Frankly Speaking, need your help/wisdom for a friend

[Ione]

Hi,
Frank (and anyone, really), I need your help/advice for a friend with an intact two-year-old...

Here're are her posts on another board I frequent (I'm posting them here at her request, as she doesn't post here herself):

DS's in pain and I don't know what to do. Last night he got me up repeatedly to go to the bathroom. Then today he'd go pee, and we'd no more than get in the other room, and he'd say he had to go again. Which, of course he didn't. He's been peeing normally (normal amount, normal color, no pain going).

Sometimes he get's fuzzies in there, so I looked to see if it was irritated, and nothing, not even red. I gave him a long soak and thought nothing of it. Then during his nap, he woke up to pee (not unusual), but did the double pee thing again. When I tried nursing him back to sleep, he kept grabbing himself and telling me "Hurt! Hurt!" I looked, and on the underside of his penis about where the glans meets the shaft, There's a big swollen spot.

I tried to get him to let me push his foreskin back and look, thinking he has something in there. It was a no go. It hurts and he's not letting me mess with it. I call the pediatricians office, and they tell me to take him to the emergency room.

We go, and end up seeing some old Dr. Who instantly gives me attitude (DS is not 'up to date' on his vaccinations, and is not circ'ed). He pushes his foreskin back, and we find it's still partially adhered to the glans. I'd say it retracts about 2/3 of the way. Except there is one spot that is open farther. It actually looked like another urethral opening, but between the glans and the foreskin. (does that make sense?)

The guy tells me "He has penile adhesions. His foreskin should retract all the way by this age. That's his problem." I informed him that it wasn't unusual for it to still be adhered at this age. He treated me like a total fucking moron, told me again that it shouldn't be adhered at all because if I didn't retract it and clean it from the start, it was full of bacteria and nasty stuff.

He pushed his foreskin back again, and I said "Wait a minute, I want you to explain to me exactly what you are going to do BEFORE you do anything to him."
He said, "I'm not going to do anything with it. Because you didn't retract it, it now has adhesions and you'll have to take him to see a urologist to fix it. Call your regular Dr next week, and he'll send you to see someone."

Now I'm home, and my son is still in pain (of course, the fuckheaded Dr didn't DO anything!) It's still swollen, and I don't know what the hell to do. I'm worried that he's got an opening, and may have something nasty in there. It's not red, but it IS swollen!

I'm calling my regular ped in the morning, but is there anything I can do? I can't believe they expect him to go at least 3 days in pain!

and

That Dr WAS a total ***, even my Mother said so.

I feel terrible that I didn't notice the swelling before. But we've never had any other problems with this.

Do you think it would be okay to give him tylenol tonight? It hurts, and it's the only thing I can think of.

and

He's peeing totally normally. No fever, and it doesn't hurt when he pees. I"m pretty sure it's not a UTI. (DD had tons of them) It's that swollen spot that hurts. The saying he has to pee again is because it's irritated I think, he does the same thing when he has fuzzies in there.

I'll start him on cranberry juice in the morning anyway. He drinks diluted apple juice, so maybe if I mix them he'll drink it.

The *** wouldn't check him for a UTI, because he had no symptoms. He was sure the problem is in his foreskin. I have a feeling that we are going to be in the ER again tomorrow if we can't get a urologist to see him right away.

and

Okay, I'm calling the Ped. first thing. If he can't do anything, I'm taking DS to the big hospital in town and insisting he be seen by a urologist.

They are going to give me hell for having gone to our regular hospital first ( my regular hospital is smaller, but has the quickest wait time for an ER, you can actually see a doctor in less than 15 minutes usually. The bigger hospital always has hours and hours of wait time)

and

hypospadias? Is that where they have more than one urethral opening? I don't think so, but damn, maybe... aww shit

and

I know someone that has that [hypospadias]. His urethral opening is on the underside of the glans, about half way back to where it attaches to the shaft. He was circ'ed, so they knew right away. They never did anything about it, and he's never had a problem.
I've read that sometimes they can have 2 openings, with either only 1 or both being 'functional'.

The spot I was talking about on DS is more on the side, and the swelling wasn't exactly under it, but close.. Even if that's what it is, wouldn't we have noticed it before??

Oh wait, if it's not a functional opening, it would have been fine, until the foreskin retracted back enough to let crap get in there...

I have this horrible feeling they are going to forcibly retract his foreskin all the way. Can I request they knock him out for that? Oh hell, can I request they knock me out for it?? :cry

I don't post there [MDC]. Never have. I would so very much appreciate it if you would do that for us!

Everything I'm reading is just scaring the crap out of me.

This is the best article I can find so far on a double urethral opening;
http://www.drgreene.com/21_801.html

Any suggestions, advice (including on to what to demand from the drs to help and not make worse whatever it is) would be welcome and appreciated.
Thanks in advance.

[Frankly Speaking]

I can't give you an absolute answer but here is what I suspect.

First, a frequent need to urinate is usually a symptom of a urinary tract infection. This is because the infection will irritate the urethra causing a feeling that urine is starting to move through the urethra. It can also cause a full feeling in the bladder when the bladder is not full. I would definitely have him checked for a UTI.

