CHAPTER 57 ■ PAIN: DYSURIA JACQUELINE BRYNGIL CORBOY, PATRICIA LOPEZ INTRODUCTION Many conditions of the genitourinary tract produce symptoms of pain or burning associated with urination, or dysuria This sensation is produced by the muscular contraction of the bladder and the peristaltic activity of the urethra, both of which stimulate the pain fibers in the edematous and inflamed mucosa Young children may complain of painful urination when they are instead experiencing related symptoms, such as pruritus When a child is too young to verbalize his or her symptoms, parents may interpret various nonspecific statements or behaviors by their child as indicative of painful urination Dysuria is a commonly reported symptom associated with a number of infectious and noninfectious causes, but it usually stems from one of several common disorders of childhood and adolescence Most children presenting with dysuria as a chief complaint will have primary disorders of the genitourinary tract Although patients with urethritis secondary to systemic illnesses may have dysuria as one of their many symptoms, it is rarely the principal reason for a visit to an emergency department (ED) Most diseases causing dysuria are self-limited or easily treated; but systemic causes of urethritis or the spread of some bacterial pathogens beyond the genitourinary tract may be life threatening A differential diagnosis of the many systemic, infectious, and noninfectious causes most commonly presenting as dysuria may be found in Tables 57.1 to 57.4 EVALUATION AND DECISION The approach to the child with dysuria must be broad; history and physical examination will help determine the direction and scope of the workup Conduct a thorough investigation of possible causes, including questions about trauma (both accidental and nonaccidental), exposure to chemicals such as detergents, fabric softeners, perfumed soaps, bubble baths, and medications that may irritate the mucosal lining of the urethra or bladder A negative history for injury does not rule it out as most traumas are not recalled by young patients In the case of masturbation or abuse, such history may be denied Obtaining a history about the nature and extent of sexual activity may facilitate the detection of sexually