Pediatric Urology

Pediatric urology deals with the urinary tract and genital organs of children from birth to adolescence. This field covers structures such as the kidneys, ureters, bladder, and urethra. Pediatric urology examines and treats diseases and problems in these organs.

The main diseases and conditions pediatric urology addresses are:

Congenital Anomalies:

• Hydronephrosis

• Vesicoureteral Reflux (VUR)

• Ureteropelvic Junction (UPJ) Obstruction

• Ureterovesical Junction Obstruction

• Posterior Urethral Valve (PUV)

• Hypospadias

• Epispadias

• Undescended Testis (Cryptorchidism)

• Hydrocele

• Inguinal Hernia

• Problems with Foreskin

• Genital Anomalies

Acquired Diseases:

• Urinary Tract Infections (UTIs)

• Kidney Stones (Nephrolithiasis) and Ureteral Stones (Ureterolithiasis)

• Urinary Incontinence

• Voiding Disorders

• Genital Trauma

• Testicular Torsion

• Epididymitis and Orchitis

• Varicocele

• Kidney and Urinary System Tumors

Pediatric urologists also diagnose and treat conditions such as neurogenic bladder, which is related to bladder problems caused by nervous system disorders.

Urological diseases in children involve various issues affecting the urinary system (kidneys, ureters, bladder, and urethra) and reproductive organs. Symptoms may vary depending on the child's age, the type of condition, and its severity. It is important for parents to monitor their child’s health and be alert to specific signs.

Urination-Related Symptoms:

• Frequent Urination (Pollakiuria): Needing to urinate more often than normal.

• Difficulty Urinating (Dysuria): Straining or trouble starting urination.

• Painful Urination (Alguria): Burning, stinging, or pain while urinating.

• Urinary Incontinence:

  • Daytime Incontinence (Diurnal Enuresis): Involuntary urination during the day.

  • Nighttime Bedwetting (Nocturnal Enuresis): Involuntary urination during sleep.

• Sudden Urge to Urinate (Urgency): Sudden, strong urge to urinate that’s hard to control.

• Changes in Urine Flow: Weak, intermittent, or dribbling urine stream.

• Changes in Urine Color: Pink, red (hematuria – blood in urine), or cloudy urine.

• Changes in Urine Odor: Unusual or foul-smelling urine.

Abdominal and Side Pain:

• Abdominal Pain: Especially pain radiating to the groin or sides.

• Flank Pain: Dull or sharp pain in the kidney area.

Genital Symptoms (in Boys):

• Swelling or Pain in the Testicles: Unilateral or bilateral testicular enlargement or sudden, severe pain.

• Undescended Testicles: One or both testicles not present in the scrotum from birth or later.

• Abnormal Urinary Opening on the Penis: Urethral opening located on the underside or top of the penis (hypospadias or epispadias).

• Swelling, Redness, or Tightness of the Foreskin: Inability to retract foreskin (phimosis) or it getting stuck when pulled back (paraphimosis).

Other Symptoms:

• Fever: Common with urinary tract infections.

• Nausea and Vomiting: May accompany urinary infections or kidney issues.

• Loss of Appetite and Irritability (in Infants): Often seen in infections or congenital anomalies.

• Growth Retardation: May occur in chronic kidney issues.

If any of these symptoms are observed in your child, it is crucial to consult a pediatrician or pediatric urologist promptly.

Various methods are used to identify urinary system problems in children. These problems may involve the kidneys, ureters, bladder, urethra, and genital organs. The diagnostic approach may vary depending on the child’s age, symptoms, and complaints.

Main diagnostic methods used in pediatric urology:

• The child’s complaints (e.g., pain, burning during urination, urinary incontinence)

• Voiding habits (e.g., frequent urination, straining)

• Bowel habits (e.g., constipation)

• Family history of urological issues

• General health status of the child

Physical Examination:

• Abdominal examination (swelling, tenderness)

• Genital examination (abnormalities, undescended testicle)

• Back examination (kidney tenderness)

• Blood pressure measurement

Laboratory Tests:

• Urinalysis

• Urine culture

• Kidney function tests (urea, creatinine)

Imaging Techniques:

• Ultrasonography (USG)

• Voiding Cystourethrography (VCUG)

• Radionuclide Scintigraphy (DMSA, MAG-3)

• Computed Tomography (CT)

• Magnetic Resonance Imaging (MRI)

Functional Tests:

• Urodynamic studies

• Cystoscopy

The selection of diagnostic methods depends on the child’s condition and complaints. The goal is to make an accurate diagnosis and create the most appropriate treatment plan.

