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Urological Causes of Abdominal Pain in Children: a Mini-Review

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Urological Causes of Abdominal Pain in Children: a Mini-Review Central Annals of Pediatrics & Child Health Mini Review *Corresponding author Ahmed M Eliwa, Urology Department, Faculty of medicine Zagazig University, Zagazig , Egypt, Tel: Urological Causes of Abdomi- 00201018119977; Email: Submitted: 25 January 2016 Accepted: 05 April 2016 nal Pain in Children: A Mini- Published: 07 April 2016 Copyright Review © 2016 Eliwa OPEN ACCESS Ahmed M Eliwa* Department of Urology and Andrology, Zagazig University, Egypt Keywords • Urological • Abdominal pain Abstract • Children Abdominal pain is a common presentation to a various abdominal and extra- abdominal diseases in children.Most of urologic disorders may present in children with abdominal pain yet, their presentation may be atypical and confusing. Pediatrician and primary care giver must have high index of suspicion for these disorders. Good interpretation of the clinical manifestation and appropriate acquisition of suitable laboratory and radiologic investigations are the keys to accurate diagnosis of an abnormality in the child’surogenital tract.Urological disorders that may cause abdominal pain in children may include some common disorders such as: -urinary tract obstruction and hydronephrosis –urinary tract infections –tumors and trauma of the urinary tract –other conditions. INTRODUCTION torsion of the testis. Referredscrotal pain may arise in the kidneys or retroperitoneum. Abdominal pain in children is in one of the most important symptom in clinical practice as it represents a wide plethora of Etiology and Management of urologic abdominal pain causes and predisposing factors that may be attributed to either a in children local cause or even a systematic cause. It is important to mention An overview: that abdominal paina common presentation of various urologic diseases in children (which in turn are common in children). An A. Hydronephrosis and Urinary Tract Obstruction important issue to state is that abdominal pain in children due to B. Urinary tract infections [UTIs] urologic cause may differ in clinical presentation and course than in adults, that’s to say that urologic abdominal pain may have C. Urinary tract trauma a non-classical presentation.Another critical issue to consider D. Tumours of the urinary tract is that pain in the genitalia (due to torsion or orchitis) may be referred to the abdominal and vice versa hence workup of a E. Genital tract abnormalities case of abdominal pain should include genital thorough genital F. Other Causes examination.Primary care physician or care provider must have a A. Hydronephrosis and Urinary Tract Obstruction high index of suspicion to identify a urologic cause for abdominal Urinary stone disease in children pain. Urinary stone disease is the most common cause of urologic Types and classification of urologic abdominal pain abdominal pain. Abdominal pain due to Upper urinary tract Renal Pain: It is located in the ipsilateralcostovertebral adults. In many cases the condition may present with vague upperabdomen and umbilicus and may be referred to the testis or abdominalstone in children pain, recurrent may differ UTI, lowerthan urinarythe classic tract flank symptomand pain in labium.angle the Association pain may radiate with gastrointestinalsymptoms across the flank anteriorly is towardcommon the hematuria.Renal colic, which occurs in approximately 40–75% of children with urolithiasis [1,2] presents with a sudden onset Bladder Pain: Produced either by bladder distension or with gastrointestinalsymptoms (nausea and vomiting). of severe cramp-likeflank, abdominal, or pelvic pain associated bladderTesticular inflammation. Pain: Scrotal pain is either primary or referred. Irritativevoiding symptoms (i.e. urgency, andfrequency) occur Primary scrotal pain is usually due to acute epididymitis or when the calculus is in the distalthird of the ureter. In some Cite this article: Eliwa AM (2016) Urological Causes of Abdominal Pain in Children: A Mini-Review. Ann Pediatr Child Health 4(1): 1097. Eliwa (2016) Email: Central patients the pain canpresent as diffuse abdominal pain and can causeof neonatal hydronephrosis. They usually affect male boys and occur on the left side [15,16]. Clinical presentation includes recurrent UTI, hematuria, and abdominal mass or (76%).obscurethe Other clinical symptomsincluded picture, delaying gross the correcthematuria diagnosis (15%) [3]. of cyclic abdominal pain. Diagnostic Work up includes ultrasound, Sternberg et al found that frequent symptoms were loin patients voiding cystourethrography, dynamicnuclear renography and urethrocystoscopy in some cases.Treatment is by surgical patients and concurrenturinary tract infection (UTI) in (8%) of patientsInitial [4]. investigation includes pelvi-abdominal ultrasound, urinalysis and KUB. The most sensitive testfor identifying stones ureteralVesicoureteral tailoring and reflux anti-reflux [VUR] re-implantation in the urinary system is non-contrast helical computerized tomography scanning. It is safe and rapid, with 97%sensitivity Vesicoureteral reflux is an anatomical and/or functional in children, butmay be needed to delineate the calyceal anatomy. disorder that lead to retrograde flow of urine from the urinary Nonand 96%contrast specificity computerized [5-7]. Intravenous tomography pyelography [NCCT] can is rarelydetermine used this condition may lead to serious consequences, suchas renal scarringbladder to[due the toureter repeated with pyelonephritis],or without the hypertension,kidney.in children and stone density and skin-to-stone distance; all of whichhave not develop renal scars and probably do not need anyintervention an impact on extracorporeal shock wave lithotripsy (ESWL) [17].renal VURfailure. in childrenFortunatelygood has an incidence proportion of ofnearly reflux 1%.The patients Classic does outcome [8-11]. The disadvantage of non-contrastCT is the age of presentationoccurs in school children. They present disease.Treatmentabsent quantification options of renal includes functions, conservative as well as high management radiation. Metabolic workup is mandatory in children with urinary stone imaging tests include renal and bladder ultrasonography, voidingwith abdominal cystourethrography pain as a prime [VCUG] symptom and nuclear [18]. Therenalscans.A standard laparoscopic[fluids and medical surgery. expulsive therapy], [ESWL], percutaneous baselinerenal isotope scan using dimercaptosuccinic acid [DMSA] nephrolithotomy [PCNL], ureteroscopy [URS], and open or scan atthe time of diagnosis can be used for detection of renal Pelvi-ureteric Junction obstruction [PUJO] PUJO is the most common cause of congenital urinary scarring and later during follow-up [19,20]. The treatment tract obstruction in children. The obstructing factors may [endoscopiclines for VUR injection includes of bulkingnon-surgical agent ortreatment surgical ureterovesical[follow up or reimplantation].continuous antibiotic prophylaxis] or surgical correction the pelvi-ureteric junction. Secondary causes of PUJO such as include fibrous band, adynamic segment or crossing vessel at Urinary tract obstructions at other levels congenital hydronephrosis are diagnosed during the prenatal stone, polyp, or stricture may be present. Most of children with Urinary tract obstructions at other levels, such as clinical presentation is abdominal pain and recurrent UTI. bladderoutlet or the urethra [posterior urethral valve, congenital ultrasonographic imaging during pregnancy [12]. The usual meatal stenosis] may cause abdominal pain. PUJO is one of the common causes of recurrent abdominal B. Urinary tract infections [UTIs] and includes episodic, upper abdominalcrampy pain, nausea, and Urinary tract infections (UTIs) are the most common bacterial pain in children. Dietl’s crisiswas described by Josef Dietl in1864, (Table 1), especially considering age, gender, pathogenand vomiting associated with intermittent renal pelvic obstruction infection in children [21-23]. Clinical presentation is variable [13]. Recurrent abdominal pain ceases after surgical correction children depends on adequate clinical evaluation [through history of theThe PUJO preliminary [14]. diagnostic method is pelviabdominal anatomical malformations [24-27]. The diagnosis of UTI in ultrasonography. Ultrasonography can detect degree of hydronephrosis, antero-posterior diameter of the renal pelvis, and examination], urinalysis and urine culture and sensitivity. parenchymal thickness and echogenicity. Doppler US can be Table 1: Clinical presentation of UTI according to site. Upper urinary tract Lower urinary tract (Cystitis) to demonstrate crossing vessel at the pelvi-ureteric junction. used to calculate renal artery resistive index and can be used (pyelonephritis) Diffuse pyogenic infection of the important tool of diagnosis. Split kidney function, GFR, Renal renal pelvis and parenchyma urinary bladder mucosa Diuretic Radio-isotope renography [with 99mTc-MAG3] is isotope uptake curve and time, all are information obtained InflammatoryDysuria, frequency, condition urgency, of the chills, costovertebral angle or malodorous urine, enuresis, includes open pyeloplasty or laparoscopic pyeloplasty. Other • Abrupt onset Fever (>38°C), • hematuria, and suprapubic pain by this technique.Surgical treatment of PUJO [when indicated] Cystitis symptoms in older flank pain, and tenderness. options of treatment include watchful waiting and endoscopic • pain. children along with fever/flank incisionMegaureter [Endopyelotomy]. and Ureterovesical junction (UVJ) Infants and children may have obstruction • poor
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