Pediatric Urology

Pediatric urology refers to the diagnosis and treatment of a wide range of conditions affecting children, both males and females. Some of these conditions have been present since birth, while others may arise throughout childhood. Pediatric urologists most commonly treat urinary tract infections, a condition that especially affects females. Other conditions include bedwetting, uretopelvic junction obstruction, and abnormally located urethral opening.

A pediatric urological examination consists of a physical examination and a full review of your child’s medical history. Diagnostic tests are typically performed as well, including:

• Urinalysis
• Blood test
• Renal scan

• Ultrasound
• MRI scan

The pediatric urologist will discuss any findings with you and your child, and work with you to develop a customized treatment plan.

Some of the pediatric conditions we treat include:

Antenatal Hydronephrosis

Antenatal hydronephrosis is the term for fluid buildup in the kidneys before birth. The condition can be diagnosed in a fetus as early as the first trimester. Ultrasound monitoring is usually sufficient, and in most cases the baby is delivered normally. Only rarely is tubal or surgical intervention required to drain the kidneys. Exams after birth will determine the cause of kidney enlargement and which treatment method is appropriate. Children diagnosed with vesicoureteral reflux typically follow a course of antibiotics with periodic exams until the condition resolves on its own. Surgery may be recommended if a blockage is responsible for hydronephrosis.

Hydrocele

Hydrocele is a common condition in newborn boys in which fluid collects in the sac around the testicle. Compression of the scrotum indicates whether the hydrocele is noncommunicating (cut off from the abdomen) or communicating (fluid flows to and from the abdomen). Fluid in a noncommunicating hydrocele is usually absorbed by the body over time. Surgery is recommended when the hydrocele grows or has not resolved by the time the infant is 12-18 months old.

Hypospadias

Hypospadias occurs when the urethra opens not at the tip of the penis but instead somewhere along the underside. About 1% of newborn boys have hypospadias, and about one in every five of those diagnosed have a male family member with the condition as well. Hypospadias may be accompanied by chordee, or a bending of the penis when erect. Surgery is performed at 6-9 months to extend the urethra to the penis tip and correct chordee if present. This allows children to stand when urinating and ensures proper sexual function later in life. About 10% of patients require follow-up surgery.

Nocturnal Enuresis (Bed-wetting)

Nocturnal enuresis, better known as bed-wetting, is a common problem for children who have recently been toilet-trained. Some children with enuresis produce insufficient levels at night of the hormone vasopressin, which helps the body remove water from urine. Additionally, the brain does not seem to receive messages from the bladder that it is full when the child is asleep.

Incidents of bed-wetting tend to occur less frequently as time passes, and some children require nothing more than emotional support. However, enuresis may be a sign of an underlying problem such as urinary tract infection or abnormality, and may be accompanied by painful or stressful symptoms such as daytime incontinence and painful urination. In these cases and in children who continue to wet the bed when they are old enough to attend overnight social events, treatment may be recommended in the form of fluid restriction, waking the child at night, alarm systems, behavior modification and, in a few cases, medication.

Torsion of the Testicle

Torsion of the testicle is the most common pediatric urologic emergency. It occurs when the testicle twists in its sack, cutting off its blood supply. Symptoms include a sudden pain on one or both sides of the scrotum and sometimes in the groin and abdomen as well; nausea and vomiting; and difficulty urinating. Children and adolescents who experience any of these signs should be immediately examined by a physician so treatment may be delivered before the testicle suffers damage – decreased sperm production and testicle death can occur as soon as six hours after torsion. A small incision is made in the scrotum under general anesthesia, the torsed testicle is untwisted (or removed if it has died), and both testicles are sewn into the scrotal wall to prevent future torsion.

If you have any further questions regarding Pediatric Urology or its treatment options, ask your doctor.