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Sunday, May 19, 2013
Urinary and Genital Disorders (Children)
Pain on urination
I am a physician. I have a 9 year old son (circumcised) who has been complaining for years of intermittant (about once a week) burning at the end of his penis (he says it is inside and points to his frenulum) when he urinates. It seems to be generally associated with more forceful urination when his bladder is full. He complains of burning beginning somewhere during mid urination that is fairly intense and lasts about 10 minutes after urination. He has had no instrumentation or surgery other than circumcision. He was examined by a urologist who saw nothing..he saw no evidence for stenosis or other abnormality on physical exam. His urinalysis and cultures were normal and his bladder completely empties after urination (based on ultrasound). His stream appears normal and he never complains of hematuria. He has no psychological issues to suggest this is psychogenic and it is pretty clear to me when he complains of this that it isn`t psychogenic.
The urologist said that he could try some more invasive testing (cystogram or urethrogram) but thought those would be fruitless and an unnecessary risk at this time.
This is very concerning to my child...it is clearly painful. Do you have any suggestions?
This is a difficult question. Often in situations such as this we do not find a definite cause. Possibilities include intermittent hypercalciuria, some form of crystalluria, or possibly some other irritant in the urine. Another possibility is that when he showers or bathes, some soap may be getting just inside the urethral meatus. The difficult aspect is the fact that it occurs infrequently. I would suggest increasing his fluid intake to try to maximize the likelihood that his urine remains dilute throughout the day and night.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University