and male gender. POUR should be actively screened and treated in this patient population. LEVEL OF EVIDENCE Prospective Cohort Study II.
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Affiliation(s)
- Heli Keskinen
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
| | - Linda Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Olli Pajulo
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Ilkka J Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
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Chern BZH, Rajaraman S, Verma G, Heng KWJ. Unusual case of acute urinary retention in a young female. BMJ Case Rep 2017; 2017:bcr-2017-221411. [PMID: 28978599 DOI: 10.1136/bcr-2017-221411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We report an unusual case of a 17-year-old young female presenting to the emergency department with varicella infection, acute urinary retention (AUR) and no other neurological deficits. An MRI of the spine confirmed the diagnosis of acute transverse myelitis. Positive serum IgG antibodies against varicella zoster virus (VZV) suggested a parainfectious aetiology. The patient eventually developed weakness and a sensory level from the third thoracic dermatome on day 2 of hospitalisation. Awareness that AUR can precede other neurological deficits in VZV transverse myelitis will prevent misdiagnosis and allow for the prompt treatment of this debilitating illness.
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Affiliation(s)
- Belinda Zer Hui Chern
- School of Medicine, National University Singapore Yong Loo Lin, Singapore, Singapore
| | - Shivani Rajaraman
- School of Medicine, National University Singapore Yong Loo Lin, Singapore, Singapore
| | - Geetika Verma
- School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Yağmur I, Turna B, Tekin A, Akıncıoğlu E, Sarsık B, Ulman İ. Benign prostatic hyperplasia: Case report of a 17-year-old. J Pediatr Urol 2016; 12:267.e1-4. [PMID: 27593922 DOI: 10.1016/j.jpurol.2016.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is generally common in men older than 50 years of age but is extremely rare in childhood. In the literature to date, fewer than five cases have been reported under 18 years of age. Owing to the limited number of cases, the etiology and management of BPH in the first two decades is not clear. OBJECTIVE We herein report a 17-year-old boy who presented with acute urinary retention due to BPH and was treated with endoscopic transurethral resection of the prostate (TUR-P). CASE REPORT A 17-year-old male patient with a history of intermittent hematuria was admitted elsewhere with acute urinary retention. An increase in prostate size was detected on digital rectal examination. Pelvic ultrasound revealed a large mass arising from the prostate and filling the bladder lumen. Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) was performed to exclude malignancy. After the documentation of benign prostate tissue in the histopathological analysis, the patient was referred to our clinic for further evaluation and management. Magnetic resonance (MR) imaging revealed a 48 × 55 × 68 mm mass arising from the middle lobe of prostate and filling the bladder lumen (Figure) with an initial diagnosis of a non-ductal malignant tumor because of his age. Enlarged lymph nodes or any sign of metastasis were not detected. Re-examination of the previous biopsy specimens confirmed the absence of malignancy; therefore he underwent endoscopic treatment with TUR-P. Histopathological examination reported BPH. The postoperative 1-year follow-up was uneventful. DISCUSSION The patient was extensively evaluated with a suspicion of malignancy, especially rhabdomyosarcoma, which is more expected for this age group. Reviewing juvenile cases with BPH in the literature, two authors explained the possible etiologic factors of their cases as gonadotropin supplement therapy for undescended testes and the mother's utilization of a human chorionic gonadotropin-containing agent during pregnancy to prevent spontaneous abortion. Our case had no history of drug intake, endocrinologic abnormality, or any other possible relevant factor. Owing to the limited number of cases, there is not enough data to understand the etiology and also no consensus on the treatment of BPH in the adolescents. Therefore, experiences gained from adult cases guide the pediatric treatment modalities. CONCLUSION Despite the fact that BPH is very rare in childhood, one should keep it in mind in the differential diagnosis of acute urinary retention and malignant prostate diseases. The endoscopic method is the treatment of choice in BPH.
