Pediatric Urologist and Urology

Are There Symptoms

Symptoms depends on the genetic sex the child –

Female (genetically)

• An enlarged clitoris that looks like a small penis.
• The urethral opening (where urine comes out) may not be in the typical place.
• The “lips” of the vagina (labia) may be fused and look like a scrotum (a pouch that normally contains the testicles).
• A lump of tissue within the labia that looks like a scrotum with testicles.

Male (genetically)

• A penis doesn’t form or is very small and looks like an enlarged clitoris.
• The urethral opening (where urine comes out) may be at the base of the penis instead of the tip.
• A small, separated scrotum that looks like labia.
• Undescended testicles

Treatment?

Treatment depends on the hormonal, chromosomal, and biopsy of the gonads (abnormal testis or ovary) status

It ranges from hormonal therapy, reconstruction of the genitalia preferably at puberty.

What causes it?

There are many conditions like transient hydronephrosis, PUJO( pelviureteric Junction obstruction), VUR( vesicoureteric reflex), PUV( posterior urethral valves) and so on

Are There Symptoms

It is kidney and its tracts swelling noticed on the antenatal scan This is indication for follow up of the child after birth.

Treatment?

Most of them disappear by the time the pregnancy is complete or with in an year after birth Few of them need surgical correction depending on the conditions described above.

It needs surgical correction at the earliest and needs correction of the hip bone.

What causes it?

Abnormal lower abdominal wall development resulting in opened urinary bladder remaining outside the tummy.

Are There Symptoms

Pink mass noted in the lower tummy of the child with continuous leak of urine.

Abnormal appearing genitalia

Can have groin swelling (hernia)

Treatment?

Surgical correction is needed in these children, closure of bladder and urine tube (urethra) – thereby the child can normally urinate.

Also would need enhancement of bladder capacity with food pipe( augmentation).

What causes it?

The sac which brings the testis in to the scrotum should remain closed after that ,sometimes the sac remains open and letting fluid or bowel from tummy to get in to it – there by leading to hernia.

Are There Symptoms

Swelling noted in the groin or inguinal region on and off.

Sometimes associated with pain.

Treatment?

All the case of hernia irrespective of age would need surgery.

Treatment usually involves closing the patent sac.

It can be preformed open or laparoscopic

All the case of hernia irrespective of age would need surgery.

What causes it?

The sac which brings the testis in to the scrotum should remain closed after that ,sometimes the sac remains open and letting fluid– there by leading to hydrocele.

Are There Symptoms

Swelling noted in the scrotum.

Sometimes associated with pain.

Treatment?

Hydrocele can be observed till 18 month to 24 months of age and thereafter if it present then warrant surgery .

Treatment usually involves closing the patent sac.

It can be preformed open or laparoscopic.

It needs treatment form removal of mass alone or along with the kidney, followed by chemotherapy, the survival rate and quality of life these children are good after early detection and treatment.

What causes it?

Multiple factors are attributed to the cause of the tumor in the kidney in children most accepted on is genetic mutations.

Are There Symptoms

The tummy getting larger

Mostly noticed my mother while bathing the children

Blood in the urine

High blood pressure (though rare).

Treatment?

Treatment depends on the ageof the child , stage ,type and nature of the tumor; it ranges from surgical removal of tumor to complete removal of the tumor along with the kidney and chemotherapy, radiotherapy.

Therefore need medical attention to streamline the voiding pattern there by protecting the kidney, the treatment may range from medication, CIC(clean Intermittent catheterization), BOTOX bladder injections and Augmentation Cystoplasty( surgical bladder volume enhancement with food pipe).

What causes it?

Neurogenic bladder condition in which the nerve supply to the bladder is disturbed due to abnormality in spine or operative procedure carried out on the spine, rarely trauma to the spine.

Less folic acid intake during pregnancy would lead to these abnormal spinal column, this further lead to neurogenic bladder.

Are There Symptoms

Lump in the back of the child.

Abnormal back of the child( over the spine).

Abnormal walking pattern

increased frequency of urination.

Treatment?

Medications-

CIC(clean Intermittent catheterization),

BOTOX bladder injections

Augmentation Cystoplasty ( to increase the size of urinary bladder, to decrease bladder pressure).

What causes it?

The cause is not clearly known, risk factors included inherited genetic mutations.

Are There Symptoms

A feeling of pressure or fullness in the abdomen or pelvis.

