Pediatric Urology Conditions
A number of conditions are fairly common at birth and/or in children. When it comes to genitalia and the urinary system, common pediatric conditions include:
Undescended Testicle — Also called "cryptorchidism," in this condition a testis (the organ that produces sperm after puberty and the hormone testosterone) stays up in the body instead of dropping down into the scrotum.
Varicocele — This is a collection of enlarged veins along the spermatic cord leading to the scrotum, similar to varicose veins. It can develop at any time but often occur in adolescence. In teens, a varicocele can interfere with growth in the testicle. Later in life, a varicocele may be determined to be a cause of infertility.
Hypospadias — In this condition, the tube that carries urine out of the body (the "urethra") opens at a point on the underside of the penis rather than at the very tip. Learn more on the hypospadias page.
Vesicoureteral Reflux — In this condition, urine can backflow into the kidneys instead of simply draining one-way into the bladder. In children, it occurs because the valve-like structure where urine drains from the kidney into the bladder doesn't function properly. This condition can cause infections and possibly kidney damage.
Bed-wetting — Technically called "enuresis" or night-time incontinence, this condition usually clears up naturally on its own by age 5, but for some children, bed-wetting continues for a number of years.
Bed-wetting often "runs in the family." It poses no health risks but can be embarrassing and uncomfortable, especially for older children. By itself it is almost never associated with any more serious condition but should be evaluated as soon as it becomes an issue for the child and/or the family.
Urinary Tract Infections — "UTIs" can occur in the bladder or urethra (lower UTIs) or in the kidneys (upper UTIs or pyelonephritis). Any urinary tract infection that causes fever in a child should be treated immediately, and the child should later be evaluated for structural abnormalities that might make UTIs more likely.
Treatment for pediatric problems with the urinary system vary widely depending on the problem, the age of the child, the persistence of a problem and other factors. Treatment for each of the conditions described above is summarized below.
In most cases, the testicle descends on its own within a few months. If not, a urologist can make a small incision, move the testis into the scrotum and stitch it into place. This surgery is usually done when the child is about a year old.
This condition, if minimal, often resolves itself during the first few years of life. In the meantime, a child may be placed on a small daily dose of antibiotic to reduce recurring infections.
When the reflux doesn't resolve itself, urologists can repair the valve through a small incision just above the pelvic bone.
Alternatively, it is sometimes possible to perform a minimally invasive procedure through a small instrument guided into the bladder through the urethra (the tube that carries urine out of the body) to inject a bulking material into the valve area.
Traditional "open" surgery is the most common procedure to repair a varicocele. The procedure is done through a small incision in the groin and the enlarged veins are tied off, allowing blood to flow instead through other normal veins.
Alternative procedures using a camera and instruments inserted into the abdomen or injection techniques using X-ray imaging offer no benefit over open surgery and carry additional risks.
Bed-wetting normally does not require treatment and goes away with age. Persistent bed-wetting may be helped by a number of non-surgical treatments:
- Alarms that sense moistness on pajamas or the bed and make a sound to wake a child
- Medication that helps calm bladder contractions and increase bladder capacity
- Medication that allows the body make less urine during the night
Recurrent Urinary Tract Infections
For children with recurrent UTIs, it's important to check for structural abnormalities. Tests may include ultrasound studies and other imaging to examine the kidneys and bladder. These tests may involve a small injection and possibly a small catheter guided into the bladder through the urethra.
These studies may reveal a condition requiring surgical treatment, such as:
- Vesicoureteral reflux (described above), in which valves that control the flow of urine into the bladder fail to close properly
- Hydronephrosis — an enlargement of part of the kidney, sometimes present at birth
Kidney stones, which can cause persistent infection
Urologists at UMass have many years of experience managing pediatric urology conditions and will treat your child with compassionate care.