Now, the description of the problem with his penis is not as clear and I'm really just guessing. First, the separation process between the glans and foreskin is not an even process and it is quite common that there will be areas that are separated and adjacent areas that are still firmly attached. I suspect this may be the case here and I also think this separation process may be the cause of the irritation. Please read my sticky at the top of the forum "Red, Swollen or Inflamed Foreskin" for more information. If this is what it is, it will pass quickly, within 24-36 hours. If there is in fact a urinary tract infection, the bacteria from the infection will also be within the foreskin. As these bacteria live and die, they produce toxins that can be very acidic and irritate the bladder, the urethra and yes, the inner lining of the foreskin and the glans. The good news is that if all of this is the result of a UTI, a simple regimine of medication by mouth will clear the infection in the bladder and the foreskin simultaneously.

As far as hypospadius, if the urinary meatus, the opening of the urethra, is normal, it is extremely unlikely (essentially impossible) that there is hypospadius and this is something she does not need to worry about. Hypospadius manifests itself first at the meatus in very mild cases an goes progressively further down the glans and shaft as the severity increases. If she needs a more detailed description for her comfort, let me know.

It appears that her son is already naturally retractile at least to a degree but it is also obvious that retractrability is not complete yet. I can not emphasize enough how much she needs to be on guard and how much she needs to warn anyone examining his penis not to forcibly retract him any further than what is completely painless for the boy. In no circumstances should they be allowed to separate the remaining adhesions. They will take care of themselves with time. I can also tell you that they are going to insist on catherizing him. This is because there is irritation in the foreskin and a urine sample would be contaminated by bacteria there and could possibly indicate a UTI that involved the bladder and urethra when there was none and they will want to guard against this.

She may want to give her son cranberry juice to help aleviate the symptoms. If he doesn't like the taste (I personally hate it) she can mix it with a favorite juice. What ever the problem is, there are medications available that will aleviate the symptoms within a day or two and will provide a complete cure in 7 to 10 days. She just needs to be sure to continue the medication until the prescription is completely used up to be sure all of the critters are eliminated and don't make a return appearance.

I also want to assure her that this is a simple and easily cured problem and that it will have no long term effect on her son as long as it is addressed promptly. I know it's virtually impossible for a Mom to not worry but I just want to put her mind to ease as much as possible.




Frank

[Ione]

THANK YOU very much, Frank!

She's feeling better after reading your words of wisdom. Still no diagnosis as far as I know, but I'll let you know what it was if and when I find out.

Thank you, again.

[hummingbear]

Originally Posted by Frankly Speaking

I can also tell you that they are going to insist on catherizing him. This is because there is irritation in the foreskin and a urine sample would be contaminated by bacteria there and could possibly indicate a UTI that involved the bladder and urethra when there was none and they will want to guard against this.Frank

Frank, with a boy who retracts 2/3 can they capture a "clean" urine sample by retracting enough to expose the opening (perhaps rinsing before with a warm water squirt bottle or catching the stream midway)?

I have had the fortune to have never needed to give a urine sample to determine a UTI. Do they catheterize women in these circumstances? I only know of practices which ask women to seperate the labia, wipe with a moist towelette and catch the stream midway so that the first portion (which may be contaminated?) is not caught.

I know, maybe a little involved for a 2 year old, but I was wondering.

[Jane]

In the intermediate time, she can offer to let him pee in the bath. It can dilute the urine enough to ease the pain on a sore spot.

I do think it sounds like a UTI, though

[hummingbear]

Originally Posted by Frankly Speaking

She may want to give her son cranberry juice to help aleviate the symptoms. If he doesn't like the taste (I personally hate it) she can mix it with a favorite juice.Frank

My son loves cranberry juice mixed in with other juices. We have an 8 oz bottle of pure unsweetened cranberry juice concentrate (Knudsen) which he loves with a half and half mix of orange juice and water!

Hope your friend finds relief for her son!

[Frankly Speaking]

Originally Posted by hummingbear

Frank, with a boy who retracts 2/3 can they capture a "clean" urine sample by retracting enough to expose the opening (perhaps rinsing before with a warm water squirt bottle or catching the stream midway)?

Well, possibly but with a child this young, it's going to be difficult at best and with the symptoms he is exhibiting, I suspect each urination episode will be extremely brief making it even more difficult.

I have had the fortune to have never needed to give a urine sample to determine a UTI. Do they catheterize women in these circumstances?

Toddler girls, yes but older girls and women, I don't know about. I've had to give a urine sample twice for testing for a UTI and I was not catheterized but I was an adult and there was no irritation outside so it's a very different situation.




Frank

[Nathan1097]

Usually they just do a urine dip to determine a UTI. That is, they ask you to do a "clean-catch"- use special wipes to clean yourself then pee in the toilet for a moment, then pee in a special cup till its half full, put the lid on and finish peeing if you have to. They dip a litmos paper thing in and it turns colors of if you have a UTI. However, that doesn't always catch them. I had a bladder infection while pregnant once and that dip said I didn't. They sent the urine for testing in the lab which showed I had group-B strep. (Which meant I had to get antibiotics during labor. But that's a side note.) Catheters can GIVE someone a UTI (been there done that!), so that would be very extreme to use one to see if you had one.

As a note, they have "U-bags" for collecting urine in infants.