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Affiliation(s)
- Ismail Yağmur
- Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey.
| | - Burak Turna
- Department of Urology, Ege University, Izmir, Turkey
| | - Ali Tekin
- Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey
| | | | - Bnu Sarsık
- Department of Pathology, Ege University, Turkey
| | - İbrahim Ulman
- Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey
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Traslaviña GAA, Del Ciampo LA, Ferraz IS. [Acute urinary retention in a pre-school girl with constipation]. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2015; 33:488-92. [PMID: 26298658 PMCID: PMC4685571 DOI: 10.1016/j.rpped.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a case of a preschool girl who developed acute urinary retention associated with constipation. CASE DESCRIPTION A girl aged six years old presented a 24 hour history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 hours after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300 mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450 mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow-up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow-up. COMMENTS Acute urinary retention in children is a rare phenomenon and constipation should be considered as a cause.
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Affiliation(s)
- Guillermo A Ariza Traslaviña
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Luiz Antonio Del Ciampo
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil.
| | - Ivan Savioli Ferraz
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil
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Binder Z, Iwata K, Mojica M, Ginsburg HB, Henning J, Strubel N, Kahn P. Acute Urinary Retention Caused by an Ovarian Teratoma—A Unique Pediatric Presentation and Review. J Emerg Med 2015; 49:e139-42. [DOI: 10.1016/j.jemermed.2015.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/11/2015] [Indexed: 11/25/2022]
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Kilincaslan H, Silay MS, Erdem MR, Donmez T, Bilici M, Erenberk U. Extraordinary cause of complete colonic obstruction in children: urinary retention. Pediatr Int 2014; 56:419-22. [PMID: 24894928 DOI: 10.1111/ped.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/30/2013] [Accepted: 11/25/2013] [Indexed: 01/17/2023]
Abstract
Complete colonic obstruction in children may occur secondary to congenital, and acquired factors related to the gastrointestinal system. Herein, we report an extraordinary presentation of complete colonic obstruction due to extensive urinary retention in a 3-year-old boy. The possible underlying mechanism was detected as urinary infection in a child with horseshoe kidney. The treatment of the bladder symptoms and urinary infection relieved the obstruction of the colon. To our knowledge, especially in children, colonic obstruction due to urinary retention has not been reported in the literature.
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Affiliation(s)
- Huseyin Kilincaslan
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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20
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Ortíz San Román L, Sanavia Morán E, Campos Domínguez M, Peinador García M. Síndrome anticolinérgico por dexclorfeniramina como causa de retención urinaria. An Pediatr (Barc) 2013; 79:400-1. [DOI: 10.1016/j.anpedi.2013.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022] Open
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Faubel S, Patel NU, Lockhart ME, Cadnapaphornchai MA. Renal relevant radiology: use of ultrasonography in patients with AKI. Clin J Am Soc Nephrol 2013; 9:382-94. [PMID: 24235286 DOI: 10.2215/cjn.04840513] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
As judged by the American College of Radiology Appropriateness Criteria, renal Doppler ultrasonography is the most appropriate imaging test in the evaluation of AKI and has the highest level of recommendation. Unfortunately, nephrologists are rarely specifically trained in ultrasonography technique and interpretation, and important clinical information obtained from renal ultrasonography may not be appreciated. In this review, the strengths and limitations of grayscale ultrasonography in the evaluation of patients with AKI will be discussed with attention to its use for (1) assessment of intrinsic causes of AKI, (2) distinguishing acute from chronic kidney diseases, and (3) detection of obstruction. The use of Doppler imaging and the resistive index in patients with AKI will be reviewed with attention to its use for (1) predicting the development of AKI, (2) predicting the prognosis of AKI, and (3) distinguishing prerenal azotemia from intrinsic AKI. Finally, pediatric considerations in the use of ultrasonography in AKI will be reviewed.
