FIGURE 57.1 Prepubertal children pathway (Adapted from: Fleisher GR Etiology and evaluation of dysuria in children and adolescents In: UpToDate, Post TW (Ed), UpToDate , Waltham, MA Available at www.uptodate.com ) Labial adhesions in the prepubertal age may be a potential cause for painful urination (see Table 57.4 ) Since most girls with labial adhesions are asymptomatic, evaluation for infection or other cause for dysuria should be considered A few patients with a normal examination and negative cultures may complain of dysuria persistently In this setting, dysfunctional voiding and idiopathic hypercalciuria represent potential diagnoses If suspected, the diagnosis of hypercalciuria/uricosuria can be confirmed by measurement of calcium excretion in the urine Another possible explanation in a female is that the patient is experiencing vaginal pruritus secondary to pinworms Confirmation of this