Pediatric Urological Conditions

Urinary Tract Infection:

The most common condition seen by pediatric urologists is a urinary tract infection, which occurs more frequently in girls than in boys. An estimated 1-2 percent of children develop a UTI, characterized by blood in the urine, an unusual odor to the urine, or a change in urinary patterns. UTI in children can be associated with other congenital urological problems like vesicoureteral reflux, posterior urethral valve, megaureter and pelviureteric junction obstruction- so detailed evaluation is advised in all children.

Antenatal hydronephrosis:

A fluid-filled enlargement of the kidney prior to birth, typically diagnosed with prenatal ultrasound. It is seen in 1% of male pregnancies and 0.5% of female pregnancies. It may be due to blockage at the junction between the kidney and the tube that conveys urine from kidney to bladder (medically termed pelviureteric junction) or blockage at the junction between the tube and the bladder (medically termed the ureterovesical junction) or blockage at the level of urethra, the outlet from bladder to outside (a condition called posterior urethral valve). Depending upon the abnormality, ultrasound imaging may be needed throughout pregnancy and after a baby is born. In most cases, this diagnosis does not affect when, where or how a baby is delivered. Surgery is required in a small percentage of children during infancy and childhood.

Inguinal Hernia:

A protrusion of all or part of an organ or tissue through a weakened area in the belly. The hernia creates a soft lump or bulge under the skin. When the hernia happens in the groin area, it is called an inguinal hernia. A hernia requires urgent surgical opinion and can be rectified using laparoscopic (keyhole) or open surgery. Laparoscopic surgery offers benefits like early recovery, less pain and cosmesis.

Hydrocele :

An accumulation of fluid that can occur in the scrotal sac. Up to 1 in 10 baby boys have a hydrocele at birth. In most cases, it goes away without treatment in the first year. A hydrocele that lasts longer than 12 to 18 months is often a communicating hydrocele. A hydrocele that lasts longer than 12 to 18 months is often a communicating hydrocele. This often needs surgery to prevent an inguinal hernia. Often surgery can be performed using laparoscopic (keyhole) technique with benefits like early recovery, less pain and cosmesis.

Postnatal hydronephrosis:

Swelling of the kidneys caused by obstruction in the urinary tract, detected after the child is born. The causes remain the same as Antenatal Hydronephrosis. Treatment depends on the disease condition and severity of the blockage.

Hypospadias:

A birth condition, usually diagnosed during infancy, in which the opening of the urethra (the tube that carries urine from the body) is on the underside of the penis rather than at the tip. Surgery usually restores the normal appearance of your child’s penis. With successful treatment of hypospadias, most males can have normal urination and reproduction.

Neurogenic bladder:

A disorder resulting from interference in the normal nerve pathways that send signals to the bladder regarding urination. It causes a child to have problems with holding or releasing urine. Many of these children also experience chronic constipation. The most common causes of this condition in a child are problems with the spinal cord. It can be diagnosed with urine tests, a urodynamic study, or an ultrasound. Common treatments for this condition include bladder training, bladder relaxing medications, surgery, intermittent catheterization (insertion of a tube to empty the bladder).

Nocturnal enuresis (Bedwetting):

Bedwetting beyond the age at which a child would be expected to remain dry – believed to be caused by a developmental delay in the bladder and usually something the child outgrows. At five years of age, 15 to 25 percent of children wet the bed. With each year of maturity, the percentage of bed-wetters declines by 15 percent. 8 percent of 12-year-old boys and 4 percent of 12-year-old girls are enuretic; only 1 to 3 percent of adolescents are still wetting their bed. All children with bedwetting issues need detailed evaluation to rule out underlying disease conditions. Treatment options include Bladder Training, Medications, use of Bed-wetting Alarm.

Spina bifida – a neural tube defect in which the tissue surrounding the spinal cord fails to close properly during fetal development

Undescended testes:

A condition in which at least one testicle fails move into the scrotal sac as the male fetus develops. In about 10 percent cases, it may affect both sides. In some cases, the testis may descend by itself by 6 months after birth (especially in prematurely born babies). Surgery is usually recommended if it has not descended by 6 months and this is best adjudged by the pediatric urologist. The surgery may be performed by laparoscopy (keyhole) technique, with several advantages over open surgery. Early surgical treatment appears to lower the risk of later complications. In some cases, the testicle might be poorly developed, abnormal or dead tissue.

Ureteropelvic junction obstruction:

Blockage of the flow of urine in the area where the ureter meets the kidney. This usually leads to swelling of the affected kidney called hydronephrosis. All cases need consultation with pediatric urologist. Neglected obstruction or severe obstructions can lead to loss of the affected kidney function. The condition may require corrective surgery that may be performed through endoscopic, laparoscopic (keyhole) or open approach. The type of approach, depends on the disease severity and the surgeon’s expertise.

Vesicoureteral reflux:

Vesicoureteral reflux is the abnormal flow of urine from the bladder back up the tubes (ureters) that connect the kidneys to the bladder. Normally, urine flows from your kidneys through the ureters down to your bladder in unidirectional manner.

It’s not supposed to flow back up. The disorder increases the risk of urinary tract infections, which, if left untreated, can lead to kidney damage. Children with less severe vesicoureteral reflux are usually advised to take preventive antibiotics to avoid urine infection and consequent damage to kidneys. Children with severe reflux may require corrective surgery that may be performed through endoscopic, laparoscopic (keyhole) or open approach.

Phimosis:

A condition where the foreskin is too tight to be pulled back over the head of the penis (glans). Phimosis is normal in babies and toddlers, but in older children it may be the result of a skin condition that has caused scarring. Phimosis is not usually a problem unless it causes symptoms such as redness, soreness or swelling. Surgery (circumcision) may be needed if the foreskin is painfully tight or the child experiences repeated episodes of local redness or scarring.