Pediatric urology deals with urological problems in children and complex and rare conditions that require special care with experienced doctors need to be treated in designated centers with a well-established pediatric urology practice and a multidisciplinary team.
Pediatric urologists are a doctor who specializes in treating children with urinary or genital conditions. They can treat problems that develop in an infant's, child's or adolescent's urinary system, including the kidneys, bladder, and urethra, the part of the body that helps you excrete toxins and waste from the body. They are also responsible for all kinds of diagnosis and treatment of the child's body and the genital system, which includes the reproductive organs inside and outside the body.
It can be difficult for parents to decide when the child should be taken to a pediatric urologist. When the urinary problem reoccurs, the child should be taken to the pediatrician and, if necessary, pediatric urology options should be explored from there.(1)
Definition and Overview
Pediatric urology is a surgical subspecialty of medicine that treats conditions affecting children's genitourinary systems. Boys and girls can receive care from pediatric urologists from infancy through early adulthood. Infants, kids, and teenagers who might require surgery for general surgery or a urological issue can receive specialist care from the pediatric surgery and urology department. The most typical illnesses are those that affect the testicles, reproductive organs, and urination.
To examine and treat patients with extremely complex gastrointestinal, respiratory, and genital (sexual differentiation disorders) conditions, they provide a variety of collaborative multidisciplinary clinics with other colleagues, including
- pediatric gastroenterologists,
- pediatric respiratory physicians,
- pediatric endocrinologists,
- and speech therapists.
Pediatric urologists diagnose and treat a wide range of conditions, including pediatric genitourinary cancers, more complex and unusual congenital defects, and common genital and urinary tract illnesses. (2)
A wide range of diagnostic and therapeutic methods are used in pediatric urology procedures to treat children with urological problems. The following are some common pediatric urology procedures.
The urethra, the tube that transports urine from the bladder and out of the body, is passed through during a cystoscopy procedure using a small fiber optic camera. Children have general anesthesia for the cystoscopy procedure.
With the aid of cystoscopy, the pediatrician can examine the urethra, the interior of the bladder, and the ureters. Through the cystoscope, simple treatments can be carried out, and if necessary, a sample (a small piece of tissue) can be obtained for testing. (3)
- Voiding cystourethrogram (VCUG)
An X-ray examination of a child's bladder and urethra termed a pediatric voiding cystourethrogram (VCUG) uses fluoroscopy, a specialized type of X-ray, and a contrast agent. Doctors use X-ray examinations to identify and treat medical conditions. To create images of the inside of the body, a small amount of ionizing radiation is exposed to the child.
Internal organ motion is visible thanks to fluoroscopy. The anatomy and functionality of the bladder and lower urinary system can be seen and assessed by the radiologist after the bladder has been filled with a water-soluble contrast agent and then emptied. (4)
- Surgical Procedures
Pediatric surgical procedures in urology may include circumcision, orchiopexy, pyeloplasty, ureteral reimplantation, nephrectomy, stone removal, and augmentation cystoplasty. (5)
A pediatrician or primary care physician can treat minor pediatric urology issues including urinary tract infections or genital adhesions (tissue that connects sections of the genitalia). However, it is essential to make an appointment with a pediatric urologist when more significant problems develop. Especially, children who have the following problems should be taken to the doctor for diagnosis and treatment without wasting time.
- swelling around the testicles (hydrocele),
- undescended testicles (undescended testicles at 12 to 18 months of age.),
- kidney or bladder stones,
- hernias in the groin or scrotum,
- recurrent urinary tract infections with high fever (pyelonephritis or pyelonephritis.),
- bedwetting in children and teens,
- bladder control problems.
Pediatric urologists review and recommend the level of treatment needed for the child's condition. They provide further counseling to determine if surgery is needed and may operate on the child's urinary system if necessary. (6)
Risks and Side Effects
Although pediatric urology treatment procedures are generally safe, they do have some risks and side effects. These include the following.
- Bleeding and bladder damage
- Pain and discomfort
- Being unable to empty the bladder
- Urinary tract infections
- Vascular injury
- Ureteral injuries
- Anesthesia risks (7,8)
Post-Procedure and Follow-up
The child may experience shoulder aches, cramping, and incisional pain. "Reflected pain" is the term for abdominal pain that radiates into the shoulder and can happen after laparoscopic surgery. This is typical and will go away within a few days.
Use over-the-counter pain relievers such as acetaminophen continuously for the first 48 hours following surgery, even if the child is not experiencing discomfort unless the child's doctor instructs differently. The child will take the medication every 24 hours, rather than only when necessary. (9)
Recovery times generally vary from patient to patient. Patients who have robotic surgery typically stay in the hospital for a lot less time and recover faster than those who undergo open surgery. In contrast to the few weeks needed following an open operation, children can typically resume their routine activities within a few days. The doctor's advice should be followed throughout this procedure, and emphasis should be placed on exercise and good health.
Treatment for pediatric urological conditions requires pediatric urology treatments. These conditions or diseases are frequently congenital, which means they exist from birth. Surgery is the most common form of treatment for urological disorders. At the completion of all treatments, it is aimed to return the child to his normal activities and regain his urological health.
1,6- WebMD. What Is a Pediatric Urologist? (https://www.webmd.com/a-to-z-guides/what-is-a-pediatric-urologist)
2- Cambridge University Hospitals. Paediatric surgery and urology. (https://www.cuh.nhs.uk/our-services/childrens-services-paediatrics/paediatric-surgery-and-urology/)
3-Cambridge University Hospitals. Cystoscopy in children. (https://www.cuh.nhs.uk/patient-information/cystoscopy-in-children/)
4- Radiologyinfo.Org. Pediatric VCUG. (https://www.radiologyinfo.org/en/info/voidcysto)
5- Royal College of Surgeons of England. Urology. (https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/urology/)
7- NHS. Cystoscopy Risks. (https://www.nhs.uk/conditions/cystoscopy/risks/)
8- Washington University School of Medicine. Urologic Complications from Surgery (https://urology.wustl.edu/patient-care/reconstructivesurgery/urologic-complications-from-surgery/)
9- Michigan Medicine. Caring for Your Child After Surgery (Pediatric Urology). (https://www.med.umich.edu/1libr/Pediatrics/Urology/PedUrologyPostopInstructions.pdf)