Pediatric urologists

Children have unique medical needs that differ from those of adults. They may have difficulty communicating their symptoms or may not be able to tolerate a medical examination calmly and cooperatively.

Pediatric urologists are specialists who are trained to provide care that addresses the unique needs of children and their parents, including sensitive topics related to genitalia and bowel problems. They have the expertise to examine and treat children in a way that is gentle, soothing and designed to create a comfortable and non-threatening environment. In addition, they often use specialized equipment that is adapted to the needs of children.

If your child's pediatrician recommends a visit to a pediatric urologist, rest assured that he or she will receive the highest level of care. These specialists have a wide range of treatment options, extensive training, and unparalleled expertise in treating children with urinary tract disorders.

Pediatric urologists are highly trained medical professionals who have undergone extensive training and specialized training. This includes at least 6 years of medical school, 1-3 years of surgical residency, and at least 3 years of residency training in public health urology. In addition, they have completed a 1-2 year fellowship in pediatric urology.

Becoming a pediatric urologist requires an in-depth understanding of urological problems that can affect infants, children, and adolescents. As such, they must devote at least 75% of their activity to caring for this patient population. This ensures that you have the expertise and expertise to provide the best possible care for your young patients.

Pediatric urologists are skilled surgeons who specialize in diagnosing, treating and managing urinary and genitourinary problems in children. They offer a range of services, including:

Evaluation and management of voiding disorders, vesicoureteral reflux, and urinary tract infections requiring surgery

Surgical reconstruction of the urinary tract (including kidneys, ureters and bladder), as well as genital abnormalities, hypospadias and disorders of sexual development

Surgery for inguinal conditions occurring during childhood and adolescence (such as undescended testicles, hydrocele/hernia, and varicocele)

Evaluation and surgical management of kidney stone disease

Surgical management of kidney, bladder and testis tumors and malignancies

Evaluation and management of prenatally identified urological tract problems

Evaluation and management of urinary tract problems associated with neurological conditions, such as spina bifida.

Pediatric urologists are highly trained specialists who have the knowledge and skills necessary to provide compassionate, effective care to children with urological conditions.

Pediatric Urologist

A child’s paediatric urologic specialist has the knowledge needed to treat ailments of the restroom or testicles.

Children have unique needs when it comes to medical care. They may not always be able to communicate their symptoms clearly or feel comfortable during a medical examination. This is where Pediatric Urologists come in – they are specialists who are trained to provide care that is tailored to children and their parents.

Pediatric Urologists have expertise in dealing with sensitive and potentially embarrassing issues related to genitalia and voiding problems in children. They know how to examine and treat children in a way that is gentle and non-threatening, and they use specialized equipment that is designed for children to help create a comfortable environment.

If your child’s Pediatrician recommends seeing a Pediatric Urologist, you can rest assured that they will receive the highest level of care. These specialists have the widest range of treatment options, the most extensive training, and the greatest expertise in treating urinary tract disorders in children. They will work closely with you and your child to ensure that their unique needs are met and that they receive the best possible care.

Pediatric Urologists are highly specialized medical doctors who have undergone extensive training to provide the best possible care for infants, children, and adolescents with urologic problems. To become a Pediatric Urologist, a medical doctor must complete:

  • At least six years of medical school
  • One to three years of surgical residency
  • At least three additional years of residency training in general Urology Health
  • One to two years of additional fellowship training in Pediatric Urology.
  • Pediatric Urologists are experts in the diagnosis and treatment of urinary tract disorders in children, including conditions affecting the kidneys, bladder, and genitalia. They have a deep understanding of the unique needs of pediatric patients and are trained to provide care that is sensitive, compassionate, and effective.

Pediatric Urologists are specialized surgeons who are trained to diagnose, treat, and manage urinary and genital problems in children. They provide a range of services that are tailored to meet the unique needs of pediatric patients, including:

  • Evaluation and management of voiding disorders, vesicoureteral reflux, and urinary tract infections that require surgery
  • Surgical reconstruction of the urinary tract, including the kidneys, ureters, and bladder, to treat conditions such as genital abnormalities, hypospadias, and disorders of sex development
  • Surgery for groin conditions in childhood and adolescence, such as undescended testes, hydrocele/hernia, and varicocele
  • Evaluation and surgical management of kidney stone disease
  • Surgical management of tumours and malignancies of the kidney, bladder, and testis
  • Evaluation and management of urological tract problems that are identified before birth
  • Evaluation and management of urinary tract problems that are associated with neurological conditions such as spina bifida.

Pediatric Urologists are experts in performing complex surgical procedures on infants, children, and adolescents, and they use the latest technologies and techniques to ensure the best possible outcomes for their patients. They work closely with other medical professionals, including pediatricians, radiologists, and neurologists, to provide comprehensive care for their patients. If your child has a urological or genital problem, a Pediatric Urologist can provide the specialized care and expertise they need to achieve optimal health and well-being.

