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.