Pediatric Urology

• Circumcision
• Hypospadias
• Testis Absent/Undescended/Torsion of Testis
• Neurogenic bladder
• Nocturnal Enuresis
• Urinary Tract Infection
• Hydrocele & Hernia
• Antenatal Hydronephrosis

Circumcision:

Surgical removal of excessive long prepusial skin. Child may have complained of ballooning of prepusial skin, crying while urination or recurrent U.T.I. and on Examination found to have in ability to retract prepusial skin, Procedure is performed under anaesthesia and requires one day stay /day care.

Hypospadias:

Is a birth defect in boy where urethral opening is in abnormal position instead of at tip of penis.There could be bending of penis alongwith (chordee).

It requires surgical correction depending upon location of meatus and (chordee)- stages of surgery is decided i.e. it may require one and two or sometime more stage surgeries. Surgery can be performed after one year of age.

Disease of testis:

In normal male child-both testis should be in scrotal sac, but sometime it could be in abnormal position i.e. in groin/intra-abdominal.

If it doesn't reach in to scrotum by 6 months, it requires surgical procedure to bring it down so it does not get damage because of an abnormal environment as well to prevent / recognise certain complications earlierlike torsion / malignancy.

Torsion of testis:

Sometimes Testis is having long Mesentery,hanging freely it can get rotation of 180 / 360 degree and child develop sudden excruciating pain which is an emergency condition – where after diagnostic test (USG Doppler) it may require surgical correction in form of un-twisting and fixation, along with contralateral fixation as well.

Neurogenic bladder:

Patients with Neurogenic bladder may have abnormal urinary voiding complains, incontinence of urine or recurrent urinary tract infection even sometime patient can develop renal failure also. Apart from routine investigations, urodynamic study would be of help.

• This kind of problems usually arise from spinal cord problems like Meningomyelocele, Spina bifida etc.
• Usually it is treated by conservative treatment with medications or sometime with self-catheterization (CIC)

Nocturnal enuresis (bed-wetting):

• This is commonest urological problem seen in children.
• Approximate 10 to 20% of children between the age of 5 to 6 years are having this problem
• In rarecases, it may persist upto age of 15 years, if it persists more than this age then requires thorough evaluation.
• If it is only nocturnal incontinence, usually it does not require detailed investigation,
• Only behavioural therapy, fluid intake modifications etc. are sufficient.

Urinary tract infection:

• If child is having episode of urinary tract infection particularly associated with fever, requires detailed evaluation in the form of routine blood / urine analysis, ultra-sonography and if requires Micturating Cysto-Urethrogram (VCUG).
• Common causes are phimosis, vesico-ureteric reflux, anatomical obstruction in urinary tract, Neurogenic bladder etc.
• Treatment ranges from course of antibiotic to correction of cause. (Surgical correction)

Hydrocele & hernia:

• A swelling in scrotum or lower abdomen is the presenting complain
• Usually it requires surgical correction

Antenatal hydronephrosis:

• It could be because of pelvi-ureteric junction obstruction, vesico-ureteral reflux, (Multi-cystic kidney) etc.
• During pregnancy, only surveillance is kept, usually it doesn’t affect course of pregnancy
• After birth – sonography should be repeated, as well blood reports to be done if swelling in both kidneys.
• If it is affecting only one kidney after three months Renal Scan / MCUG to done and treated accordingly.
• If it is affecting both the kidneys – treatment should be offered aggressively.