title: Dysfunctional elimination syndrome as an etiology of idiopathic urethritis in childhood.
abstract: OBJECTIVE
  Idiopathic urethritis (IU) of childhood or urethrorrhagia is a common problem characterized by blood spotting in the underwear between voiding. A clear etiology has not been established and treatments vary. We postulate that idiopathic urethritis is a manifestation of underlying dysfunctional elimination syndrome (DES).
  
  
  METHODS
  During a 5-year period we reviewed the records of all children diagnosed with IU in our practice. In total 72 children fit the analysis criteria. There were 68 boys and 4 girls. All children presented with either gross blood per urethra or microhematuria. Children with active infection, immunodeficiency, neurogenic bladder, vesicoureteral reflux, infravesical obstruction, urethral trauma or other genitourinary anomalies were excluded. Evaluation included thorough history and physical examination, urinalysis and urine culture. Renal and bladder ultrasound, voiding cystourethrogram and uroflow/electromyogram/post-void residual volume were obtained in select patients. Study children were divided into 2 cohorts. The first cohort (group 1, 37 patients) was treated with traditional remedies using antibiotics, urinary analgesics and/or anticholinergics. The second cohort (group 2, 35 patients) was treated by bowel and bladder regimens, laxatives when necessary, and biofeedback and/or alpha-blockers when sphincter dyssynergia was identified.
  
  
  RESULTS
  A total of 13 patients in group 1 (35%) had a full response to treatment, 6 (16%) had a partial response and 18 (49%) failed to respond. A total of 29 patients in group 2 (83%) had a full response to treatment, 2 (6%) had a partial response and 4 (11%) had no response. It took an average of 12.1 months to respond fully in group 1, while in group 2 the same full response took an average of 5.2 months. Of the 18 children who crossed over from group 1 to group 2, 15 (83%) had a full response with an average response time of 7.3 months.
  
  
  CONCLUSIONS
  Our data clearly reveal a higher cure rate when children with urethritis are treated according to DES guidelines. IU of childhood is a manifestation of underlying DES and should be treated as such.
authors.affiliation: Division of Pediatric Urology, Department of Urology, New York Medical College, New York, New York, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herz
authors.forename: Adam
authors.initials: A
authors.lastname: Weiser
authors.forename: Therese
authors.initials: T
authors.lastname: Collette
authors.forename: Edward
authors.initials: E
authors.lastname: Reda
authors.forename: Selwyn
authors.initials: S
authors.lastname: Levitt
authors.forename: Israel
authors.initials: I
authors.lastname: Franco
mesh_terms: D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002400:Cathartics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D015331:Cohort Studies; D003248:Constipation / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003558:Cystoscopy; D004043:Dietary Fiber / Q000008:administration & dosage; D005260:Female; D006417:Hematuria / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D013577:Syndrome; D014039:Toilet Training; D014526:Urethritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014555:Urination Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014567:Urography
chemical_list: D000317:Adrenergic alpha-Antagonists; D000700:Analgesics; D000900:Anti-Bacterial Agents; D002400:Cathartics; D018680:Cholinergic Antagonists; D004043:Dietary Fiber