Urethrorrhagia Idiopathica and Urethritis Posterior in Prepubertal and Pubertal Boys
Urethrorrhagia idiopathica and urethritis posterior refer to the same condition, but the former term is used more frequently in american english literature. This phenomenon occurs frequently and alarms many prepubescent and pubertal boys and their parents. At the end of micturition, a few drops of lineage look at the meatus, frequently associated with a atrocious irritating ace within the urethra. The intense blood color staining of the underwear besides causes dismay. sometimes, son report megascopic hematuria, so a careful history and distinct examination of midstream and endstream urine are important to recognize this phenomenon. Bleeding from localized irritate mucosal changes in the bulbar urethra just distal to the external sphincter causes this circumstance. There are sometimes areas of leukoplakia. If special attention is taken during urethroscopy, one might observe thin fibrin membranes covering these areas. Histologically, metaplasia of the radical epithelial cells containing keratin is found.32 These cells have an estrogen level–dependent proliferation capacity and can interfere with the early epithelial cells. The condition occurs in boys at the onset or during puberty. In some of these boys, a higher serum estrogen degree can be found, which explains why this phenomenon occurs at puberty, although a definite explanation is not known.33
The diagnosis should be suspected based on the typical history. Microscopic examen of midstream and endstream urine should far confirm the distrust diagnosis. In summation, a detail ultrasonographic probe of the kidneys and bladder should be able to exclude pathological conditions. Because there are no specific radiographic signs and urethral catheterization can cause further excitation and induce fibrosis, there is no indication to perform VCUG or retrograde urethrography. For the lapp reasons, urethrocystoscopy is not indicated, although it might be the lone gamble to confirm the distrust diagnosis of urethritis back tooth.
In the differential diagnosis of blood dripping from the meatus ( outside the micturition ), a bleeding from a coffer magna should besides be considered. A coffer magna occurs when the fossa navicularis ( ectoderm ) does not directly reach the distal urethra ( endoderm ), resulting in a minor coffer or diverticulum. In this situation, the diagnosis is made during VCUG, and sometimes this test is necessity to make the diagnosis if the clinical findings are not clear. With bleeding from a lacuna magna, endoscopic marsupialization by endoscopic cautery is necessity to solve the problem.
Urethrorrhagia caused by urethritis posterior in prepubescent and pubertal boys is a benign condition that disappears ad lib. It is sometimes necessary to perform a cautious urethrocystoscopy to reassure the son and his family and to exclude the presence of a lacuna magna in the distal urethra .