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Affiliation(s)
- Sarah Faubel
- Division of Internal Medicine, Nephrology, University of Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado;, †Department of Radiology and, §Department of Internal Medicine and Pediatrics, Nephrology, University of Colorado Denver, Denver, Colorado, ‡Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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22
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Woo JR, Sisul D, Kaplan G, Chiang G. Urologic outcomes of pediatric pelvic neuroblastoma presenting in acute urinary retention. Pediatr Hematol Oncol 2013; 30:662-7. [PMID: 24050765 DOI: 10.3109/08880018.2013.816811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate long-term urologic outcomes of patients with pelvic neuroblastoma (NB) presenting with urinary retention. METHODS Five cases of pelvic NB presenting with urinary retention were identified between 1971 and 2011. Clinical presentation, treatment, survival and long-term voiding outcomes were analyzed. RESULTS All five patients presented with acute urinary retention and pelvic outlet dysfunction including bladder perforation (20%), constipation (40%), or fecal incontinence (20%). The presenting age ranged from 7 days to 4 years with female to male ratio of 3:2. Two patients presented with bilateral hydronephrosis and three patients were stage 4 at presentation. All required debulking surgery, four patients required combined anterior and posterior approaches for tumor resection, with two patients requiring concurrent laminectomy. Adjuvant or neoadjuvant chemoradiation was used in four of five cases. Follow-up ranged from 2 to 41 years. Although the long-term oncological outcome is favorable, urologic outcomes of these patients ranged from normal bladder function to the need significant reconstructive procedures. CONCLUSION Urologic outcomes are related to pelvic nerve and organ preservation during resection more than the severity of urinary symptoms at presentation.
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Affiliation(s)
- Jason R Woo
- 1Department of Urology, UC San Diego Health System, San Diego, California, USA
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23
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Akuter Harnverhalt bei einem 3-jährigen Jungen mit Phimose. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Park JS, Park TJ, Hwa JS, Seo JH, Park CH, Youn HS. Acute Urinary Retention in a 47-month-old Girl Caused by the Giant Fecaloma. Pediatr Gastroenterol Hepatol Nutr 2013; 16:200-5. [PMID: 24224155 PMCID: PMC3819695 DOI: 10.5223/pghn.2013.16.3.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 09/06/2013] [Accepted: 09/15/2013] [Indexed: 11/14/2022] Open
Abstract
We present a case of a 47-month-old female suffering from acute urinary bladder neck obstruction and bilateral hydronephrosis secondary to a fecaloma. Fecaloma is defined as an accumulation of inspissated feces in the colon or rectum giving the appearance of an abdominal mass. A fecaloma can be developed by diverse causes and the causes of the fecaloma in this case were septum reformation after the Duhamel procedure and long-term constipation. Chronic constipation is very common at outpatient clinic. However, acute urinary retention and voiding difficulty caused by fecaloma in the giant Duhamel pouch has never been reported in Korea. We would like to present our case with acute urinary retention due to a fecaloma and suggest that fecaloma might be considered as one of the causes for acute urinary retention, especially in cases with previous Duhamel operation for repair of Hischsprung disease.
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Affiliation(s)
- Ji Sook Park
- Department of Pediatrics, Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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25
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Princelle A, Hue V, Pruvost I, Potey C, Dubos F, Martinot A. [Systemic adverse effects of topical ocular instillation of atropine in two children]. Arch Pediatr 2013; 20:391-4. [PMID: 23433845 DOI: 10.1016/j.arcped.2013.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/15/2013] [Accepted: 01/21/2013] [Indexed: 02/02/2023]
Abstract
A medication-related cause must be sought when unusual symptoms occur. Topical treatments, including eye drops, whose side effects are more common in exposed children, need to be verified. We report here the cases of two children who developed systemic symptoms after the administration of atropine-based mydriatic eye drops. A 6-month-old boy was admitted to the emergency department with acute urine retention lasting 36h. Investigations identified only eye drop treatment 3h before the onset of symptoms, with 2 drops of homatropine 1 %, as a cause. No other urinary retention was observed during the 1-year follow-up. A 2-year-old boy was admitted to the emergency department for drowsiness, thirst, and dry mouth 30min after the administration of three eye drops of atropine 1 % instead of atropine 0.3 % (error made by the pharmacy). Symptoms disappeared after 6h. Both observations highlight the possible side effects related to mydriatic eye drops. Indeed, because of small penetration of such medications in the eye, a high concentration of the active part of the medication is contained in each drop. In young children, at least 20 to 40 % of the volume of a drop drains into the nasolacrimal duct and thereby into the systemic circulation, without passage through the liver. A close national pharmacologic vigilance follow-up has been set up for atropine-based mydriatic eye drops in young children, who are the most exposed to systemic and potentially severe complications of these medications. We emphasize the appropriate procedure for the use of eye drops in young children to limit systemic passage, with only a 0.3 % maximum atropine concentration in infants, compression of the internal angle of the eye for at least 1min, and at least a 15-mins interval between two eye drop administrations.
