I have a puzzling case. 8 y.o. healthy male child. Had normal urinary habits. Has now had several months of fairly abrupt onset urinary frequency, which translates into urge to urinate every 1/2 to 1 to 2 hours, and even includes occasional nocturia x1 which beforehand did not occur. No dysuria, no hematuria, no genital exam findings, no abuse hx, no signs/sx nor risk factors for UTI, Diabetes, STD, etc. Child thriving in every other way including psychological. Only history which is of questionable accuracy in child of this age is that while playing rough with friends (basketball collision, kids tumbled to ground) he received a blow in the area of mons pubis. On exam there is in fact an area of skin round appx 1 cm diameter with slight discoloration which really could represent a healing blow to the skin, although whether this has to do with the case remains unclear. Eval at primary care office included completely normal dipstick urinalysis.
What's the differential? What's the next step? Peds urology evaluations are very hard to access in our rural location, so the more that can be done in PCP setting the better.
Well, without a detailed clinical evaluation it would be difficult to determine the cause of the symptoms. Possible causes that may need to be considered include increased emotional stress/ anxiety, GU infections/ inflammations, hormonal/ endocrine issues, neuro-muscular causes, autonomic disturbances, medication side effect etc. I would suggest considering an evaluation by a primary care physician initially and depending on the cause diagnosed/ suspected, this can be managed accordingly or specialist care may be sought.
Hope this is helpful.
Good morning. Thanks for weighing in. Child has had thorough eval by 2 primary care physicians. Stress unlikely -- parents divorced but no more stress in child's life than before acute onset of symptoms. Infection seemingly ruled out with clean UA & Cx. Hormone/endocrine issues seem ruled out by virtue of clean UA (no glucose) and by virtue that this is frequency but not polyuria (frequent voiding of low rather than high volumes of urine). Neuromuscular and autonomic unlikely as child thrives athletically and in all other physical ways. No meds OTC or otherwise, so not a med side effect. No dietary changes, either.
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