You are evaluating an 8-year-old boy who has had constant burning suprapubic abdominal pain for the past 4 weeks. At first, the pain was exacerbated by ambulation. Recently, it has awakened him from sleep. He has had anorexia and lethargy, but no fevers or weight loss. He has experienced persistent dysuria and recently has had right flank pain, nocturia,and frequency. His bowel habits are normal.

Physical examination reveals a well-looking boy who has abdominal tenderness limited to the suprapubic area. There is tenderness on percussion over the right costovertebral angle. There are no peritoneal signs. The remainder of the examination yields normal findings.

Urinalysis reveals normal results except for 1 to 4 erythrocytes per high-power field. Electron microscopy of the urine shows no abnormalities, and viral and bacterial cultures are negative. Abdominal radiographic findings are consistent with mild constipation. There is minimal stool output and no change in symptomatology following...

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