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Treating urological conditions in children can be tricky and necessitates specific knowledge and training. Urological conditions in children can sometimes be congenital (present at birth) and diagnosed during infancy or even prenatally. Other urological conditions can develop during childhood. Let’s help you understand everything you must know about paediatric urology.
Synopsis
What Is Paediatric Urology?
Paediatric urology is a sub-specialisation of urology that deals with the examination and treatment of congenital and acquired genitourinary tract diseases in newborns, toddlers, and adolescents. Paediatric urologists specialise in treating children's urinary problems. This can include:
- Infants with abnormalities in their urinary system found during prenatal ultrasounds
- Prepubescent females with genital problems
- Children and teenagers (up to 18 years old) with:
- Congenital problems in their urinary system that may require reconstructive surgeries
- Acquired urinary problems like recurrent urinary tract infections (UTIs), bladder control issues (bedwetting), or injuries.
When to See a Paediatric Urologist?
If your child has unusual or critical urinary problems, it's important to see a paediatric urologist. The specialists address issues related to the urinary system, including the urine ducts, kidneys, urethra, bladder, genital area, and testicles. Some common conditions they treat are:
- Hernia: It is a noticeable bulge in the scrotum or groin.
- Undescended Testicles: Testicles that have not descended into the scrotum.
- Hydrocele: It is a swelling around the testicles due to fluid buildup.
- A varicocele: An enlarged vein in the scrotum.
- Vesicoureteral Reflux: Backflow of urine from the bladder to the kidneys.
- Hypospadias: It is an abnormal development of the urethral opening in boys.
- Ureteropelvic Junction Obstruction: It is a blockage in the kidney outflow.
- Neurological Disorders affecting bladder function.
- Pyelonephritis: A recurrent urinary tract infection causing high fevers.
- Bladder or kidney stones
- Hydronephrosis: Swelling of the kidneys, noticed before birth.
Common Urological Conditions: Signs and Symptoms
While some abnormalities are visibly apparent, others may require observation over time. Symptoms to be aware of are:
- Testicular mass
- Abnormal genital shape
- Skin tethering abnormalities
- Improper positioning of the urinary opening
- Persistent urge to urinate
- Weak urinary stream
- Frequent urination in small amounts
- Burning or painful sensation during urination
- Blood in urine
- Hesitancy to urinate
- Strong-smelling or cloudy urine
- Abdominal pain or lump
- Hernia development.
Diagnosis for Paediatric Urology Conditions
The initial step is a thorough diagnosis, for which Manipal Hospitals offers advanced tests and diagnostic tools for children. The diagnostic tests for paediatric urology include:
- Kidney, ureter, and specialised urology scans
- Bladder and dysfunctional voiding tests
- Kidney, Ureter, and Specialised Urology Scans:
- DMSA scan for kidneys
- MAG3 renal scan
- Magnetic resonance urography (MRU).
DMSA Scan
A DMSA scan uses dimercaptosuccinic acid and a camera to capture detailed images of the kidneys. The material improves image clarity and is safe for children, exiting their bodies within hours.
MAG3 Renal Scan
The MAG3 renal scan assesses kidney function and diagnoses conditions like ureteropelvic junction (UPJ) obstruction. It uses an intravenous (IV) line to administer an isotope for clear kidney imaging.
Magnetic Resonance Urography (MRU)
MRU utilises radiation-free magnetic waves to produce detailed images of the kidneys, bladder, and ureters. Younger children require sedation during this test in the magnetic resonance imaging scanner.
Bladder and Dysfunctional Voiding Tests:
- PVR test
- Renal bladder ultrasound
- Uroflow
- VUDS
- VCUG
Post Void Residual (PVR) Test
The test evaluates bladder emptying and function using ultrasound imaging to measure leftover urine post-urination and aid in detecting bladder emptying issues.
Renal Bladder Ultrasound
Technicians use ultrasound to examine the kidneys and bladder for hydronephrosis and other kidney problems.
Uroflow
The Uroflow measures urine flow rate using a specialised chair resembling a small toilet. It diagnoses dysfunctional voiding or bladder issues.
Video Urodynamic Study (VUDS)
A VUDS assesses bladder expansion and contraction, pelvic floor muscle function, and bladder emptying patterns. It's crucial to diagnose bladder dysfunction.
Voiding Cystourethrogram (VCUG)
A VCUG checks bladder size, shape and urinary system blockages and aids in diagnosing vesicoureteral reflux and causes of urinary tract infections.
Treatment for Paediatric Urology Conditions
Once a diagnosis is made, the medical team guides families through the next steps of treatment.
Noninvasive Treatments
- Biofeedback and interactive video games for bedwetting and voiding dysfunction
- Medications or pelvic floor training for neurogenic bladder
- Medications or nutritional counselling for kidney and urinary stones
- Ultrasound imaging for fetal urology conditions.
Minimally Invasive Treatments
- Bladder augmentation
- Bladder diverticulectomy
- Mitrofanoff creates a channel between the appendix and the abdominal wall for catheterisation
- Pyeloplasty
- Ureteral reimplantation.
Reconstructive Surgery
- Complete repair for bladder exstrophy
- Genital reconstruction for congenital adrenal hyperplasia (CAH)
- Urinary diversion or stoma surgery for neurogenic bladder
- Surgical removal of the foreskin from the penis
- Creation of a channel between the appendix and the abdominal wall for catheterisation
- Surgical removal of non-functioning or severely damaged kidneys
- Correction of vesicoureteral reflux (VUR) to ensure proper urine flow
- Surgical correction of abnormal urethral conditions like hypospadias or epispadias.
A paediatric urologist understands and treats a child’s urinary tract and reproductive system conditions. After a precise diagnosis, you can consult and collaborate with your child's doctor to devise an effective treatment plan. There is hope and several noninvasive, minimally invasive treatments and reconstructive surgery solutions to help your child feel better.
FAQ's
Following a discussion about your child’s medical history, prior testing, and symptoms, the doctor performs a physical examination. From there, the doctor decides whether to proceed with any testing to help make a diagnosis or rule out issues. Sometimes, based on the history and prior evaluation, the doctor schedules scans and treatments.
Paediatric Urologists treat:
- Urinary tract infections
- Bedwetting or daytime wetting
- Kidney stones
- Congenital genital disorders
- Pediatric cancers of the urinary tract
- Questions regarding hormone function
- Urine flow issues
- Bladder dysfunction.
Paediatric urologists use urodynamics to assess bladder function and treat bladder dysfunction with behavioural therapy, medicines, and, in certain cases, surgery.
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