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Affiliation(s)
- A Princelle
- Université Lille Nord-de-France, 59000 Lille, France; Urgences pédiatriques et maladies infectieuses, hôpital Roger-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
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Hsueh CW, Chen HS, Li CH, Chen YW. Eosinophilic meningitis caused by Angiostrongylus cantonensis in an adolescent with mental retardation and pica disorder. Pediatr Neonatol 2013; 54:56-9. [PMID: 23445744 DOI: 10.1016/j.pedneo.2012.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/29/2011] [Accepted: 09/14/2011] [Indexed: 11/16/2022] Open
Abstract
Eosinophilic meningitis or encephalitis is a rare disorder and is most commonly caused by Angiostrongylus cantonensis. Humans are accidentally infected when they ingest raw snails or vegetables contaminated with the parasite larvae. Because of the improvement in sanitary food handling practices, the occurrence of A. cantonensis eosinophilic meningitis has been decreasing in Taiwan in recent decades. The common symptoms and signs of eosinophilic meningitis are severe headache, neck stiffness, paresthesia, vomiting, nausea, and fever. Acute urinary retention is a rare presentation. We report a case of A. cantonensis eosinophilic meningitis in an intellectually disabled patient who presented with acute urinary retention without any other meningeal signs. The patient received supportive treatment with corticosteroid therapy and was discharged and received urinary rehabilitation at home.
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Affiliation(s)
- Chang-Wei Hsueh
- Department of Pediatrics, Landseed Hospital, Taoyuan, Taiwan
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Steele JW. Urinary retention in an adolescent with a history of urethral transection. J Emerg Med 2011; 43:461-4. [PMID: 22018981 DOI: 10.1016/j.jemermed.2011.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 05/18/2011] [Accepted: 06/11/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Urinary retention is rare in adolescence. Here I describe such a case in a patient who had transected her urethra in a motor vehicle accident at 3 years of age. The presumptive diagnosis of urethral stricture was proven incorrect. OBJECTIVES Both to present a complicated and unique case whose history pointed strongly to one diagnosis initially but turned out very differently than expected; and to give an example of the use of bedside ultrasonography in the Emergency Department as a diagnostic tool in an unusual circumstance. CASE REPORT A 13-year-old girl was evaluated for 3 days of urinary retention. Her history of pelvic fracture and urethral transection in childhood suggested a urethral stricture. Her work-up revealed, however, a vaginal stricture and resultant hematocolpos compressing the urethra. Upon surgical excision, the stricture was confirmed to be scar tissue, rather than a coincidental congenital septum. CONCLUSION Hematocolpos is an uncommon but well-described cause of urinary retention in premenarchal females. This is a difficult diagnosis in any circumstance, and this patient's complex history complicated the process. It was the bizarre bedside ultrasound that prompted further work-up than simple urethral catheterization and urologic follow-up, which her urologist had suggested over the phone. This patient's case is unique in the literature.
