Chapter 10.  Disorders of the Female External Genitalia 105

6 years of age with vaginal discharge or bleeding, 11 who had persistent vaginal discharge after antibiotic treatment underwent evaluation under anesthesia, vaginoscopy, and cystoscopy. Five (45%) were found to have vaginal foreign bodies and two (18%) had evidence of sexual abuse.6

Vagina bleeding in young girls is relatively rare, but is often associated with severe underlying pathology. Vaginal bleeding can occur in up to 10% of normal female neonates due to maternal estrogen withdrawal, but vaginal bleeding after 10 days of age is not physiological and requires investigation. Differential diagnosis includes infection,vulvar lesions,trauma, foreign bodies, benign and malignant tumors, urethral prolapse, endogenous or exogenous hormonal exposure, and precocious puberty. In the above referral population of 24 girls, 13 were referred for vaginal bleeding and underwent evaluation under anesthesia with vaginoscopy, cystoscopy, and biopsy as needed. Six (45%) were found to have vaginal malignancies, two (15%) had foreign bodies,two (15%) had benign Müllerian papillomas, and two (15%) had evidence of sexual abuse.6

The usefulness of radiographic imaging in the evaluation of vaginal discharge or bleeding is not well-defined. Prepubertal girls with severe or persistent vaginal discharge and all young girls with vaginal bleeding should be referred immediately for pelvic evaluation under anesthesia, vaginoscopy, and cystoscopy.

References

1.Mayoglou L, Dulabon L, Martin-Alguacil N, et al. Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments. J Pediatr Adolesc Gynecol. 2009; 22(4):247-250.

2.Myers JB, Sorensen CM, Wisner BP, et al. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. 2006;19(6):407-411.

3.Nussbaum AR, Lebowitz RL. Interlabial masses in little girls: Review and imaging recommendations. AJR Am J Roentgenol. 1983;141: 65-71.

106 R.S. Hurwitz

4.Bertolotti A, Gonzalez SGT, Etcheverry R, et al. Giant congenital urethral polyp. J Pediatr Surg. 2008;43:1211-1212.

5.Ben-Meir D, Yin M, Chow CW, et al. Urethral polyps in prepubertal girls. J Urol. 2005;174:1443-1444.

6.Striegel AM, Myers MD, Sorensen PD, et al. Vaginal discharge and bleeding in girls younger than 6 years. J Urol. 2006;176(6 Pt 1): 2632-2635.

Chapter 11

Disorders of Elimination:

Voiding Dysfunction

Tom P.V.M. de Jong and Marianne A.W. Vijverberg

Key Points

››Between 7–10% of school age children have lower urinary tract symptoms (LUTS).

››Common manifestations of LUTS are overactive bladder (OAB), underactive bladder (UAB) voiding postponement and dysfunctional voiding (DV).

››Evaluation of LUTS should include a full history and examination and assessment of micturition and defecation.

››Treatment is multifaceted , depends on the underlying cause and is tailored to individual children.

11.1  Introduction

Between 7% and 10% of school age children are seen by a specialist for recurrent urinary tract infections and/or urinary incontinence based on non-neurogenic lower urinary tract dysfunction.

According to the International Continence Society definition, any method that gives information on the function of the lower urinary tract may need to be used in dealing with

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