Paediatric (Ped) Urology

The Paediatric Urology department provides care and treatment to children suffering from genitourinary conditions. Children may not be able to comprehend and express the pain that they may be going through. Paediatric urologists are trained to understand and treat such medical problems in children.

Symptoms

Children will not always be able to communicate their pain and discomfort to you, but you can look for a few symptoms that could hint at a brewing urinary condition. A few such symptoms are as follows:

• Severe pain in the groin, abdomen, or lower back
• Constant bed wetting
• Urge to pass urine frequently
• Blood being passed in the urine
• Pain and swelling in the testicles
• Fever that doesn't go away
• Inability to empty the bladder
• A weak stream of urine
• Incontinence of urine
• Severe pain while urinating
• Defects relating to the kidney and urinary tract diagnosed during pregnancy

When to see a Paediatric urologist?

Identifying urological conditions that need special attention can be challenging for a parent. You can never know if your child's bedwetting is just a phase or a sign indicating something severe, or if your daughter's Urinary Infections (UTIs) are something to worry about. You may need to take your child to consult a paediatric urologist if:

• Your child does not have dry nights by the age of six. It is considered that children overgrow their bedwetting phase by this age. If your child has been potty trained and is yet bedwetting at six, you must consult a paediatric urologist.
• Your child suddenly faces wetting issues during the day or night, regardless of being potty trained. A trip to the paediatric urologist could help to rule out infection or other underlying causes.
• The child frequently suffers from UTIs. Children are prone to UTIs, but if they face several UTIs within a short period, you must consult a paediatric urologist.
• The child has congenital anomalies relating to the bladder, kidney, reproductive organs, and genitalia. A paediatric urologist can help to correct these defects and regain the functionalities of these organs either entirely or to a large extent. Usually, surgery is involved in treating such conditions.

If you identify the slightest hints of infection or disorders relating to your child's bladder or kidney, consult a paediatric urologist immediately. Conditions can become severe over time. Immediate medical attention can help reduce the risks of extreme damage to the child. Few infections, if found early, can be treated by medications alone. Your paediatrician can treat UTIs in your child with medications alone. But they may advise you to see a paediatric urologist if the UTIs frequently occur in your child and medicines are unable to reduce their intensity.

Diseases treated by paediatric urologists

Paediatric urologists treat a vast number of diseases. Some of them are:

• Inguinal hernia: Here, swelling is observed in the groin. Early surgery is the best course of action when this occurs in babies and children.
• Undescended testicles: Testicles are expected to move out of the belly to the scrotum before birth. However, if this doesn't happen, surgery will be required. The surgeries will vary depending on the location of the undescended testicle.
• Hydronephrosis: This refers to swelling of kidneys, which can be on one or both sides. Treatment for hydronephrosis varies depending on the cause.
• Hypospadias: In this condition, the urethra of male infants opens on the underside of the penis instead of the tip. Surgery is performed to treat this condition.
• Vesicoureteral reflux: This condition causes the urine to flow back into the bladder or sometimes even to the kidney. Several treatment options are available based on each patient's case. There have been cases of patients outgrowing it too.
• Voiding disorders: This disorder is related to constant wetting during the day or night. It usually resolves over time but can sometimes become chronic.
• Recurring UTIs: Frequent UTIs can result in voiding disorders in children. Doctors conduct several tests to identify the cause of the UTI and treat it accordingly.
• Dysuria: Here, the patient has severe pain while passing urine. Neurological conditions, injuries, or UTIs can be the cause.
• Pyuria: In this condition, the patient notices pus in the urine. It is an extremely dangerous condition and requires immediate medical attention.
• Bedwetting: It occurs in 5-10% of children, and may not lead to severe health conditions. However, it may cause some harm to the mental health of the child by causing low self-esteem issues since they would not have the confidence to stay overnight at a relative's or friend's house. Medication and therapy can help overcome this.
• Ureterocele: In this congenital disability, the ureter near the bladder inflates like a balloon. This can lead to kidney infections and vesicoureteral reflux and is usually treated by surgery.
• Renal duplication: Here, the child is born with two ureters attached to the kidney.
• Ectopic ureter: Here, the ureter doesn't connect properly to the bladder and drains elsewhere, outside the bladder. Surgeries are conducted to treat ectopic ureters.
• Wilms tumour: A rare kind of cancer develops in the kidney. Paediatric urologists perform surgeries to treat it.
• Bladder exstrophy: It is a congenital condition where the bladder protrudes through the belly. It is usually diagnosed when the baby is in the womb through imaging tests and is cured via reconstructive surgery.

Diagnosis

A paediatric urologist conducts several diagnostic tests. Some of them are:

• Ultrasound imaging: Images of kidneys and bladder are created using sound waves.
• Voiding cystourethrogram: An imaging test, the bladder is filled with a radiocontrast agent using a catheter. It is mainly performed to check for reflexes. Fluoroscopy is used to view real-time images.
• Nuclear Renal Scan: Evaluates the patient's kidney function. A radioactive tracing substance is injected into the patient before performing an MRI or a CT scan.
• MR urography: It is an MRI study conducted after injecting a specific dye into the patient's blood.
• Urodynamic testing: It measures the pressure and flow of urine. A catheter is placed through the urethra, into the bladder to measure the flow and pressure of urine passed by the bladder.

Review

Reviewed by Dr. Anurag Krishna Chairman - Paediatrics & Paediatric Surgery on 06-Feb-2023.