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Affiliation(s)
- Jeffery W Steele
- Department of Emergency Medicine, University of Arkansas for Medical Science, Little Rock, Arkansas, USA
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Abu-Ghanem S, Novoa R, Kaneti J, Rosenberg E. Recurrent Urinary Retention Due to Imperforate Hymen After Hymenotomy Failure: A Rare Case Report and Review of the Literature. Urology 2011; 78:180-2. [DOI: 10.1016/j.urology.2010.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/28/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
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Ercan CM, Karasahin KE, Alanbay I, Ulubay M, Baser I. Imperforate hymen causing hematocolpos and acute urinary retention in an adolescent girl. Taiwan J Obstet Gynecol 2011; 50:118-20. [DOI: 10.1016/j.tjog.2011.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2009] [Indexed: 10/18/2022] Open
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Rasmussen A, Muñiz AE, King B. Neuroblastoma Causing Acute Urinary Retention: A Rare Presentation. J Emerg Med 2010; 39:602-6. [DOI: 10.1016/j.jemermed.2009.04.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 02/21/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
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Wan KS, Liu NH, Liu CK, Hwang IZ. Psychogenic urinary retention in children: a case report. Pediatr Neonatol 2010; 51:300-2. [PMID: 20951362 DOI: 10.1016/s1875-9572(10)60058-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 11/12/2009] [Accepted: 12/04/2009] [Indexed: 11/18/2022] Open
Abstract
Psychogenic urinary retention occurs relatively infrequently in children and is less common than in adults. The influence of psychogenic factors on voiding generally results in an irritative syndrome, but rarely in urinary retention. A definitive diagnosis is established by excluding other pathological conditions. Evaluation includes urine culture, renal echography, spine magnetic resonance imaging, voiding cysto-urethrography, intravenous pyelography, and uroflowmetry. Here, we report on a 6-year-old girl with a 1-month history of voiding difficulty. Urology studies, including urine culture, revealed Escherichia coli, which was not present in preadmission urine cultures. Renal ultrasound and radiological images showed no gross abnormalities or vesicoureteral reflux, but uroflowmetry showed a low flow rate with residual urine. The results of imaging studies and pediatric psychiatric consultation led to a diagnosis of psychogenic urinary retention combined with urinary tract infection. Urinary rehabilitation included intermittent catheterization, bladder training, and supportive psychotherapy, after which the patient recovered and was discharged.
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Affiliation(s)
- Kong-Sang Wan
- Department of Pediatrics, Taipei City Hospital, Renai Branch, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Koomen E, Bouman E, Callewaerdt P, Vos GD, Prins MH, Anderson BJ, Marcus MAE. Evaluation of a non-invasive bladder volume measurement in children. ACTA ACUST UNITED AC 2009; 42:444-8. [PMID: 18609281 DOI: 10.1080/00365590802054600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Postoperative urinary retention (PUR) is associated with overdistension of the bladder. The prevention of PUR by routine catheterization may increase the risk of urinary tract infection. Postoperative monitoring of the bladder volume by ultrasound to prevent PUR is reliable in adults, but has not been evaluated in children. MATERIAL AND METHODS The BladderScan BVI 6200, an ultrasound device specifically designed for children, was assessed. Forty patients who required urinary catheter placement during surgery or during intensive care unit stay were entered into this blinded calibration study. An assessment of bladder urine volume by ultrasound was performed before and after catheterization in surgical patients. In these patients and intensive care patients 0, 2.5 or 5 ml/kg sterile normal NaCl was injected through the bladder catheter and the catheter was clamped. Volumes estimated with ultrasound were compared with measured catheter drainage or/and injected volume after the scan. RESULTS The mean relative difference (bias) between the ultrasound estimate and the injected volume was -20% (95% confidence interval 140 to -180%). Precision, estimated using the Wilcoxon signed ranks test, showed a significant difference (Z = -3.25, p = 0.001) between the ultrasound-estimated volumes and the injected volumes. CONCLUSIONS This study could not confirm good agreement between the ultrasound-estimated volumes and the injected volumes at volumes below 5 ml/kg. Bladder volumes were underestimated with a very broad 95% confidence interval. The ultrasound device should not replace current clinical assessment.