Antenatal hydronephrosis, which refers to the enlargement of the kidney due to fluid-filled sacs before birth, can be detected in a fetus through ultrasound studies as early as the first trimester of pregnancy. Although most cases do not require changes in obstetric care, surveillance and possible surgery during infancy and childhood may be necessary.

There are several possible causes of antenatal hydronephrosis, including blockages in the Uretero Pelvic Junction (UPJ), the Uretero Vesical Junction (UVJ), or the urethra. Vesicoureteral reflux, which occurs when the valve between the bladder and the ureter is incompetent, is another possible cause. Other less common causes include duplications and multicystic kidneys, which are non-functional cystic kidneys.

In many cases, ultrasound surveillance is all that is necessary during pregnancy. However, in rare cases where there is severe obstruction of both kidneys and insufficient amniotic fluid, drainage of the kidneys or bladder may be necessary. Postnatal ultrasound is usually performed before the child leaves the hospital, and a Voiding Cystourethrogram (VCUG) is performed to exclude vesicoureteral reflux.

Children with vesicoureteral reflux are managed with antibiotics and periodic ultrasound and voiding cystogram surveillance, while those with obstruction or blockage may require surgical correction. In cases where the evidence for obstruction is marginal or the degree of blockage is mild, the tests may be repeated after a few months.

If a child is diagnosed with a multicystic dysplastic kidney, which doesn’t function, the opposite kidney is usually normal. In most cases, unless the multicystic kidney is causing a problem, such as mass effect or pain, it is usually left alone and followed up with ultrasound at 6 months and a year after. However, if it is found to be enlarging during follow-up or if there is a suspicion of tumor or blockage, nephrectomy (removal of the affected kidney) may be necessary. Follow-up care for the opposite normal kidney is essential.

Circumcision/Circumcision Revision

It is important to note that circumcision is a personal decision that should be made by the parents or the individual themselves. There are potential benefits and risks associated with the procedure. Some people believe that circumcision may reduce the risk of urinary tract infections, sexually transmitted infections, and penile cancer, while others argue that these benefits are not significant enough to justify the risks and pain associated with the procedure.

It is also worth noting that some people have strong cultural or religious beliefs that influence their decision to circumcise. In some cultures, circumcision is seen as a rite of passage or a symbol of identity. It is important to respect these beliefs and allow individuals and families to make their own decisions about circumcision.

If parents decide to have their child circumcised, it is important to choose a qualified and experienced healthcare provider to perform the procedure. Parents should also be aware of the potential risks and complications associated with circumcision and should monitor their child for any signs of infection or other complications following the procedure.

Overall, the decision to circumcise is a personal one that should be made after careful consideration of all the potential benefits and risks. It is important to consult with a healthcare provider and to make an informed decision based on the individual circumstances and beliefs of the family.


Hypospadias is a congenital condition seen in male infants where the opening of the urethra is not located at the tip of the penis but instead can be present anywhere on the underside of the penis up to the scrotum. Although there appears to be a genetic link to the development of hypospadias, the exact cause of the condition is unknown. Chordee , a condition characterized by penile curvature during erection, may be associated with hypospadias. The incidence rate of hypospadias is about 8.2 per 1,000 male births, and there is a familial risk associated with the condition. Boys with hypospadias have a 15% chance of having a family member, such as a father or brother, with the same condition. The severity of hypospadias can vary from mild to severe, and it is classified based on the anatomical location of the urethral opening, which may be near the tip of the penis or near the anal opening (perineal). Determining whether cordy is associated with hypospadias is critical to determining appropriate surgical intervention, which may require one or two stages. Some children may have cordy without hypospadias, and their urethral opening may be in a normal location.

Hypospadias is a condition that can affect the male reproductive system, causing the urinary tube (urethra) to be improperly positioned on the penis. Surgical correction of hypospadias involves two main steps. First, any cordi or curvature of the penis , is straightened. Then, the urethra is extended to the tip of the penis (glans) to ensure a straight penis for satisfactory sexual function. While this may not seem critical during childhood, it is an important consideration for sexual health later in life

Hypospadias is a condition that can be treated by various surgical operations. Fortunately, the techniques used for treatment have improved dramatically over the years, reducing the number of operations required to correct the condition. During the operation, any excess skin is removed to give the baby a circumcised appearance.


It is recommended that children undergo surgery to correct hypospadias at around 6 to 8 months of age. While most children can be cured with one operation, severe cases may require two surgeries. In rare cases, another surgery may be necessary to manage complications. To minimize the impact of multiple surgeries, the second operation is usually delayed 6 to 12 months after the first operation.


Correction of hypospadias is usually done on an outpatient basis under general anesthesia. For children with more severe cases, a catheter may be needed to drain urine from the bladder and allow the new urethra to heal. This catheter may need to remain in place for one to two weeks, draining into the baby’s diaper until it is removed.


