A three-year-old boy with a history of hypospadias status-post urethroplasty at six months of age is brought in to the ED for dysuria.  He was admitted for influenza pneumonia one week prior at which time he had an “in-and-out” urethral catheterization.  The child has been doing well at home until he began to complain of pain with urination today.  No fever, abdominal pain, rash, or hematuria.  He has been able to void at home with straw-colored urine.  He is fearful of medical staff and hesitates to urinate in the ED on request.

On arrival, you see a well appearing child with normal vital signs and a normal physical exam.

Which is the BEST approach to his management?


    A.    After thorough cleaning of the perineum with antiseptic, obtain a bag specimen             for urinalysis and culture
    B.    Place a urinary (Foley) catheter and leave in place to ensure urine output and             to treat possible stricture
    C.    Observe patient until he is able to perform a clean catch specimen
    D.    Perform suprapubic catheterization


In the meantime, a quote –

“A clinician is complex.  He is part craftsman, part practical scientist, and part historian.”

– Thomas Addis, Scottish-born U.S. clinical scientist and pioneer in nephrology (1881-1949)