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Affiliation(s)
- Erik Koomen
- Department of Anaesthesia, Sophia Children's Hospital, Rotterdam, The Netherlands.
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Sharifiaghdas F, Abdi H, Pakmanesh H, Eslami N. Imperforate hymen and urinary retention in a newborn girl. J Pediatr Adolesc Gynecol 2009; 22:49-51. [PMID: 19241622 DOI: 10.1016/j.jpag.2008.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urinary retention is relatively rare in infants,especially in girls. Imperforate hymen is the most frequent congenital malformation of the female genital tract and is usually asymptomatic until puberty. Mucocolpos with an abdominal mass in neonatal age is extremely rare. We report a case of a 20-day-old newborn girl with acute urinary retention due to isolated imperforate hymen and mucocolpos.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti Medical University, Tehran, Iran.
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Shih SL, Liu YP, Tsai JD, Tsai YS, Yang FS, Chen YF. Acute urinary retention in a 7-year-old girl: an unusual complication of cytomegalovirus cystitis. J Pediatr Surg 2008; 43:e37-9. [PMID: 18970919 DOI: 10.1016/j.jpedsurg.2008.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/13/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
Abstract
Acute urinary retention in children is rare. There are a variety of causes about the disease. We report a case of a 7-year-old girl with acute urinary retention and hematuria. Pelvic sonogram revealed an isoechoic mass in the urinary bladder that appeared as a lobulated filling defect over the bladder neck on intravenous urography and computed tomography studies. The surgical specimen from cystoscopic examination showed reactive changes on pathologic analysis. Cytomegalovirus was isolated from urine culture. The girl recovered after supportive treatment.
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Affiliation(s)
- Shin-Lin Shih
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
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Sherburne E, Sawin K. Investigating time to void after lower-extremity orthopedic surgery in a pediatric population. J SPEC PEDIATR NURS 2008; 13:36-47. [PMID: 18096011 DOI: 10.1111/j.1744-6155.2008.00132.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to determine the time frame of postoperative bladder volume assessment in order to identify children at risk for urinary retention in a pediatric orthopedic population. DESIGN AND METHODS This is a descriptive and nonexperimental study. Variables included age, sex, length of anesthesia, type of analgesia, analgesia delivery, bladder volume, and intravenous fluid rate. RESULTS Twenty-nine percent of the children (n = 38) required straight catheterization. The average length of time to bladder emptying was 5 hr. There were significant correlations (p < .05) between several variables. PRACTICE IMPLICATIONS The standard practice of waiting 8 hr before assessment of voiding was not supported in this study.
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Affiliation(s)
- Eileen Sherburne
- Department of Advanced Practice Nursing and Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
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36
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Tobias N, Mason D, Lutkenhoff M, Stoops M, Ferguson D. Management principles of organic causes of childhood constipation. J Pediatr Health Care 2008; 22:12-23. [PMID: 18174085 DOI: 10.1016/j.pedhc.2007.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Constipation is extremely common in the pediatric population; however, it is a symptom and not a disease. Organic causes of constipation include Hirschprung's disease, anorectal malformation, and spina bifida. This article also discusses constipation and urinary tract pathology and dysfunction. The function of the gastrointestinal and urinary tracts are intertwined, and this concept will assist the practitioner in managing patients accordingly. Children and adolescents who experience bowel dysfunction require patience and sensitive support from their health care providers so that they can live productive and emotionally healthy lives.
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Affiliation(s)
- Nan Tobias
- Cincinnati Children's Hospital, Division of Urology, 3333 Burnet Ave, MLC 5037, Cincinnati, Ohio 45229, USA.
