• Meatal stenosis
• Urethral stricture
• Posterior urethral diverticula
• Urethral stones
• Urethral valves
• Ureterocele
• Ectopic ureter
• Vesico-vaginal fistula

• Viral infection
• Gonorrhea
• Herpes simplex
• Tuberculosis
• Cystitis
• Urethritis
• Pinworms
• Prostatitis

• Bubble bath urethritis
• Cytoxin

• Diaper dermatitis
• Foreign body
• Bicycle injury
• Masturbation
• Sexual abuse

• Sarcoma botroides

• Cysteinuria

• Food allergy
• Stevens-Johnson syndrome
• Contact dermatitis such as poison ivy

• Attention mechanism

• Appendicitis

Question: Do the symptoms occur at any special time of day?
Significant: May indicate an attention mechanism if occurs before school, etc.

Question: What kinds of medicine do you take?
Significant: Some medications such as cytoxin will cause irritation of the urethra.

Question: Have there been any new foods or known food allergens?
Significant: Milk and citrus fruits can cause dysuria in certain patients. Best determined if symptoms regress on elimination of possible offending food.

Question: Do you use bubble bath?
Significant: Bubble bath is fun but causes the urethra to lose its protecive lipids.

Question: Any signs of bleeding?
Significant: Can indicate trauma, infection, or congenital anomalies. Some feel that calcium exretion can cause dysuria as well as hematuria.

Question: Fever
Significant: Common sign of urinary tract infection.

Question: Frequency
Significant: Both frequency and dysuria are common findings in urinary tract infections.

Question: Past history of urological operations
Significant: Anti-reflux may have a side effect of dysuria

Question: What have you taken for the discomfort?
Significant: Common usage of cranberry juice is used for many urinary problems. The additional volume is usually helpful but the effect of cranberry juice is neglible in the volumes usually consumed.

Question: Quality and strength of the urinary stream
Significant: Patients with posterior urethral valves have small frequent voidings with low pressure because of the obstruction in the posterior urethra.

Finding: Any signs of redness or ecchymoses?
Significance: May indicate trauma from masturbation or abuse

Finding: Any bleeding?
Significance: Seen in trauma, tumors, and infection

Finding: Any change in behavior?
Significance: This symptom may be an attention seeking device.

Finding: Abnormal swelling?
Significance: May occur in trauma or rare tumors.

Finding: Abnormal urethra?
Significance: Prolapsed urethra or diverticula

Finding: Grape-like stuctures in vagina?
Significance: Sarcoma boitriodes

Finding: Abdominal pain?
Significance: Intra-abdominal abscess or low lying inflamed appendix can cause dysuria

Test: Urinalysis
Significance: Most urinary tract infections will have white cells in the urine.

Test: Urine culture
Significance: Check for infection.

Test: Ultrasound
Significance: Not routinely requested unless a congenital anomaly is suspected.

Test: Metabolic screens
Significance: If sediment shows crystals; if familial history of metabolic disease.

Q: How does bubble bath cause dysuria?
A: The bubble bath removes lipids that protect the urethra causing the tissue to swell and become inflamed.

Q: Can allergies cause dysuria?
A: It is difficult to directly prove allergies as a cause of dysuria. However, in some cases, elimination of certain foods such as spices, citrus fruits, or known skin allergens have improved symptoms.

Q: How do children get infected with gonococcus?
A: This is a red flag of sexual abuse, which must be investigated.

Q: Which viruses cause dysuria?
A: Adenovirus has been identified

• Evidence of congenital anomaly
• Increasing severity of symptoms
• Failure to respond to symptomatic or specific treatment

• Sometimes difficult to differentiate dysuria from frequency, which may cause an uncomfortable feeling or pressure that is described by the child as “pain”
• Discharge with dysuria suggests gonococcal or chylamidia infection
• Low lying inflamed appendix may cause bladder irritation and dysuria
• Urethral prolapse may present as hematuria or frequency

Anonymous. 1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 1998;47(RR-1):1–111.

Lee HJ, Pyo JW, Choi EH, et al. Isolation of adenovirus type from the urine of children with acute hemorrhagic cystitis. Pediatr Infect Dis J 1996;15(7):633–634.

Rushton HG. Urinary tract infections in children. Epidemiology, evaluation, and management. Pediatr Clin North Am 1997;44(5):1133–1169.