Cystoscopy is used in children for diagnosing and, if necessary, treating urination problems, urinary tract infections, injuries, or congenital issues. This procedure should be planned and performed appropriately according to the child's age and condition.

Ultrasonography (USG) is a commonly used imaging technique to evaluate problems related to the kidneys, ureters, bladder, and genital organs in children. This method uses high-frequency sound waves to obtain real-time images of internal organs.

Computed tomography (CT) is a method used to obtain detailed images of the urinary system. This system includes the kidneys, ureters, and bladder. CT is a radiological examination method. This method is preferred especially when sufficient information cannot be obtained with ultrasonography (USG) or when further evaluation is needed.

Radionuclide scintigraphy is an important nuclear medicine technique used to evaluate the function and structure of the kidneys. These methods provide critical information in the diagnosis and management of various kidney and urinary system problems in children.

The purpose of urodynamic studies is to understand the causes of urination disorders in children, make an accurate diagnosis, and determine the most appropriate treatment plan. They provide important information especially in the evaluation of conditions such as neurogenic bladder and vesicoureteral reflux.

Urodynamic studies can consist of various tests, including uroflowmetry (measurement of urine flow rate), cystometry (measurement of bladder pressure), electromyography (EMG) (assessment of pelvic floor muscles), and pressure-flow studies (examining the relationship between bladder pressure and urine flow rate). These tests provide detailed information about bladder filling, urination, and the coordination of the urethra and pelvic floor muscles.

Voiding cystourethrography (VCUG) is an important imaging technique used to evaluate the bladder and lower urinary tract. This method is frequently used by pediatric urology specialists. It is especially preferred to examine the structure of the bladder and urinary tract. Additionally, it is used to investigate the backward flow of urine from the bladder to the kidneys (vesicoureteral reflux) during urination.

Magnetic Resonance Imaging (MRI) is a method used to obtain images of the urinary system and surrounding structures. This method provides detailed and high-resolution images.

MRI does not involve radiation, making it safe for use in pediatric patients. MRI plays an important role in the evaluation of various urinary system anomalies and diseases.

Treatment methods used in pediatric urology are important for managing children's urinary and genital organ problems. The selection of these methods is carefully made according to the nature and severity of the underlying condition and the child's age.

Treatment methods used in pediatric urology are important for managing children's urinary and genital organ problems. The selection of these methods is carefully made according to the nature and severity of the underlying condition and the child's age.

• Medication treatment plays an important role in conditions such as urinary tract infections, voiding dysfunctions, and hormonal issues. Various medications can be used, including antibiotics, antispasmodics, alpha-blockers, and hormone replacement therapy.
• Behavioral therapies are used for voiding disorders, enuresis (bedwetting), and other urinary problems. These treatments aim to regulate voiding habits and improve bladder control.
• Observation and monitoring are important in some cases. Especially in congenital conditions or mild hydronephrosis, periodic evaluations and follow-up imaging may be performed.

Surgical interventions are important in pediatric urology. These procedures are considered options for urinary system obstructions, anatomical abnormalities, tumors, and other serious conditions.

Surgeries for Congenital Anomalies:

• Pyeloplasty

• Ureteroneocystostomy

• Ureteral Dilation/Reconstruction

• Posterior Urethral Valve (PUV) Ablation

• Hypospadias Repair

• Epispadias Repair

• Orchiopexy

• Hydrocelectomy

• Inguinal Hernia Repair

• Circumcision

• Surgical Correction of Genital Anomalies

Surgeries for Acquired Diseases:

• Kidney Stone Surgery

• Bladder Stone Surgery

• Appendectomy

• Testicular Torsion Surgery

• Varicocelectomy

• Kidney Tumor Surgery (Nephrectomy)

• Bladder Tumor Surgery