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BASAR H, BATISLAM E, YILMAZ E, BASAR M, TOPRAK R. An unusual cause of acute urinary retention in a child with pica disease. BJU Int 2007; 92 Suppl 3:e18. [DOI: 10.1111/j.1464-410x.2003.02953.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chang JW, Yang LY, Wang HH, Wang JK, Tiu CM. Acute urinary retention as the presentation of imperforate hymen. J Chin Med Assoc 2007; 70:559-61. [PMID: 18194899 DOI: 10.1016/s1726-4901(08)70061-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Acute urinary retention is unusual in children and is usually a candidate for visiting the emergency department upon initial discovery. We report a 12-year-old girl who complained of acute urinary retention. Ultrasonography demonstrated a large echogenic mass over the vagina and mild dilation of the uterus. Imperforate hymen associated with hematocolpos and hematometrium was diagnosed. Cruciate hymenotomy was performed. The symptoms resolved after treatment. Adolescent girls who complain of urinary symptoms with no previous menstruation should have their external genitalia examined in order to rule out the possibility of imperforate hymen as the cause of acute urinary retention.
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Affiliation(s)
- Jei-Wen Chang
- Department of Pediatrics, Taipei Veterans General Hospital, and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, R O C
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Abstract
Urinary retention can be described as the inability to void volitionally despite an adequate volume of urine in the bladder. It is a common complaint in adults, especially among elderly males with benign prostatic hyperplasia. Children, in contrast, are more likely to have voluntary retention of urine due to urethral irritation or dysuria. Gently massaging the suprapubic region while the child is in a warm bath often relieves the retention in these cases. Other patients described as lazy voiders can present with acute urinary retention. These patients are typically young girls who are embarrassed to void at school. Retraining or timed voiding is often successful managing lazy voiders. However, these benign disorders should only be diagnosed after anatomical or organic causes for their symptoms have been considered and ruled out.
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Affiliation(s)
- Curt Stankovic
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Murshidi MS, Akl K. A case of urinary bladder benign polyp treated successfully by resection in a child. Ann Saudi Med 2007; 27:52. [PMID: 17277501 PMCID: PMC6077030 DOI: 10.5144/0256-4947.2007.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Place RC. Acute urinary retention in a 9-year-old child: an atypical presentation of acute appendicitis. J Emerg Med 2006; 31:173-5. [PMID: 17044580 DOI: 10.1016/j.jemermed.2005.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute urinary retention is unusual in childhood and when present is likely to have an identifiable cause. Although the evaluation is often performed by the urologic specialist after relief of the obstruction, it is imperative that some causes be identified in the Emergency Department. This is a case of a 9-year-old boy in acute urinary retention caused by a ruptured appendix with a periappendiceal abscess.
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Affiliation(s)
- Rick C Place
- Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, Virginia 20042, USA
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Abstract
The more common urologic problems seen in infancy and childhood that require urgent or emergent pediatric urologic referral are discussed, including a brief description of the usual presenting signs or symptoms, differential diagnoses, proper diagnostic work-up recommended before or at the time of referral, and the usual therapeutic course of management after evaluation by the urologist. These conditions include the acutely swollen scrotum, scrotal masses, penile swelling and erythema, exstrophy, hematuria, urinary retention, abdominal masses, and various genital abnormalities including interlabial masses, hypospadias with any degree of cryptorchidism, and ambiguous genitalia. This article is designed to provide the primary care practitioner with a focused review and a useful resource for managing children who have genitourinary abnormalities in the hospital or clinic setting.
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Affiliation(s)
- Jeffrey A Leslie
- Division of Pediatric Urology, Indiana University School of Medicine, J.W. Riley Hospital for Children, 702 Barnhill Drive, #4230, Indianapolis, IN 46202, USA
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43
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Sakakibara R, Yamanishi T, Uchiyama T, Hattori T. Acute urinary retention due to benign inflammatory nervous diseases. J Neurol 2006; 253:1103-10. [PMID: 16680560 DOI: 10.1007/s00415-006-0189-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 12/13/2005] [Indexed: 10/24/2022]
Abstract
Both neurologists and urologists might encounter patients with acute urinary retention due to benign inflammatory nervous diseases. Based on the mechanism of urinary retention, these disorders can be divided into two subgroups: disorders of the peripheral nervous system (e.g., sacral herpes) or the central nervous system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities include increased herpes virus titers in sacral herpes, and increased myelin basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic abnormality in both conditions is detrusor areflexia; the putative mechanism of it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal shock in MRS. There are few cases with CSF abnormality alone. Although these cases have a benign course, management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. Clinical features of sacral herpes or MRS differ markedly from those of the original "Elsberg syndrome" cases.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Chiba University, 1-8-1 Inohana Chuo-ku, 260-8670 Chiba, Japan.