After surgery, a bandage is left on the penis to aid in healing. Due to the nature of the surgery, there may be significant swelling and disfigurement of the penis for a period following the surgical repair. It is important to closely monitor the child’s healing and follow up with the surgeon as needed.


In conclusion, while hypospadias can be a challenging condition to treat, advances in surgical techniques have led to improved outcomes for patients. With proper care and management, children can undergo surgery to correct the condition and achieve satisfactory sexual function later in life.

Skin and urinary tract infections are potential risks associated with surgical correction of hypospadias. Additionally, bladder spasms can be caused by the presence of an indwelling catheter. While medications can help control spasms, they don’t completely eliminate them.

Fistula is another risk associated with hypospadias repair, involving leakage of urine from the new urethra. This risk is minimal in simple repairs, but can be up to 10% in more extensive operations. Fortunately, fistulas can usually be repaired through an outpatient surgical procedure. However, repairs are usually delayed 6 to 12 months from the time of the original operation.

A stricture or stenosis, in which the new urethra joins the original urethra or is narrowed by scar tissue at the new opening at the end of the penis, is another potential complication. Careful monitoring and follow-up with the surgeon can help detect and manage these risks.

In summary, while there are risks associated with surgical correction of hypospadias, most can be managed successfully with careful monitoring and follow-up care. With proper care and management, children with hypospadias can achieve satisfactory sexual function later in life.

Labial adhesions are a condition in which the inner folds of the female genitalia (labia) temporarily grow or adhere together. This condition is most common in young girls aged between 3 months to 6 years, and it is related to hormonal influence. Labial adhesions usually occur due to inflammation of the skin, which causes the labia to stick together. Poor genital hygiene and bacteria in the area can also contribute to labial adhesions. Keeping the area clean and dry is essential for the treatment and prevention of labial adhesions.

Symptoms of labial adhesions are usually minimal, and most cases are asymptomatic. However, post-void dribbling may occur due to labial adhesion. Urinary tract infections are rare with labial adhesion.

Estrogen cream is the primary treatment option for labial adhesions. A trial of estrogen cream is usually initiated, and parents need to apply the cream twice a day for 2-8 weeks, as directed by the urologist. A small pea-sized amount of cream is applied to the middle of the adhesion, followed by slight pressure with the finger.

In some cases, doctors may recommend separating the labial adhesions in the office with topical anesthetic (numbing cream). However, this procedure is occasionally done under general anesthesia in the hospital.

After the adhesions are resolved, preventing their recurrence is essential. It is recommended to apply a thin layer of estrogen cream on the area every night for at least a month.

There are a few risks associated with treating labial adhesions. In rare cases, skin infections and allergic reactions may occur. Additionally, estrogen cream can cause vaginal itching or burning. Parents must speak to their urologist if their child experiences any adverse reactions.

In conclusion, labial adhesions are a common condition in young girls, but they usually resolve with minimal intervention. Estrogen cream is the primary treatment option, and parents must maintain good genital hygiene to prevent their recurrence. While there are some risks associated with the treatment, the benefits typically outweigh the risks. It is important to consult with a urologist for proper evaluation and management of labial adhesions.

Neurogenic Bladder

“NB” refers to a condition characterized by lower urinary tract dysfunction that is not caused by primary urinary tract issues.

In individuals beyond infancy and early childhood, urination is a voluntary act that can be initiated or controlled depending on the circumstances. Urination should be done without straining and should result in complete emptying of the bladder. During bladder filling, the sphincter tightens to prevent urine leakage, while it opens during bladder contractions to allow urine to pass. Any involuntary urine leakage or difficulty urinating is considered abnormal and requires medical evaluation because it may cause social inconvenience or impair a person’s daily activities.

Urination is controlled by the central nervous system, which sends messages to the bladder and sphincter via the spinal cord and lumbar and sacral nerves. However, if the spinal cord or its nerves are damaged or there is a problem with the normal functioning of the brain, this control can be lost. As a result, the bladder may not empty properly or become overworked due to lack of sensation. The sphincter may also fail to open or close properly.

When dealing with neurogenic bladder, the primary aim is to prevent renal damage. Kidney damage can develop due to excess pressure within the bladder, which can lead to a backpressure effect on the kidneys. This type of damage may be symptomless during the initial stages, but can eventually lead to urinary tract infections, stone formation, and other related problems. To minimize the risks associated with renal damage, treatment should focus on reducing bladder pressure.

