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Pediatric Urology
Pediatric urology is a sub-speciality of urology that focuses attention on those urologic conditions that are unique to the pediatric population. The most common congenital conditions happen to be urologic in nature. Fortunately, there are numerous treatment options, both medical and surgical, to help these children. Several very common urologic conditions are as follows:
Vesical Ureteral Reflux (VUR): As you know, the kidneys (which sit in the mid-back, just under the rib cage) filter the blood and make urine. The urine travels away from the kidneys down thin tubes called ureters. The ureters then deposit the urine in the bladder where it is stored until urination occurs. Most of the time, this is a one-way journey. For some children, though, the urine can squirt backwards up the ureters when they are urinating. This can happen on one side or both. The can concerning because a certain volume of urine never gets emptied from the body. Overtime this urine can get infected and cause damage to the kidneys. No two children with VUR are the same. The first step is to assess the severity of the reflux because the severity will oftentimes dictate the management. Sometimes the reflux resolves on its own as the child grows. For these children we often provide antibiotics (to protect against infection) and monitor the reflux to watch for improvement. Sometimes, though, surgery may be necessary to correct the reflux.
Undescended Testicle: As a male fetus develops during pregnancy, the testicles initially form in their mid-back (near the kidneys) and then travel down to the scrotum. Sometimes a testicle does not make it all the way to the scrotum. It is important to determine where the testicle is and, if possible, to reposition the testicle into its proper position in the scrotum. Oftentimes surgery is required to find and reposition the testicle and this surgery is called an orchiopexy. Sometimes a healthy testicle is not found during surgery. In these instances, it is believed that the testicle did not develop properly. Fortunately, these children often have a well positioned testicle on the other side that will allow for normal development and maturity.
Hypospadius: The meatus is the opening at the end of the penis that a male urinates through. As a male fetus develops during pregnancy, the penis tubularizes and the meatus positions itself normally at the tip of the penis. Sometimes, the process is disrupted and the meatus is positioned along the shaft of the penis rather than at the tip. A surgical procedure can reposition the meatus to the tip of the penis and return normal function and appearance to the penis. The first step is to determine the severity of the hypospadius because the further away the meatus is from the tip of the penis the more challenging the surgery can be. Often times we do not recommend immediate circumcision in children with hypospadius because the foreskin tissue can be used during the surgical reconstruction. Please know that the surgery may be delayed until the newborn child has matured to an age (often around age 1). This is done to optimize the surgical outcome.
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