A firm, painless swelling in the lower abdomen.

Frequent urination or retention of urine

Persistent Abdominal pain

Breast Enlargement

Pubic hair

Vaginal discharge or bleeding

Abnormal menstrual bleeding

Treatment?

Treatment depends on the age, stage and nature of the tumor; it ranges from fertility preserving surgical removal of tumor to complete removal of the tumor along with the ovary and along with chemotherapy and radiotherapy. Along with multidisciplinary approach for physical and pshyco-emotional well being.

What causes it?

It is normal and the skin would retract back by the time of 6 to 7 years.

Some time few condition subtle trauma, inflammatory conditions like BXO( balanitis xerotica obliterans) can also lead to phimosis, this warrant circumcision irrespective of age.

Are There Symptoms

Ballooning of the tip of penis while passing urine

Splaying of urine while urinating.

Color change of skin at the tip of penis can ( BXO)

Treatment?

Most of times local application of steroids creams would be the treatment

Some time would warrant surgical removal skin of the tip of the penis( circumcision)

What causes it?

The specific cause is still unknown.

Are There Symptoms

Smaller children can swelling of kidney could lead to fullness in tummy and makes the child uncomfortable.

The bigger children can have pain in tummy & sometimes urinary tract infections.

Treatment?

Serial ultrasound scans follow of the kidney swelling

Surgery is warranted in case of increasing kidney swelling on the scans.

It can be performed with open,or laparoscopic or Robotic means

What causes it?

A leaf like curtain which is normal present in the urine tube of male child while developing in the mother’s womb, which thereafter vanishes as the development happens, but in case of failure of vanishing of this leaf like curtain leads to blockage of urine flow both in womb and later on in life.

Exact reason for its cause is still unknown.

Are There Symptoms

Scan of baby in the womb can show big urinary bladder and sometime abnormal kidneys

After birth there is poor stream of urine, can develop urinary tract infection.

Can be associated with significant kidney damage.

Treatment?

The leaf like curtain (posterior urethral valves) will be removed by endoscopic means.

There after the child would need a long term medication and follow up.

What causes it?

Multiple factors most accepted on is genetic mutations, particularly in children with ambiguous genitalia and Undescended testis.

Are There Symptoms

A painless lump in the testicle (the most common sign).

A feeling of weight in the scrotum

Swelling of the testicle (with or without pain)

Pain or a dull ache in the testicle, scrotum or groin.

Treatment?

Treatment depends on the age, stage and nature of the tumor; it ranges from surgical removal of tumor to complete removal of the tumor along with the testis and along with chemotherapy and radiotherapy.

What causes it?

Undescended testis is caused by multifactorial like combination of genes, environmental factors, and factors such as what the mother eats or drinks during pregnancy.

Are There Symptoms

Absence of testis in one of both sides in the scrotum.

Cans sometime be associated with

- Abnormal look of foreskin and penis

- Abnormal location of urinary tube on the undersurface of penis

- Ambiguous genitalia

Treatment?

In some cases, undescended testis does not require surgery.

Treatment usually involves surgically bringing the undescended testis back to scrotal position in a single or two stages ( orchiopexy).

Usually, surgery is performed between 6 and 12 months of age.

The treatment also varies depending the associated conditions and nature of testis.

What causes it?

More than half of times the stone developed in children because of metabolic reasons, followed by infection and dietary causes.

Are There Symptoms

Pain the tummy.

Passing whitish material in the urine.

Urinary tract infections.

Treatment?

Most of the small stone does not treatment as they would passing out with out any trouble Larger stones and painful stones would need its removal.

It can be done by with a small cut on the tummy or even without a cut by placing with very small scopes in urinary system

Smaller stones can be dealt with ESWL( extracorporeal shock wave lithotripsy), with out any cuts or placement of any scope on to the child.

These children would warrant a long term follow up.

What causes it?

This can be primary VUR- causes unknown

Secondary VUR- can be caused by constipation, abnormal voiding of urine, posterior urethral valves- and much more

Are There Symptoms

Incidentally finding on evaluation for tummy pain or urinary tract.

Most of times the children present with repeated UTI( urinary tract infection).

slow down in the growth of the children.

Treatment?

Minor grade of reflex need mostly nothing sometimes, can sometime be given low dose antibiotic for a while.

High grade reflex warrant either endoscopic or surgical modality of treatment