Pediatric urology focuses on illnesses or diseases of the urinary tract (kidneys, ureters, bladder and urethra) and genitals in children. This subspecialty deals with the unique complex birth defects in infants, children and adolescents.
In addition to the many urologic conditions found in adults, many conditions affect children specifically. Some of the most common pediatric urologic conditions occur during fetal development and must be addressed quickly after birth.
Urology Associates physicians are specially trained experts in treating pediatric urologic conditions that often require an understanding of complex surgical procedures.
Following are common urologic conditions children may experience, listed according to the affected area.
General urinary conditions & treatments
The urinary tract includes the kidneys that process blood and produce urine, the ureter tubes that carry that urine to the bladder, which stores urine then expels it through the urethra tube opening just above the vagina in girls and at the end of the penis in boys.
Urinary tract infections in children
Urinary tract infections (UTIs) are caused by microbes (usually bacteria) affecting the ureter, bladder, urethra and sometimes the kidneys. Up to 8 percent of girls and 2 percent of boys will develop a urinary tract infection. While most UTIs are not serious, younger children have a greater risk of kidney damage linked to urinary tract infection than do older children or adults. UTIs are commonly treated with antibiotics.
Kidney conditions & treatments
The kidneys are two bean-shaped organs located in the lower back area behind the abdominal organs. The kidneys control blood pressure, are responsible for protein metabolism, direct the production of blood in our bone marrow and process waste into urine and send it out of the body. The kidneys are well-suited for ultrasonic inspection both prenatally and then in early infancy and childhood. Children may require treatment for the following conditions affecting the kidneys.
This is a condition initially diagnosed by ultrasound which describes stretching of the collecting system of the kidney. Hydronephrosis may not require treatment and can result from blockage and/or vesicoureteral reflux.
Children with a duplex kidney have two ureters (rather than one) coming from a single kidney. These two ureters can drain independently into the bladder or connect and drain as a single ureter into the bladder. Duplex kidney can occur in one or both kidneys. Children with this condition may also have a ureterocele (an enlarged ureter) from blockage or vesicoureteral reflux.
Kidney dysplasia, a condition that can occur in babies as they grow in the womb, is when cysts grow inside one or both of the kidneys. In some cases the cysts may even replace one or both kidneys. This condition is usually detected during an ultrasound.
In extreme cases, dysplasia will affect both kidneys, endangering the baby’s survival. Babies who do survive with extreme cases of kidney dysplasia will need dialysis and a kidney transplant after birth.
Bladder conditions & treatments
The bladder is a pelvic organ that stores urine produced by the kidneys until a person is ready to urinate (expel the urine through the urethra tube). Pelvic muscles trigger the bladder to completely empty the urine (also known as bladder voiding).
Bladder conditions alter or negatively affect the normal process of storing or expelling urine. Common bladder conditions in children include the following.
Common voiding problems
Voiding problems is a term that covers any abnormal urination patterns in children and usually involves either problems with bladder filling or emptying. These conditions can sometimes be treated by lifestyle changes, or in more severe cases with medication or surgery. Types of voiding dysfunction are:
- Bedwetting. This commonly occurs while children are asleep. Typically, it is not a medical condition and most all children outgrow it. Parents should seek a doctor’s advice if a child 7 years of age or older wets the bed more than two or three times in a week.
- Daytime wetting. This can be small urine leakage or complete soaking of undergarments.
- Giggle incontinence. When a child laughs or giggles, his or her bladder empties completely.
- Urge syndrome. Frequent onset of the need to urinate immediately, followed by efforts to hold urine, such as squatting or holding the crotch.
Bladder dysfunction is an abnormality or impairment in the way the bladder works. Children may experience one or more types of dysfunction in the bladder (or the bowel). Bladder dysfunctions can include urinary incontinence. It is important that a boy (or man) with a bladder dysfunction consult a physician to determine the root cause and work to treat it.
Vesicoureteral reflux (VUR)
VUR occurs when urine in the bladder backs up into one or both ureters and often into the kidneys. The reflux is graded according to its severity. VUR increases a child’s risk of developing kidney damage and may require surgery.
Genital & reproductive organ conditions & treatments
Male genitals include the penis, testicles (or testes) and the scrotum that holds the testicles. Testicles are two egg-shaped organs found below the penis that make sperm and testosterone. Female genitals include the vagina, ovaries, fallopian tubes and uterus (womb).
Children may require treatment for the following conditions involving their genitals.
Meatal stenosis occurs in boys and is the narrowing of the urethra opening at the tip of the penis. It can exist from birth or be acquired, is rarely seen in uncircumcised children, and can be treated by surgically enlarging the opening.
Labial fusion or adhesion
This is a common birth defect in young girls where the two sides of the labia (the inner lips of the vagina) become fused together. The condition affects only 2 percent of girls in the U.S. and usually separates naturally in infancy. An adhesion may require medical treatment if it impacts urine flow or if the area becomes irritated.
Hypospadias is a birth defect in infant boys where the urethra does not open at the tip of the penis but somewhere else on the penis, usually on the underside. Hypospadias affects approximately 1 in 300 baby boys and is usually diagnosed during a physical exam. Most babies will need surgery to correct the condition.
Chordee is a birth defect in boys in which the penis is bent downward during an erection. This can cause pain and discomfort, as well as problems with sexual function in adulthood. Chordee is best treated surgically before age 2 so that the condition does not affect growth or development.
Penoscrotal webbing is characterized by a web or fold of skin obscuring the shaft of the penis as it attaches to the scrotum. It typically occurs during fetal development but can also result from complications after circumcision. This condition doesn’t alter a boy’s health but it can produce complications during adulthood. If necessary, this can be corrected by surgery.
Hernia and hydrocele
A hernia in a child is the protrusion of a section of intestine through a weak spot in his or her abdominal muscles into the scrotum around the testicle in boys or into the labia in girls. Hernias are an extremely common condition and can occur in the first few months or years after birth.
A hydrocele is a sack filled with fluid that can develop around a boy’s (or a man’s) testicle and cause his scrotum to swell. Usually a hydrocele goes away a few months after a boy’s birth, but hyrdocelectomy surgery may be needed.
Testicular torsion occurs when one of the cords that secure the testicle in the scrotum twists around the testicle, cutting off its blood supply. This condition is mainly experienced by males under age 25 and can be treated by surgery.
Varicoceles are enlarged varicose veins in a boy’s scrotum, and often form during puberty. Up to 15 percent of males may have varicoceles, which are found frequently in men with infertility issues. Varicoceles may not require treatment; however, if pain, atrophy or very large varicose vein size occurs, surgery may be necessary.
Penoscrotal webbing, which affects only males, is characterized by a web or fold of skin obscuring the shaft of the penis. It typically occurs during fetal development but can also result from complications after circumcision. This condition doesn’t alter a boy’s health but it can produce complications during adulthood. If necessary, the excess skin can be removed by surgery.
Undescended testicle occurs when a testicle hasn’t moved from the male fetus’ belly into its scrotum before birth. Most of the time the testicle descends on its own during the first six months.
Occasionally an infant is circumcised but there is a problem with the healing process, potentially leaving extra skin behind or causing adhesions or scar tissue. In which case, the circumcision may need to be corrected or “revised.” Circumcision revision procedures are fairly similar to a first-time circumcision in terms of method, recovery and possible complications.