Common urological woes in kids-A A +A
The Urology Corner
Monday, November 18, 2013
UROLOGY is a branch of medicine that deals with problems of the urinary tract, as well as the male reproductive tract from the pediatric to the geriatric age group.
The pediatric age group includes children from newborns to 18 years old. Genitourinary problems in children are congenital (in-born) in nature. The urologist deals with such problems, which range from structural abnormalities, obstructive and non-obstructive urinary tract problems, and recurrent urinary tract infections.
Commonly encountered structural abnormalities include: hypospadias, and undescended testis.
Hypospadias is an abnormality of the opening of the penis. Instead of the opening at the tip, the opening is found elsewhere from underneath the penis to below the scrotum. This is managed by reconstructive surgery by the urologist. The best time to repair this is between 6 months to 12 months of age.
Undescended testis is another structural anomaly where there is failure of descent of the testis to the scrotum. This may be involve one or both testes. An undescended testis can either be found from below the kidney (abdominal) to the groin area (inguinal). Undescended testis has been found to be associated with an increased risk for developing testicular cancer and may be associated with infertility if both testes are involved. This is also repaired surgically to bring down the testis to the scrotal sac. The best time to repair this is again between 6 months to 12 months of age.
The most common obstructive urinary problem in children is the ureteropelvic junction (UPJ) stenosis. This is caused when the connection of the renal pelvis (part of the kidney) to one of the tubes (ureters) that move urine to the bladder is blocked. Since there is obstruction in the flow of urine( stasis), there is build of urine in the kidney causing it to balloon (hydronephrosis) thereby causing damage to the kidney. This condition can be detected during prenatal ultrasound of the mother (antenatal hydronephrosis). Newborns diagnosed with hydronephrosis should be worked up by the urologist within the first month of life and carefully monitored to plan out the manner of treatment. Reconstructive surgical repair of the blocked area is best done starting at 6 months old.
Non obstructive conditions are also noted in the kidney. In children the most common condition is a tumor found in the kidney called the Wilm's tumor. This is a malignant tumor involving one or both kidneys and is found in newborns and children commonly 3-4 years old and is rare in children over 5 years old. For very large tumors or if both kidneys are involved, chemotherapy by a pediatric oncolist prior to surgical removal of the tumor is recommended. Once there is decrease In the tumor size then the urologist will perform the surgery.
Recurrent urinary tract infection in children may be associated with defects in their urinary tract. The most common are phimosis and vesicoureteral reflux (VUR).
Phimosis is a condition where the foreskin of the child’s penis is tight causing difficulty in passage of urine. This is usually noted by the parents when the foreskin balloons during urination or the child strains or cries during urination due to difficulty. Circumcision is performed to correct this condition.
Vesicoureteral reflux (VUR) is a condition causing recurrent urinary tract infection. This is disorder where urine in the bladder goes back up (reflux) the kidney when the child urinates. This occurs due to an abnormally shallow insertion of the tubes of the kidney (ureter) to the bladder. Due to the structural abnormality, the valve mechanism that normally prevents reflux of urine to the kidneys is absent. The refluxing urine from the bladder to the kidney brings bacteria up to the ureters and kidney causing infection. One or both kidneys may be affected by this condition. VUR is diagnosed by doing a special xray procedure called a VCUG. This is performed by the urologist by inserting a small tube thru the urethra into the bladder and the bladder is filled up with a contrast solution and the child is made to urinate. While the child is urinating, a series of x-rays are taken to note if there is reflux. Through the VCUG, the degree of reflux is assessed so as to know the manner of treatment which range from medical treatment to surgical correction.
Urinary tract problems also affect children, each problem may present early in life or later in childhood. It is important that these problems be addressed, treated and if needed surgically repaired by a urologist as early as possible so as to preserve the kidney function and avoid the complications brought about by the said conditions.
About the Author: Dr. Latayan is a Diplomate of the Philippine Board of Urology and a Fellow of the Philippine Urological Association and of the Philippine College of Surgeons. He underwent training in Adult And Pediatric Urology; Endourology, Minimally Invasive And Laparoscopic Urology; Transplant Urology (Donor) at National Kidney and Transplant Institute. Presently, he is an Active Urology Consultant and section head of Urology in the Minimally Invasive Surgery Department of the DMSF Hospital. He is also an Active Urology Consultant in Metro Davao Medical and Research Center Hospital and Southern Philippines Medical Center.
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Published in the Sun.Star Davao newspaper on November 19, 2013.