AUR in Children

such screening against the potential but still unproven ben- metastatic lesions of the spinal cord (neuroblastoma,
efit of early language intervention in these infants. While ependymoma, and Ewing’s sarcoma), tethered cord, and
awaiting more evidence, we believe UNHS should continue unrecognized trauma. Drugs that caused retention included
because it is the best way we can diagnose early a substan- cold medication/antihistamines (brompheniramine,
tial number of children with PHL. diphenhydramine, and pseudoephedrine) and neuroleptics
(haloperidol and carbamazepine). In boys adverse drug
Editors’ Note effects and behavioral dysfunctional voiding were 6 times
The AAP has endorsed universal detection of hearing loss more common than in girls, while in girls UTI was 3 times
in infants before 3 months of age and appropriate interven- more likely than in boys. Constipation and local inflamma-
tion before age 6 months and has recommended that each tion (meatal stenosis, balanoposthitis, labial adhesions, and
AAP state chapter promote implementation of UNHS.2-3 cellulitis) were equal in both sexes but local neoplasms,
Today, 32 states have legislative mandates for UNHS. But benign obstructive causes, and idiopathic retention were
even a mandate does not assure sustained, effective imple- found only in boys. Pelvic neoplasms diagnosed in patients
mentation and intervention.4 (See AAP Grand Rounds, Sep- who presented with acute urinary retention included rhab-
tember 2001 for impact of UNHS in Tyrol, Austria.) Early domyosarcoma (2) and relapsing Burkitt’s lymphoma.
detection and intervention offer the best chance for infants The authors conclude that acute urinary retention, though
with hearing loss. a rare complaint in children, is often the first symptom of a
serious disease and requires comprehensive evaluation to
determine the etiology. They present a comprehensive algo-
References
1. Fortnum H, et al. Br J Audiol. 1997;31:409-446 rithm for evaluation of this problem in their manuscript.
2. AAP Joint Committee on Infant Hearing. Pediatrics. 1995;95:152-
156 Commentary by Anthony J. Casale, MD, FAAP
3. AAP Task Force on Newborn and Infant Hearing. Pediatrics. Pediatric Urology, Riley Hospital, Indianapolis, IN
1999;103:527-530.
4. National Center for Hearing Assessment and Management The authors rightly state that selection bias may have
(NCHAM). Logan, UT: Utah State University. Available at: skewed their results towards the more severe etiologies of
http://www.infanthearing.org/status/index.html. acute urinary retention in this retrospective series. Since
there are few papers on this problem in children there is lit-
tle to compare with the authors’ results.1, 2 The importance of
this study is that it highlights the fact that acute urinary
retention in children often heralds a severe illness and that
UROLOGY this complaint alone deserves the full attention of the eval-
uating physician. The authors did not comment on the place
Acute Urinary of imaging in the diagnostic evaluation although it is included
in their algorithm. Pelvic and renal ultrasound can be very
Retention in Children helpful in defining the anatomy of the genitourinary tract and
pelvis and a plain abdominal radiograph can easily demon-
Source: Gatti J, Perez-Brayfield M, Kirsch A, et al. Acute urinary strate significant constipation. Because of the serious nature
retention in children. J Urol. 2001;165:918-921. of the etiology of acute urinary retention in some children,
neurological and urological consultation should be consid-
A
cute urinary retention is uncommon in children but ered and follow-up assured. Functional or behavioral urinary
constitutes a genitourinary emergency. The etiology retention must be a diagnosis of exclusion.
in children differs from adults and has been infre-
quently studied. The Emory University authors identified 53 Editors’ Notes
children who presented at 1 of 2 children’s hospitals in We could not hold back in sharing the results of this study
Atlanta, Georgia, from 1993-2000. Patients were included if with you since it identifies a symptom that warrants your
they were unable to empty their bladders volitionally for prompt diagnostic attention. We suspect that the causes for
greater than 12 hours with a volume of urine greater than urinary retention would be equally worrisome in neonates,
expected for age ([age in years +2] x 30cc) or if they had a pal- although the wee ones were not considered in this particu-
pably distended bladder. Children with known causes of lar study.
voiding dysfunction were excluded.
Thirty-seven boys (median age 5 years) and 16 girls References
(median age 4 years) met the inclusion criteria. The etiology 1. Baldew IM, et al. Br J Urol. 1983;55:200-202.
of urinary retention was neurological in 17%, severe behav- 2. Peter JR, et al. Pediatr Emerg Care. 1993;9:205-207.
ioral voiding dysfunction in 15%, urinary tract infection (UTI)
in 13%, constipation in 13%, adverse drug reaction in 13%,
local inflammation in 7%, neoplasm in 6%, benign obstruc-
tion in 6%, idiopathic in 6%, combined UTI and constipation
in 2%, and incarcerated inguinal hernia in 2%.
Neurological conditions were the most common cause of
urinary retention. The specific diagnoses were serious and
included acute inflammatory processes (transverse myelitis,
Guillain-Barré syndrome, and encephalitis), primary or
6 AAP Grand Rounds

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such screening against the potential but still unproven ben- metastatic lesions of the spinal cord (neuroblastoma,

6 AAP Grand Rounds

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