Differential Diagnosis for Painful Urination in a Circumcised 6-Year-Old
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): This is a common cause of painful urination in children, and the symptoms can include dysuria, frequency, and urgency. The fact that the child is circumcised slightly decreases the risk of certain other conditions but does not significantly alter the likelihood of a UTI.
Other Likely Diagnoses
- Urethral stricture or narrowing: Although less common in circumcised males, any form of urethral narrowing can cause obstructive symptoms and pain during urination.
- Balanitis: Inflammation of the glans penis, which can be caused by infection or irritation, and can cause pain during urination if the inflammation affects the urethral meatus.
- Meatal stenosis: A narrowing of the urinary meatus, which can cause straining to urinate and pain, more common in circumcised males due to potential complications of the circumcision procedure.
Do Not Miss Diagnoses
- Posterior Urethral Valves: A congenital condition that can cause obstructive uropathy, leading to recurrent UTIs, and renal failure if not addressed. It's crucial to diagnose this condition early to prevent long-term complications.
- Testicular torsion: Although it presents more commonly with acute testicular pain, in some cases, it can radiate or be referred to the groin or abdomen and might be associated with urinary symptoms if there's an associated infection or if the pain is severe enough to cause urinary retention.
- Epididymitis: Inflammation of the epididymis, usually due to infection, which can cause pain during urination if the infection spreads or if there's associated urethritis.
Rare Diagnoses
- Urethral foreign body: Insertion of a foreign object into the urethra, which can cause obstructive symptoms, pain, and infection.
- Schistosomiasis (in endemic areas): A parasitic infection that can cause urinary symptoms including painful urination due to the eggs of the parasite causing inflammation in the bladder wall.
- Interstitial cystitis/Painful Bladder Syndrome: A condition characterized by chronic pain perceived to be from the bladder, often accompanied by at least one other urinary symptom like persistent urge to void or frequency, in the absence of a urinary infection or other pathology.