Pelviureteric junction (PUJ) obstruction is a partial obstruction that prevents urine from flowing from the renal pelvis into the ureter, causing enlargement of the renal pelvis (hydronephrosis). PUJ obstruction is usually congenital but can also occur later in life due to other factors such as inflammation or the presence of stones. Symptoms of PUJ obstruction include blood in the urine, urinary tract infection (UTI), kidney stones, pain associated with nausea and vomiting, abdominal fullness, a palpable mass, or hypertension. The diagnosis can be confirmed using nuclear scans, blood and urine tests. A common surgical procedure for this condition is a pyeloplasty, which involves removing scar tissue from the blocked area and reattaching the healthy portion of the kidney to the renal pelvis. After surgery, a ureteric stent is usually placed to drain urine from the operated kidney, and when urinating, patients may experience urgency, frequency, burning sensation in the urine, mild blood-tinged urine, and flank pain for a minute or more. Complications of untreated PUJ obstruction include progressive loss of kidney function, kidney stones, or infection. Follow-up after stent removal included obtaining a renal ultrasound three months after pyeloplasty.

Regular testicular examination should be a regular part of every adult man’s health program. This suggestion is important because testicular cancer is one of the more common tumors seen in men, especially between the ages of 20 and 40. All men should learn how to self-examine and check themselves every month. Only by becoming familiar with the normal anatomy of the testicles can they detect any changes that may occur.

The test should be done in a comfortable position, such as in the shower or bathtub. Men should monitor the shape and position of the testicles. On the outer or lateral surface, they can feel a groove called the lateral sulcus between the testicle and the epididymis, which joins it. The testicle should feel firm but not too hard.

Untreated testicular torsion can result in the testicle being so badly damaged that it needs to be surgically removed. In such cases it is important to seek early medical help within 4 to 6 hours of the onset of pain, as surgery can save the testicle by untwisting it and restoring blood flow. To prevent this from happening again, the testes are usually fixed to the wall of the scrotum. This should be done on the opposite side, as the same abnormality usually exists on the other side. In some cases, there is twisting. All cases of acute testicular pain should be referred to a urologist.

Urinary frequency is a commonly encountered problem in pediatric urology clinics. There are several possible causes of frequent urination, and the first diagnostic step is a urinalysis to rule out urinary tract infection and diabetes.

Urinary frequency usually begins around age 5, often appearing suddenly. This phenomenon is believed to be the result of increased sensitivity of the bladder. A child may feel a strong urge to urinate, even though the amount of urine in their bladder is often very low. Discouraging urination is not recommended, as it can lead to other problems such as incontinence. Most children who experience urinary frequency have good bladder control. In some cases, urination may occur every five to ten minutes, while in others it is less frequent. Some children may experience an increase in urination at night, but when they go to sleep they usually sleep peacefully. Before that, they may get up to use the bathroom frequently.

In our evaluation of children with this condition, we rely on taking a detailed medical history, performing a physical examination, and performing a urinalysis. In some cases, an abdominal ultrasound is done to rule out any abnormalities.

Unfortunately, there are limited treatment options available for this condition. Medications commonly used to treat daytime incontinence or bedwetting may not be effective. These drugs work by modulating the motor component of the bladder and do not address the increased sensation of the bladder that lowers urinary frequency. However, some physicians may prescribe medications that target bladder inflammation, which is believed to be an allergic-type phenomenon that may contribute to the condition.

The most important approach is to reassure the child that his condition will improve over time. Once they begin to focus on other activities, they will be less likely to be preoccupied with the sensation of bladder fullness. In rare cases, older children may experience a decrease in urinary frequency after taking the prescribed medication for a few days.

Urinary Tract Infection (UTI) is a common problem in children, yet surprisingly, it often goes undiagnosed. UTIs can occur in both normal children and those with urinary tract abnormalities. The reason it is so important to diagnose and manage this problem is that unlike other diseases, infants with a urinary infection may not show any symptoms related to the urinary tract at all.

UTIs are fairly common, with 6% of girls and 2% of boys developing the infection.

Contrary to popular belief, children with a UTI may not present with the typical symptoms such as burning or blood in the urine. Infants less than one year old may present with fever, poor feeding, loose stools, or vomiting. Therefore, it is essential to have a high index of suspicion about the presence of a UTI to avoid missing the diagnosis.

Infection commonly occurs due to bacteria ascending from the genital area. Girls are more susceptible to UTIs in their early years due to their short urethra. Other causes of UTI may include blockages in the flow of urine down from the kidney, or disturbances in the normal flow of urine out of the bladder, causing urine to flow backward into the kidney.

Children with a fever of unknown origin should undergo a urine test, which is inexpensive and can give a good indication of whether a UTI is present. Once a UTI is detected, further tests such as a urine culture, ultrasound abdomen evaluation, MCU X-ray, or nuclear scans may be recommended based on your doctor’s assessment.

Antibiotics are the standard treatment for UTIs in children. Your doctor will choose the appropriate antibiotic based on the urine culture report and may change it if necessary. The course of antibiotic treatment may last up to two weeks.

