Paediatric Urology

Most people don’t expect a child to need a urologist. However, there are some common conditions affecting children that need to be managed by a urologist who specialises in the care of children. Here is a brief description of the most common of these conditions.

Incontinence

Many children suffer bladder accidents and bedwetting which can continue for years. Incontinence in children can run in families or individual children can be affected. There are usually several factors that cause incontinence in children, most of which can be identified with simple assessments and non-invasive investigations. In most cases, effective treatments can be identified, and most patients can expect reduction or resolution of their incontinence and improved quality of life.

Urinary Tract Infection (UTI)

Urinary Tract Infection (UTI) is common in children and when patients have repeat infections (recurrent UTIs), can be distressing for patients and families. UTIs can lead to poor weight gain in babies, incontinence (bladder accidents) in older children, and even damage to kidneys (scarring) in the most severe cases. UTIs may be caused by:

  • Constipation
  • Vesicoureteric reflux (urine going backwards into the kidneys from the bladder)
  • Abnormal urinary tract anatomy
  • Blockage of urine flow
  • Dysfunctional voiding (poor coordination when emptying the bladder)

It is important to identify and treat causes of UTIs in children. In most cases, assessments are non-invasive and effective strategies for prevention of UTI can be identified. In cases where blockage or reflux of urine is found, surgery may be needed. Your urologist will talk you through this process.

Undescended testis

Testes develop inside the abdomen near the kidneys and usually descend into the scrotum before birth. It is important that the testes are in the correct position to ensure normal future reproductive function. Locating the position of testes is part of the healthy baby check that is done both in hospital for newborn baby boys, and by community maternity nurses. When the position is uncertain, boys are usually referred to a paediatric urologist.

The position of the testis (or testes) will be determined by examination and in some cases, a corrective procedure is recommended to bring the testis down into the scrotum. This procedure is well tolerated and usually done as a day case (not requiring overnight stay in hospital).

Foreskin issues

The foreskin can develop problems at any age, including childhood. Common issues include balanitis (infection under the foreskin) or phimosis (a foreskin that is too tight). It is normal for the foreskin to be non-retractable in babies and prepubertal children, however a foreskin that is too tight may cause irritation, ballooning with passing urine or spraying of the urinary stream. In many cases, foreskin issues can be resolved with the use of topical treatments (creams and ointments) but occasionally, circumcision (surgical removal of the foreskin) will be necessary. Your urologist will assess your child and discuss appropriate treatment options. If circumcision is required, this would be done in hospital as a day case (not requiring overnight stay).

Hypospadias

Hypospadias is a developmental abnormality of the penis and urethra (urine tube) that effects around 1 in 200 to 300 boys. The condition consists of:

  1. The opening of the urethra on the under-side of the penis (rather than the tip)
  2. A bend of the penis downwards
  3. An incomplete foreskin with a “hooded” appearance

Most cases of hypospadias need surgical correction around the age of 12 months. In most cases, a single operation is required and can be done as a day case (no overnight hospital stay required). In some cases, the foreskin can be preserved to result in a normal appearing uncircumcised penis. If the foreskin is not properly developed to allow reconstruction (or where removal of the foreskin is preferred), a normal “circumcised” appearance can usually be achieved.

More severe hypospadias cases may need “staged” repair with 2 or more procedures required to produce the best results.

Baby boys with hypospadias can be assessed by a urologist at any time after birth and advice given about whether surgical repair will be needed and which type of repair will be most appropriate. If hypospadias is suspected, it is important not to have your baby boy circumcised in the community before seeing a urologist.

Hydronephrosis

Hydronephrosis is a condition which means there is more urine within the kidney than normal. This is commonly identified during antenatal ultrasound scanning in pregnancy. It can also be found in older children who develop UTI or abdominal pain. Most cases of hydronephrosis do not require any treatment but should be monitored with ultrasound scanning to ensure it is not getting worse over time.

In more severe cases, or when the degree of hydronephrosis is increasing, more sophisticated scans may be needed, and an operation may be necessary to correct the problem. These operations can often be done using keyhole and minimally invasive techniques. Your urologist will discuss with you the severity of your child’s hydronephrosis and plan appropriate investigation and treatment.