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Abstract
Stress urinary incontinence (SUI) is the involuntary loss of urine associated with physical activities such as running, jumping, or lifting, or with sneezing and coughing. For many patients it can be a very bothersome symptom, causing social isolation, loss of self-esteem, and increased expenses. Although there is currently no single medication approved worldwide for the treatment of SUI, a variety of off-label agents are often prescribed. This paper reviews the current pharmacological treatment options for SUI, describing the mechanism of action, efficacy, and possible adverse effects of each. A new centrally-acting compound with dual activity as a balanced serotonin and norepinephrine reuptake inhibitor, duloxetine, may offer a promising new approach for treatment.
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Affiliation(s)
- Lars Viktrup
- Lilly Research Laboratories, Indianapolis, Indiana, USA.
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45
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Abstract
Urinary retention occurring after caudal anaesthesia in children has a low incidence. Most children will void within 12 h of surgery, although the incidence of retention is higher after hypospadias repair. However, overdistention causing bladder atony that is temporary, or may become permanent, is described in adults. Long-term effects of overdistention in children have not been described. Urine volume, used to describe overdistention, is traditionally measured after catheterization. We report two children suffering from urine retention after caudal anaesthesia (bupivacaine 0.25%) was used to supplement a general anaesthetic. Ultrasound bladder monitoring was used to assist with the clinical diagnosis of bladder distension in the postanaesthesia care unit (PACU) and subsequent management. In-out catheterization was required in a 1-year-old-girl with a bladder volume of 12 ml.kg-1 after external manual compression over the bladder was unable express urine. Spontaneous micturation occurred within the subsequent 8 h. A 10-year-old boy suffered distress in PACU with a bladder volume, measured by ultrasound, of 5 ml.kg-1. Catheterization relieved distress and spontaneous micturation returned 18 h after surgery. Measured urine volumes were similar to those estimated by ultrasound. Ultrasound bladder monitoring is a simple, noninvasive technique that can be used to assist with the diagnosis and management of urinary retention in children. It may replace catheterization as the prefered technique to measure urine volume. The correlation between measured bladder volumes and urine volume appears reasonable. A volume of approximately 10 mg.kg-1 may be considered as causing overdistension.
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Affiliation(s)
- Erik Koomen
- Department of Anaesthesia, Academisch Ziekenhuis, Maastricht, The Netherlands.
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Wahl RA, Shapiro E, Elliott SP, Binkiewicz AI. Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Curr Opin Pediatr 2001; 13:603-15. [PMID: 11753115 DOI: 10.1097/00008480-200112000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We once again review four areas of interest to office-based pediatricians: office laboratory procedures, office economics, parenting and patient education, and urinary tract infections. Sean Elliott reviews the current status of the Clinical Laboratories Improvement Amendments (CLIA) and their continuing impact on physician office laboratories. Eve Shapiro reviews office economics, this year focusing on managed care, the physician workforce, practice management, and health care financing for the uninsured. Anna Binkiewicz provides an update on parenting and parent education, with recent reports on nutrition and childhood immunizations. Richard Wahl again reviews recent research on urinary tract infection, discussing voiding physiology, dysfunctional voiding patterns, acute urinary retention, urine collection techniques, diagnosis in young infants, and antibiotic prophylaxis.
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Affiliation(s)
- R A Wahl
- University of Arizona College of Medicine and Steele Memorial Children's Research Center, Tucson, Arizona 85724-5073, USA.
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