Preventing recurrent UTIs involves adjusting fluid intake to age and bladder capacity, frequent bladder emptying, and avoiding constipation through a high fiber diet or medications.

Children with UTI are at risk for kidney damage and scarring, which can lead to protein leak in the urine, high blood pressure, and decreased kidney function. Early detection of urinary tract abnormalities and prevention of kidney infection through medical or surgical means is essential. Studies have shown a 10% incidence of kidney failure, 13% incidence of high blood pressure, and 13% incidence of kidney-related problems during pregnancy. The need for prevention is clear, as renal scarring is the fourth leading cause of renal transplantation in children.

Voiding dysfunction is a common problem in childhood and causes concern for parents. Symptoms of this disorder are frequent voiding, urgency to void, and wetness. These symptoms are typical in young children with immature bladders. Development of a mature bladder requires increased bladder capacity, voluntary control of the sphincter muscle, and control of involuntary bladder contractions. Most children achieve adult pattern bladder control by age four. However, almost every child will exhibit some symptoms of voiding dysfunction during the transition from infant to adult patterns of bladder control. Initial examination includes a history and physical examination as well as urinalysis. Timed voiding and anticholinergic medications are effective treatment options for children with urgency, frequency, and urge incontinence. In some cases, a special test of bladder function may be indicated. Children with significant behavioral problems may benefit from behavioral counseling. Children with developmental delays due to persistently immature bladders will often exhibit delays in toilet training.

Meatal stenosis refers to an abnormal narrowing of the opening of the urethra, which can lead to difficulty urinating and incomplete emptying of the bladder. The condition commonly affects circumcised boys, and one possible cause is prolonged exposure to urine and rubbing of the flesh against clothing or diapers, resulting in irritation and scarring.

Common symptoms of meatal stenosis include painful urination, straining during urination, frequent urination, thin urine stream, sprinkling with urine, upward turning of the urine stream, and blood in the urine.

Treatment of meatal stenosis involves mitoplasty or mitotomy. Mitoplasty involves opening or widening the meatus by making an incision at the urethral opening and placing a vascularized flap, typically from the prepuce or surrounding penile skin, to prevent recurrence of the stricture. Mitotomy, on the other hand, involves making a small incision in the flesh to widen it, and the cut margin is either sutured with dissolvable sutures or left alone to heal. The surgeon will discuss with you the best treatment plan for your child. Some children may need to open the urethra after these procedures to prevent recurrence of the stricture.

One of the primary reasons for bladder enlargement or replacement surgery is in certain conditions such as spina bifida, posterior urethral valve or bladder exstrophy, where the bladder becomes smaller and holds urine under high pressure. Such an abnormal bladder can cause incontinence and kidney damage. In these cases, the bladder needs to be enlarged to relieve symptoms and protect the kidneys. For patients with cancer of the bladder or other pelvic organs, it becomes necessary to remove the bladder, and usually to replace the bladder, a new reservoir must be created, along with a path for urine to drain through the normal passage or a new stoma.

However, this operation can lead to complications. For example, the bowel does not function like a normal bladder, so patients require intermittent catheterization to empty their bladder. Additionally, the bowel produces mucus that blocks the catheter draining the bladder immediately after surgery. This fluid needs to be removed from the bladder daily to prevent the development of bladder stones or infections. Patients are also at risk of bowel complications such as leakage of bowel contents, bowel obstruction, and bladder rupture or perforation. The risk of bladder rupture is higher in patients who fail to undergo regular catheterization, leading to chronic over-distension of the bladder and weakening of the bladder walls due to ischemia. Finally, patients on intermittent catheterization for neurogenic bladder and those who have undergone bladder augmentation are at increased risk of bladder cancer.

Constipation is a condition that can be diagnosed using the Rome IV criteria, which states that a patient must have experienced at least two of the following symptoms over the preceding 3 months: fewer than three spontaneous bowel movements per week, straining for more than 25% of defecation attempts, lumpy or hard stools for at least 25% of defecation attempts, sensation of anorectal obstruction or blockage for at least 25% of defecation attempts, sensation of incomplete defecation for at least 25% of defecation attempts, or manual maneuvering required to defecate for at least 25% of defecation attempts. Constipation is common in children with urinary tract infections, daytime wetting, and night-time wetting, but it is not a life-threatening condition.

Treatment of constipation involves education, prevention of impaction, promotion of regular bowel habits, and toilet training in older children. Daily bowel movements are essential in treating constipation, and a soft bowel movement should be the goal for the child every day. This can be achieved by providing a daily stool time, ideally 15 to 20 minutes after eating to take advantage of the gastrocolic reflex. It is important not to rush and to allow the child plenty of time in the bathroom, usually 5-10 minutes. Keeping a stool diary can also be helpful to monitor consistency.

