Managing gynecological issues in pediatric urology patients.

Introduction: Gynecological issues are common in children presenting with urinary symptoms but are often misdiagnosed or under-reported. The main objective of this review is to provide clinicians with an understanding of the common gynecological conditions in the pediatric population that can present with urinary symptoms and to improve the knowledge of treatment principles for these conditions, with supporting level of evidence and strength of recommendation. Methods: A review of meta-analyses, systematic reviews, randomized controlled trials, observational studies, and case series on pediatric gynecological conditions that could present with urological issues was conducted. Each condition was saliently explored and presented. Quality of evidence and recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation recommendations system. Results: Common conditions that can present to the urologist with urinary symptoms include vulvovaginitis, interlabial masses, Mullerian duct anomalies (MDAs), and sexually transmitted infections. Thorough history taking with emphasis on menstrual and sexual history in selected cases is crucial in guiding the investigations. Physical examination should include palpation of the abdomen and genital inspection. Ultrasound of the pelvis and renal tract is indicated in cases with suspected MDAs and may require magnetic resonance imaging to plan the treatment in complex cases. Reassurance and conservative management are adequate in certain conditions while pharmacological and surgical intervention is required in specific cases. Most of the recommendations are strong despite a moderate level of evidence. Conclusion: A multidisciplinary approach is desirable to optimize the outcomes in complex cases. Gynecological causes should be considered in girls presenting with dysuria, recurrent urinary tract infections, and urinary retention.