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Urinary and Genital Disorders (Children)

22 mo. girl intermittent painful urination

02/12/2008

Question:

My 22mo. old otherwise very healthy daughter has been having intermittent painful urination episodes. There has a been a total of three so far. The first one was believed to be a UTI, albeit the culture, (P. mirabilis,) growth showed a low colony count, it did appear to resolve with the Abx tx. ( She did have a low grade fever for 2 days, increased thirst and finally pain and discomfort with a bacterial smell to the diaper the day we had our appointment.) Now when the episodes occur they consist of one or two "bouts" in the evening/night followed by a couple more after waking and drinking. They are quiet stressful, acutely painful and can last for 1-3 mins with a few more mins of discomfort. She crys and howls and says "owee pee pee Mommy" and grabs herself, so there is little doubt as to what hurts. After the second series of these episodes, (about 3-4 weeks after the 1st,) the doctor did a catheter sample which was very dilute,(she was drinking a lot at the time, SG=1.003.) The sample came back no growth on the culture. We did nothing more. No fever or smell to the diaper. The third and most recent episode, (2 weeks from the last time,)we did nothing but talk about it and he said let`s wait and see. No fever or smell to the diaper this last time either. He did mention possible bladder spasms. (?) I am concerned we are missing something, do you have any further ideas. Thank you.

Answer:

It sounds like she may have intermittent urethritis, in which there are symptoms of a lower urinary tract UTI, but a low colony count. I would have her drink lots of water, avoid baths, and get a culture if she is symptomatic. If these are recurrent, a prophylactic dose of an antibacterial such as nitrofurantoin, sulfatrim, or trimethoprim might be beneficial.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University