There are several dietary measures that can improve constipation, including increasing fluid intake, adding fruit juices such as prune, pear, plum, pineapple, peach, papaya, apricot, orange, or apple, vegetables (either raw or cooked), fruits (including peels as often as possible), bran cereal, bran muffins, raisin bran, and bananas. It is important to avoid certain foods that may worsen constipation, including dairy products (milk, cheese, ice cream), rice or rice cereal, pastas, white bread, and potatoes.

In some cases, supplements may be prescribed to produce daily bowel movements, such as magnesium citrate, Miralax, mineral oil, or Milk of Magnesia. Dosages will be determined by a physician.

Management of constipation requires patience and effort on both the child’s and the parent’s part, and multiple clinic visits may be necessary until appropriate laxative dosage has been established. It is important to keep in mind that dietary factors alone may not alleviate chronic constipation if stool withholding and retention are a problem. In some children with neurological conditions affecting the bowel and bladder, regular enemas may also be required.

A kidney stone is a solid mass that develops in the kidney due to the crystallization of certain substances in previously dissolved urine. Usually, the stone stays in the kidney or passes through the urinary tract when dislodged.

Kidney stones can vary in shape and size from a grain of sand to the size of a golf ball. While some stones are smooth, others are jagged and staghorn stones can even fill the entire kidney. Although not all kidney stones are symptomatic, a small stone can pass through the body without causing significant discomfort. However, if stones remain in the bladder, urethra, or urethra, they can block the flow of urine and result in pain and obstruction.

Kidney stones can develop as a result of dehydration, metabolic diseases, infections, medications, limited activity, diet, family history, and conditions that increase the concentration of certain substances in the urine, such as calcium, oxalate, and uric acid. Calcium is the most common type of stone.

Symptoms of kidney stones include severe pain in the back or side that radiates to the inguinal region and usually include cramping, blood in the urine, vomiting, fever, chills, urinary urgency or frequency, and pain or burning while urinating.

Treatment of kidney stones depends on the type, size and location of the stone. Conservative measures may be sufficient for some stones, but others may require surgery, such as extracorporeal shock wave lithotripsy, endoscopy, percutaneous nephrolithotomy, or rarely, pyelolithotomy. To prevent the formation of stones in the future it is necessary to determine the root cause of kidney stones and for this purpose blood and urine tests can be done. Prevention of kidney stones is usually accomplished through water intake, dietary changes, and, if necessary, medications. During your office visit, your doctor will determine the appropriate treatment for your child’s kidney stones.

Multicystic dysplastic kidney (MCDK) is a type of congenital kidney abnormality where the kidney is completely replaced by multiple cysts held together by connective tissue like a bunch of grapes. The ureter is often atretic or absent, and the cysts usually do not communicate, distinguishing MCDK from hydronephrosis. Nowadays, 47% of cases occur prenatally, while 30% of cases present with a lateral mass, 5% with urinary tract infection, and 18% with other symptoms. Males are more commonly affected, and there is a slight left-sided predominance.

To diagnose MCDK, a renal ultrasound is usually performed, which shows characteristic features that distinguish it from hydronephrotic kidneys. A renal scan such as DMSA or MAG-3 is usually obtained to confirm the diagnosis and evaluate the contralateral kidney. In some cases, a nuclear cystogram or voiding cystourethrogram is also recommended to evaluate for contralateral vesicoureteral reflux. If MCDK is detected prenatally, it is important to assess the amount of anti-kidney and amniotic fluid. In rare cases, surgical exploration is required if the diagnosis is inconclusive despite radiological workup.

Treatment for MCDK is controversial. While some advocate surgical removal of the affected kidney, others prefer observation. Leaving the kidney in place carries a risk of hypertension (rare) and renal tumors, but the risk is low with only six reported cases. If the kidney is left in place, patients should have an annual renal ultrasound and blood pressure measurement. In general, MCDK patients do well with one kidney because bilateral disease is rare.

Bed-wetting during sleep is the most common urological issue observed in children. Also known as Sleep Enuresis or Nocturnal Enuresis, it affects about 10-20% of children aged 5-6 years. It is estimated that 80-110 million children worldwide have enuresis, which is more common in first-born children and boys than girls. There is also a higher chance of a child having enuresis if the parents had a similar problem or a family history of the condition. Enuresis is only considered a disorder if it continues for approximately one year, and the child is at least 5 years old. It is primary enuresis if it has been present since birth and secondary enuresis if it starts between the ages of 5-8 years.

Bed-wetting can affect a child’s self-esteem, and treatment is recommended. Monosymptomatic nocturnal enuresis (MNE) is when a child wets the bed only at night and has no other urological issues. MNE must be distinguished from children who have both night-time incontinence and daytime symptoms such as urgency, frequency or incontinence. Approximately 25% of children who attain initial night-time dryness by the age of 12 years, relapse and wet for a period averaging 2.5 years. The spontaneous resolution rate for nocturnal enuresis is 15% per year, and by the age of 15, it persists in only 1% of the population.

