Linking To And Excerpting From EMC Quick Hits 69 “Pediatric Urinary Retention & Acute Transverse Myelitis”

Today, I review, link to, and excerpt from’ Emergency Medicine Cases Quick Hits 69 “Pediatric Urinary Retention & Acute Transverse Myelitis”.*

* Helman, A. Schonfeld, D. McLaren, J. McArther, M. Yasmeh, J. Long, B. Myers, V. Westafer, L. EM Quick Hits 69 – Pediatric Urinary Retention & Acute Transverse Myelitis, Post-Dural Puncture Headache, Med Mal Cases: Clenched Fist Injury, IV Thrombolysis for Minor Stroke, EM Leadership Spotlight #4. Emergency Medicine Cases. December, 2025. https://emergencymedicinecases.com/em-quick-hits-month-year/. Accessed December 12, 2025.

Topics in this EM Quick Hits podcast

Deborah Schonfeld on pediatric urinary retention & acute transverse myelitis (01:27)

Jesse McLaren on Occlusion MI Diagnosis (24:44)

Matthew McArthur on post-dural puncture headache (31:34)

Joseph Yasmeh on Med Mal Cases: clenched fist injury (42:42)

Brit Long on IV thrombolysis for minor strokes (59:27)

Victoria Myers & Lauren Westafer on mentorship and what it means to be a physician leader (1:11:34)

All that follows is from the above resource. 1:13:28

Here is the link to play the complete podcast.

Pediatric Urinary Retention & Acute Transverse Myelitis.

Transverse myelitis is an emergency [as is its differential diagnosis: Osteomyelitis, Discitis, Epidural Abscess] and so if suspected consider sending the patient to the emergency department for emergency imaging [usually an MRI of the spine] but you will be talking to the emergency physician at the hospital you are sending the patient to.

Definition of urinary retention in pediatrics

Inability to void at least 12 hours, no urine output for 12 hours, greater volume of urine in the bladder expected for age, or palpable bladder distension.

Max bladder capacity in mL = age + 2 x 30 (for <12 years of age)

Pediatric urinary retention history taking tips

• Can be reported as feeling that the child is “holding urine”, unable to fully empty bladder, or frequent bathroom trips with weak stream.
• May have significant abdo pain, abdo/bladder distension, restlessness/irritability.
• Try to differentiate from oliguria vs. retention.

Differential diagnosis of pediatric urinary retention

• Infectious/inflammatory: UTI/cystitis, balanitis/balanoposthitis, vulvovaginitis.
• Obstructive: Phimosis, meatal stenosis, labial adhesions, urethral strictures, posterior urethral valves, external (intrabdominal or pelvic) compression, hematometrocolpos (vaginal/uterine accumulation of blood due to obstruction), constipation.
• Postoperative/anesthesia
• Dysfunctional urine voiding: behavioral, lack of coordination between bladder and urethral sphincter muscle.
• Neurogenic: interruption at any level from brain to spinal cord to peripheral nerves.
  • Spinal cord:
    • Compressive: spinal tumors (e.g. ependymomas, astrocytoma), epidural abscesses, herniated discs, hematoma.
    • Inflammatory: acute transverse myelitis, GBS.
    • Malformation: spinal bifida, tethered cord.
• Medications: anticholinergics/antihistamines, sympathomimetics (often in decongestants).

Clinical pearls for pediatric urinary retention

• Counsel parents to let patient urinate within warm water; decreases direct contact of acidic urine with inflamed or irritated tissue and can reduce withholding behavior.
• Unexplained urinary retention is always concerning: consider neurologic pathologies if other tests are negative.

Pediatric acute transverse myelitis

• Rare, inflammatory, demyelinating disorder of the spinal cord.
• Highest incidence between 10-40 years of age, with 20% occurring in the pediatric population.
• Etiology: idiopathic (post-infectious/autoimmune process), secondary (associated with active infections, systemic inflammatory conditions, connective tissue disorders), or part of demyelinating or CNS condition (e.g. MS, acute disseminated encephalomyelitis).

Clinical features of transverse myelitis

• Typically presents over hours to days.
• Affects transverse section of one or more levels of the spinal cord with motor/sensory/autonomic dysfunction below the level of the lesion in a myelopathic distribution.
  • Motor: Rapidly progressive paraparesis/paraplegia.
  • Sensation: reduced or absence sensation below the affected level, back pain, dysesthesia.
  • Autonomic: bowel or bladder incontinence or retention.
• Often missed on initial visit, with patients returning to ED with progressive symptoms.

Bottom line: Urinary retention may present variably in pediatric patients. In pediatric patients with otherwise unexplained urinary retention, consider neurogenic causes of urinary retention in patients.

References:

1. Gatti JM. Acute urinary retention in children. J Urol. 2001;165(3):928-931.
2. Hassan F, Uwaezuoke SN, Obu HA. Acute urinary retention in children. J Pediatr Urol. 2020;16(6):790-797.
3. Grasso EA. Transverse myelitis in children and adults. In: Handbook of Clinical Neurology. 2023.
4. Pediatric Acute Transverse Myelitis Overview and Differential Diagnosis. Wolf VL, Lupo PJ, Lotze TE. Journal of Child Neurology. 2012;27(11):1426-36.
5. Pediatric Urinary Retention in the Emergency Department: A Concerning Symptom With Etiology Outside the Bladder. Burla MJ, Benjamin J. The Journal of Emergency Medicine. 2016;50(2):e53-6.
6. Acute Urinary Retention in Children: A Systematic Review and Meta-Analysis. Ahmed HS, Dias AF, Pulkurthi SR. World Journal of Urology. 2025;43(1):513.