The Pediatric Urology Service treats congenital abnormalities of the genitourinary system in children. Reconstructive surgery for hypospadias, cryptorchidism, and other genital abnormalities is usually performed on an ambulatory surgery or short-stay basis. The spectrum of management also includes obstructive uropathy, non-obstructive uropathy, and urinary tract infections. Special services include urological management of spina bifida patients as well as bladder augmentations. Minimally invasive techniques are applied when appropriate.
What are the most common symptoms of Pediatric Urology ?
- Antenatal Hydronephrosis -
The expectant mother may undergo ultrasound evaluation during pregnancy to assess fetal development. An added benefit of this exam is that it offers a "free picture" of fetal kidney development. The interior of the fetal kidney may become dilated either due to excessive urine production and/or impairment to drainage. This may result in a condition called hydronephrosis. The hydronephrosis may be a transient in-utero condition that will resolve after birth - usually in terms of several months. Conversely, the hydronephrosis may cause increased intrarenal pressure and deterioration of renal function. We can offer prenatal counseling regarding this condition and typical postnatal diagnosis and management. Also, we can offer input regarding indications for early induction of labor in consultation with your obstetrician.
Circumcision/Incomplete Circumcision -
Circumcision is a commonly performed procedure in the newborn period, most often done by the obstetrician before discharge from hospital. However, many newborns may go uncircumcised for a variety of reasons - newborn illness, prematurity or voluntarily by parental choice. Although circumcision need not routinely be done (a position held by the American Academy of Pediatrics), the parents may opt for circumcision subsequent to the newborn being discharged from the hospital. The advantages and disadvantages of circumcision may be discussed, and a rational decision reached regarding the very need for this procedure.
Newborn circumcision is done by the obstetrician with a variety of clamps. This so-called clamp circumcision may not attain a decent cosmetic result. Occasionally an excess amount of foreskin may remain giving the appearance of still being uncircumcised. Less commonly, the head of the penis may still remain covered and unable to be exposed (hidden penis). These situations may also require a revision of circumcision (repair of incomplete circumcision.
Beyond the newborn period both circumcision and repair of incomplete circumcision are best accomplished via ambulatory or same day surgery under general anesthesia between six months and one year of age. This allows an appropriate amount of foreskin to be removed and offers the best functional and cosmetic result in a pain-free fashion.
This is a congenital problem present in some newborn boys (occurring approximately in 1:250 male births). This describes an abnormality whereby the opening is not at the very end of the head of the penis. The opening from which the stream emanates may be malpositioned on the bottom of the penis-anywhere from the head of the penis to the scrotal area. There may also be an associated bend or curvature downward, called chordee. The further removed the opening is from the end of the penis, the more likely that a chordee be present. Circumcision should not be done in infants with hypospadias, since the foreskin is often used in the requisite corrective surgery.
Surgical correction is best accomplished between six months to one year of age via ambulatory surgery under general anesthesia. As noted above, the foreskin may be used for creation of the new urinary channel and/or coverage of the bottom surface of the penis when chordee is present. Post procedure, one can anticipate both an excellent cosmetic and functional result.
Nocturnal Enuresis (Bedwetting) -
Most children gain control of urine at night by four to five years of age, but bedwetting may still occur in 15% of children by age six years. This may occur from a variety of reasons including increased production of urine while asleep, maturational lag and unstable bladder contractions. The evaluation of bedwetting or nocturnal enuresis is relatively simple, including history and physical examination and urinalysis. Treatment may be instituted, including medical management, behavior modification, or conservative/expectant treatment. The bedwetting almost invariably resolves at a rate of 10% per year as the child progresses toward adolescence. We can offer you guidance and further information should you wish to gain some control over this problem.
Undescended Testis -
This is a common abnormality seen in 1-3% of newborn boys. During fetal development, the testis develop inside the abdominal cavity and should move through the lower abdominal wall (inguinal canal) and into the scrotal sac. It is unknown exactly what causes an arrest of this descent, but the testis should ultimately reside in the scrotal compartment during the latter stages of fetal development. After birth, some incompletely descended testes may complete the descent in the first three months of life; but thereafter spontaneous descent will not occur. The incompletely descended testis may not achieve fertility potential if it resides outside the scrotal sac.
Surgical intervention is commonly performed to correct this problem. The name of the operation is orchiopexy and this is accomplished via same day or ambulatory surgery under general anesthesia. This entails a mini-incision in the groin area and recovery is quite rapid. Occasionally, laparoscopy may be performed to help in identifying the nonpalpable testis. Laparoscopy may also be utilized to help in bringing the high intra abdominal testis down.
Lastly, a word on the retractile testis. This refers to a testis that simply migrates upwards or has a tendency to move in and out of the scrotal sac, due to a prominent cremasteric reflex. This is a common phenomenon in infants and young children and the retractile testis does not require surgical intervention.
Ureteropelvic Junction Obstruction -
This refers to a partial blockage of the ureter where it enters the kidney (renal pelvis). This results in dilation of the collecting system within the kidney, called hydronephrosis. A severe degree of hydronephrosis may result in diminished renal function; and in its most extreme form, virtual complete loss of renal cortex. Ureteropelvic junction obstruction (UPJ obstruction) is commonly diagnosed in the newborn infant by maternal prenatal ultrasound study. In older children/adolescents it may present with abdominal/flank pain, hematuria (blood in the urine), or urinary tract infection.
This condition is diagnosed with various imaging modalities (most commonly renal ultrasound) and may be followed conservatively or managed surgically. If a surgical obstruction does exist, the condition is amenable to correction with an operation called pyeloureteroplasty (UPJ repair). This is attendant with gratifying results and resolution in the vast majority of cases. Selected patients may be candidates for laparoscopic intervention or a minimally invasive technique called endopyelotomy. Again, intervention is expected to attain and preserve optimal renal function.