MNE is a symptom rather than a disease, and there is no single explanation for this symptom. A variety of factors such as behavioural, genetic, developmental, neurologic, psychological, urodynamic and organic causes have been proposed. Investigations and treatments along these lines are both inappropriate and unrewarding because most children with MNE do not have psychiatric, neurologic or urological disturbances.

A variety of treatment modalities have been used to treat nocturnal enuresis. However, their effectiveness, even in control studies, has been difficult to assess because of the high spontaneous resolution rate and the extremely high placebo improvement effect. Therapy generally follows two lines – drug therapy and behavioural modification. Parents have different attitudes and expectations about bed-wetting and its cure.

Children born with spina bifida commonly have urinary tract abnormalities. The urinary tract includes the kidneys, ureters, bladder, and urethra. Kidneys filter waste from the blood and produce urine. Ureters transport urine to the bladder, which stores urine until it is excreted through the urethra. Proper bladder function requires an intact sacral spinal cord. Children with spina bifida often have damaged nerves to the bladder, which can lead to urinary incontinence and poor control. Such dysfunctions can also result in kidney and bladder damage. To evaluate the urinary tract, ultrasounds of the kidneys and x-rays of the bladder are performed to assess bladder capacity and urethra, and detect any congenital abnormalities of the kidneys. Urodynamic studies of the bladder are essential for children with spina bifida, to identify the likelihood of renal damage. Treatment depends on the degree of bladder pressure: children with lower bladder pressures (less than 35 cm H2O) may only need to be monitored. Those with high bladder pressures may require intermittent catheterization, where the bladder is emptied with a clean tube every four hours, or medication to lower bladder pressure. Regular monitoring and repeated urodynamic studies are necessary to identify any loss of bladder function. Urinary tract infections are common in children with spina bifida, especially those with high bladder pressures, and frequent emptying of the bladder is essential to prevent them. Surgical intervention may be necessary in cases of high bladder pressure.

It is not uncommon for children with urinary issues to withhold their urine for extended periods. However, it can be challenging for parents to identify this behavior since they are usually unaware of when their child has gone to the bathroom. Holding in urine can result in bacterial overgrowth or an overfilled bladder, which may cause urine to leak out.

Encouraging a child to urinate is difficult if they are not willing to do so. Emotional pressure or fear of punishment can hinder a child’s ability to relax enough to effectively empty their bladder. Normal urination requires the coordination of the pelvic floor muscles and bladder muscles. While the pelvic floor muscles can be voluntarily controlled, the bladder muscles are automatic and cannot be consciously controlled. Straining or pushing to urinate is not recommended; relaxation is essential.

Girls should sit back on the toilet with foot support if necessary, relax, and avoid straining or pushing their knees apart. They should take their time and try to urinate again once they finish since there may be more urine left in the bladder. Boys should completely open their pants zip, relax, and avoid straining or rushing. They should sit if it helps, and once they finish, wait a moment and try again.

A timed voiding program can be helpful in relearning to empty the bladder when it is time to do so rather than waiting until it is too late. This involves scheduling times to urinate throughout the day, which helps to keep the bladder empty and reduces the risk of urine leakage or infection. An alarm watch or phone alarm can be useful reminders at home or playtime, whereas a set schedule during school hours is more appropriate. The voiding habits mentioned above are crucial to ensure that the bladder is fully emptied without straining.

Some people may believe that they cannot or do not need to urinate. However, this is unlikely since everyone continuously produces urine. Therefore, learning to relax when it is time to urinate is crucial.

The male hormone and sperm are produced by the testicle. An undescended testicle occurs when the testicle cannot be found in its normal position in the scrotum. The testis normally migrates down from high in the abdomen and groin to take its normal position in the scrotum before a child is born. Up to 4% of term infants have an undescended testicle, with a higher incidence in premature males. Spontaneous descent into the scrotum occurs in three-fourths of undescended testicles during the first three months of life.

Most undescended testicles are palpable in the groin, but some are nonpalpable, being intra-abdominal or absent. Retractile testicles are not truly undescended but withdraw into a position outside of the scrotum because of a hyperactive cremasteric reflex. Retractile testicles can be manipulated into the scrotum, but some go on to become undescended as the child grows.

Treatment for the undescended testicle can be undertaken any time after 6-9 months of age. Relocating the testis into the scrotum may decrease the risk of fertility problems, particularly if done at an early age. There are other advantages to a location within the scrotum, including a cosmetic advantage and alleviation of any psychological effects resulting from an empty scrotum. The scrotal testis may be less amenable to injury than a testis outside the scrotum.

