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What are the underlying causes for child passing two distinct urine streams?

DOCTOR OF THE MONTH - Feb 2013
Feb 2013
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Pediatrician
Practicing since : 2002
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We are in Rio, my 3 year old had diarrhea after the beach.. Began scratching/digging at her genitals. Then began holding her urine saying it hurt to pee, and "waddles" for a a minute after she voids. She screams if you try to "check" her... But, looks like near her hymen there is a small black spec (I swear it is a hole).. And a thin black line about a half an inch in the direction of her anus from this "black spec". Although not positive, it appears to me urine passes through this hole as well. I know it sounds crazy, but she has 2 distinct urine streams. And one is no where near her urethra.
Posted Sat, 28 Dec 2013 in Child Health
 
 
Answered by Dr. E Venkata Ramana 38 minutes later
Brief Answer: get her examined clinically by Pediatrician. Detailed Answer: Hi, Thank you for your query on Healthcare Magic. From your description, what I understood is your child is passing urine stream through two distinct holes and the one hole is far from the urethral opening. This is usually happens with the congenital defects of urinary tract in which there may be presence of abnormal openings in the perineum. Another possibility is presence of fistula which is uncommon in children. I advice you to consult the Pediatrician for clinical examination to look for the presence of abnormal opening of urinary passages and to confirm it with relevant investigations. Hope I have answered your query, if you have any clarification please let me know. Regards.
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Follow-up: What are the underlying causes for child passing two distinct urine streams? 4 minutes later
If it was a genetic defect, wouldn't I have seen this sooner? Is it possible she picked up a parasite of some sort that could cause this? I hadn't noticed this seperate stream prior to approx a week ago
 
 
Answered by Dr. E Venkata Ramana 10 hours later
Brief Answer: delay in presentation of symptoms is possible. Detailed Answer: Hi, Thank you for getting back. Congenital defects(which are present since birth) of urinary tract such as ectopic ureter will present with this type of additional opening and its detection may be delayed due to wearing of diapers or delayed toilet training. Fistula formation may occur in urinary tract infections or parasitic infections such as schistosomiasis, but it is uncommon in children. If it is of recent development, this possibility has to be kept in mind. There may be delay in presentation of this type congenital urinary tract anomalies due to cultural, child developmental, and gender related issues. But the direct physical examination by the doctor will help to know the abnormality and investigations will confirm the nature and cause for this finding. Therefore I suggest you to consult the pediatrician for clinical examination of the child. Hope I have answered your query, if you have any clarification please let me know. Regards.
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