Pediatric urology is a basically surgical subspecialty that usually treats urogenital system malformations. It also deals with diseases acquired in children and adolescents whose treatment is not surgical.
Sometimes they are very frequent alterations that, in recent years, have incorporated new concepts into their treatment, such as phimosis. The incorporation of new technologies such as the endoscopic treatment of the megaureter or the minimally invasive approach of various pathologies using robotics have “modernized” the speciality and expanded its borders.
Pediatric Urology differs from General Urology by the age of the patients and the type of conditions they suffer. Nor is it the same as Pediatric Surgery, which surgically treats all diseases of children and not only exclusively urological diseases.
This is a brief review of the diseases treat by pediatric urologist in Noida (from the most frequent and simple to the most complex):
Phimosis
Phimosis is the difficulty in retracting the skin that covers the end of the penis (foreskin), leaving the glans visible. Up to three years is considered normal and in most cases, it can be solved without surgery. From that age, it can be treated medically with corticosteroid cream or if it does not work, by surgery. In most cases, it is possible to avoid surgery through systematic local treatment. Only if there is no response to local treatment, the intervention will be considered, which in children requires general anaesthesia.
Some children may have prepucialbalano adhesions that can also be released under local anaesthesia without the need for an operation.
Our team is a pioneer in conservative treatment and in most cases, we try to avoid intervention. If this is necessary, it will be performed by a qualified pediatric urologist in Ghaziabad.
Paraphimosis
Paraphimosis occurs when the foreskin is retracted despite having a tight phimotic ring: the skin cannot return to its normal situation and the glans are permanently visible. If time is allowed to pass, the manual reduction becomes difficult and surgery is necessary.
Persistence of the peritoneum-vaginal duct (communicating hydrocele). Cord Cyst
The majority of children who have enlargement of one or both sides of the scrotum (bag of the testicles) are not due to an increase in the size of the testicle but because of the fluid surrounding it.
This fluid enters the scrotum via the peritoneum-vaginal canal that has not closed. Until two years of age, it can close spontaneously. If it closes partially it can lead to a cyst to the cord. After two years the solution is surgical. It may be the origin of an inguinal hernia.
Pubertal varicocele
A varicocele is a dilation or “varicose veins” of the veins of the spermatic cord. They can appear with the onset of puberty (10-12 years). Most are from the left side (due to an insufficient venous valve). The venous blood stays longer in the testicle and can interfere with its development and especially with its fertility.
The varicocele solution in pubertal age or adolescence tends to preserve its future fertility. Venous reflux must be confirmed by an echo-doppler prior to surgery, which is very simple.
Cryptorchidism / testicular ectopia
During pregnancy, the testicles descend into the scrotal bags. If the testicular descent stops, the bag will be empty and the testicle may or may not be palpated in the inguinal region. This situation occurs only or bilaterally.
During the first year of life, the testicular descent can be spontaneously completed. If this is not proven, an intervention must be performed to preserve fertility: lower and fix the testicle.
Hypospadias Other penile malformations
It is a relatively frequent malformation of the urinary and genital tract.
It is a development arrest of the urethra that flows out of place (at the tip of the glans).
Depending on where the urethra is opened, the degree of penile involvement and malformation will be. It can vary from a small distal malformation that is corrected in a surgical intervention, to a severe anomaly that frequently requires several interventions so that the penis acquires a morphology close to normal and, above all, a normal functionality from the sexual point of view.
Penile aesthetics is an increasingly valued element and much experience is required to obtain satisfactory results in the shortest possible time. It is necessary for a specially trained team to act. It can be treated from 6 months of age.
Enuresis. Urinary incontinence
Urinary continence both day and night is acquired from 18 months onwards. This process can be extended to three and a half years. If at that age, daytime incontinence persists, study and act according to the precise diagnosis.
More frequent is nocturnal incontinence: enuresis. Bedwetting is a symptom that can be due to various causes. It is necessary to clearly define what type of enuresis the child suffers. For this, today we have valuable and precise diagnostic elements as well as various therapies according to the diagnosis made.
It is very rare that childhood enuresis is due to a psychological cause. However, it is known that children with enuresis may have low self-esteem due to the limitations that this problem causes in their socio-family environment. A comprehensive attitude on the part of the parents is basic since it is a completely involuntary process that the child cannot control. Our group advises the study of enuresis for 3.5 – 4 years.
Urinary infections. Reflux vesicoureteral
Urinary infections are common in children and have a tendency to recur. Today we have diagnostic assistants to investigate the causes that favour them.
There are also specific treatments to prevent them.
If they are associated with bladder-ureteral reflux, they can damage the kidney. Therefore, diagnosis and treatment of reflux is important. It is not always necessary to act through surgery. Currently, endoscopic reflux treatment is more frequent. But there are some cases in which a spontaneous resolution can be expected.
Obstructive pathologies of the urinary tract. Prenatal diagnosis
Ultrasound scans during pregnancy have allowed dilating of the urinary tract of the fetus. Not all dilations are obstructive. It is generally wise to wait for the child’s birth and perform the relevant tests.
There are variations in the degree of dilation that indicate the urgency to make the diagnosis.
Severe malformations
Serious malformations of the urogenital apparatus must be treated by teams trained in specialized centres. Fortunately, they are not frequent.
There is a wide spectrum of malformations, with bladder exstrophy being one of the best-known.
Spina bifida neurogenic bladders
Thanks to prophylaxis with folic acid in pregnancy the number of spina bifida has been decreasing and also the bladder problems due to this malformation.
However, there is a population of patients with neurogenic bladder (and a smaller percentage of new cases), which require the performance of a multidisciplinary team. They are patients in which this team must act from the neonatal period to adulthood.
Proper assistance allows these patients not only to have a long survival but also to have a good quality of life.