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Idiopathic urethritis in children: Classification and treatment with steroids

BACKGROUND: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 – 4) and report our experience with use of topical and oral steroids in IU. MATERIALS AND METHODS:...

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Autores principales: Jayakumar, Sivasankar, Pringle, Kirsty, Ninan, George K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155630/
https://www.ncbi.nlm.nih.gov/pubmed/25197191
http://dx.doi.org/10.4103/0971-9261.136464
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author Jayakumar, Sivasankar
Pringle, Kirsty
Ninan, George K.
author_facet Jayakumar, Sivasankar
Pringle, Kirsty
Ninan, George K.
author_sort Jayakumar, Sivasankar
collection PubMed
description BACKGROUND: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 – 4) and report our experience with use of topical and oral steroids in IU. MATERIALS AND METHODS: Retrospective data collection of all male children (0-16 years) diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes. Results: A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16) years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV). Mean follow up was 18.9(1-74) months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone) in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7%) patients. Significant improvement in symptoms and signs was noted in 1(5.3%) patient who is still undergoing treatment. CONCLUSIONS: IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required.
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spelling pubmed-41556302014-09-05 Idiopathic urethritis in children: Classification and treatment with steroids Jayakumar, Sivasankar Pringle, Kirsty Ninan, George K. J Indian Assoc Pediatr Surg Original Article BACKGROUND: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 – 4) and report our experience with use of topical and oral steroids in IU. MATERIALS AND METHODS: Retrospective data collection of all male children (0-16 years) diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes. Results: A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16) years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV). Mean follow up was 18.9(1-74) months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone) in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7%) patients. Significant improvement in symptoms and signs was noted in 1(5.3%) patient who is still undergoing treatment. CONCLUSIONS: IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4155630/ /pubmed/25197191 http://dx.doi.org/10.4103/0971-9261.136464 Text en Copyright: © Journal of Indian Association of Pediatric Surgeons http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Jayakumar, Sivasankar
Pringle, Kirsty
Ninan, George K.
Idiopathic urethritis in children: Classification and treatment with steroids
title Idiopathic urethritis in children: Classification and treatment with steroids
title_full Idiopathic urethritis in children: Classification and treatment with steroids
title_fullStr Idiopathic urethritis in children: Classification and treatment with steroids
title_full_unstemmed Idiopathic urethritis in children: Classification and treatment with steroids
title_short Idiopathic urethritis in children: Classification and treatment with steroids
title_sort idiopathic urethritis in children: classification and treatment with steroids
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155630/
https://www.ncbi.nlm.nih.gov/pubmed/25197191
http://dx.doi.org/10.4103/0971-9261.136464
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