A testis that has not made it into the scrotum is not accessible to physical examination and is at increased risk for testicular cancer, the most common solid tumour in men up to age 40 years. Testicular carcinoma is highly curable when detected early, and monthly self-examination is the best way to do this. Treatment for an undescended testicle may involve hormonal therapy, although the success rate is below 10% when retractile testicles are excluded from the treatment groups. The surgical treatment for an undescended testicle is called an orchiopexy. Palpable undescended testicles are found through a small inguinal skin incision. Nonpalpable undescended testicles require surgical exploration, and this is done by diagnostic laparoscopy. Most of these children probably had torsion or twisting of the testis on its blood supply prior to birth that led to the small testis. When a boy is left with a single functioning testis, we may recommend anchoring it to minimize the chances of losing it to torsion later in life.

Urotherapy counselling is a non-invasive therapy used to manage dysfunctional voiding and irregular bowel movement habits. Dysfunctional voiding occurs when the urethral sphincter does not relax during urination, causing difficulty in expelling urine. This leads to increased bladder pressure and changes in the urinary bladder’s micro-organic climate, which can result in a urinary tract infection. Irregular bowel movements can cause impacted stool in the rectum, which compresses the bladder, reduces its functional capacity, and leads to earlier sensations to void. Urotherapy aims to normalize bladder and bowel function, ultimately improving quality of life.

Urotherapy involves maintaining safe bladder storage volumes and regular bowel movements to prevent pressure on the urinary bladder and facilitate pelvic muscle relaxation. Medications like anticholinergics and laxatives may also be used, if necessary. A doctor or trained nurse counsellor will assess your clinical condition and provide tailored recommendations. These recommendations may include tailoring fluid consumption, restricting fluid consumption in the evenings, timed urination, passing urine before bed and immediately upon waking, passing urine once at night, maintaining a two-hour interval between dinner and sleep, increasing fibre in the diet, and passing stools daily at fixed times.

After a month, you will be asked to return with a bladder diary to evaluate your compliance with the advice. The bladder diary records information such as time of waking and sleeping, fluid intake, frequency and volume of urination, degree of urgency, and episodes of leakage. The nurse counsellor will provide guidance on maintaining a bladder diary.

Varicocele is a medical condition characterized by an abnormal enlargement or dilation of the veins within the spermatic cord, which carry blood away from the testicle. This condition is often painless but can cause discomfort, heaviness, or a “dragging feeling” in the scrotum. When examined, the veins above the testicle feel like a “bag of worms.” The varicocele becomes smaller when the patient lies down and larger when standing up.

While varicocele is uncommon in children under 10 years of age, it becomes more prevalent after puberty and affects 16% of adolescent boys, usually on the left side. The exact cause of varicocele is unknown.

Varicoceles have been linked to infertility, with 20-40% of infertile men found to have a varicocele and low sperm counts. However, most men with varicoceles have normal sperm counts and are fertile. The increased temperature caused by the enlarged veins in the testicle is believed to impair sperm production.

Although it is currently impossible to accurately predict which boys with varicoceles will experience fertility issues later in life, if the testicle on the side of the varicocele is smaller or not growing normally compared to the other side, this is considered a sign of ongoing damage and requires varicocele repair. Additionally, if the varicocele is large and causing pain, it should also be corrected. If there are no symptoms and both testicles are normal in size and growth, no treatment is necessary.

Microsurgical subinguinal approach is one of the most effective and least invasive methods of treating varicocele. This involves making a small incision at the root of the scrotum and using an operating microscope to identify and ligate the affected veins on one or both sides.

This brochure aims to provide information about Vesicoureteral Reflux (VUR) and the various treatment options available. VUR occurs when urine flows back from the bladder to the kidney through the ureters, instead of flowing down into the bladder. Primary reflux is caused by an intrinsic defect in the valve mechanism at the junction of the ureter and bladder, while secondary reflux is due to other causes in the bladder and outflow urinary tract. VUR can lead to urinary infections, renal scarring, hypertension, and even renal failure. Therefore, it is important to detect and treat VUR promptly to protect the kidneys from damage.

Tests used to evaluate VUR include ultrasound studies, voiding cystourethrogram (VCUG), and isotope study (DMSA) of the kidneys. Any child with urinary tract infection should be evaluated, and the choice of tests will depend on the child’s age, symptoms, and the ultrasound report. Symptoms of urinary tract infections include foul-smelling or turbid urine, fever, abdominal pain, burning or pain when urinating, frequent and urgent urination, and urine infection.

There are three options for managing or treating VUR, including antibiotics, surgery, and endoscopic treatment. Antibiotics may be used to prevent infections until low-grade VUR resolves itself as the child grows. Surgery can fix the ureters to stop high-grade VUR, and this treatment cures most children. Endoscopic treatment involves injecting a substance where the ureter joins the bladder in low-grade VUR. The choice of treatment should be discussed in detail with the doctor, taking into account the child’s medical history and the family’s personal views. It is important to understand the risks, benefits, and follow-up of each treatment.