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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #55

Have a pediatric male patient between the ages of 10-14 complaining of burning with urination?

Check a urine of course, but often times this will be normal.

This condition can result from the adolescent utilizing soap in the shower for……. well, take a wild guess. I like to call this “soap sud urethritis.”

The patient will not divulge this information to you in the room, especially if their mother is present, so a good way to word the question is to simply ask the patient “Do you wash with soap down there?”

The patient will typically respond with yes and you have your diagnosis. Obviously, this is not an ICD 10 code diagnosis, but it is a real clinical entity. Code it as “urethritis.”

Educate the patient not to vigorously utilize soap when washing their genitalia and the problem will fix itself. This is self-limited and will resolve in a matter of days with adequate fluid intake.

I have seen elaborate workups over this complaint when a simple question would have revealed the diagnosis… This is not a common complaint, but you will see it from time to time.

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