Care for conditions in children, relating to the urinary tract and genitalia. These disorders are wide ranging, and include those with which the child is born – (congenital abnormalities) – and those the child acquires – (for example infection, incontinence and tumours).
The urinary tract is one of the most common places in which mal-development occurs. This ranges from a dilatation of the kidney, commonly seen in pregnancy with ultrasound screening (antenatal hydronephrosis). In turn, this may relate to specific conditions of the urinary tract, such as pelviureteric junction obstruction, vesicoureteric reflux, congenital megaureter, and posterior urethral valves. Other congenital abnormalities may present at birth, with an obvious external abnormality. Routine checks are made to rule these out during the first few hours of life, and these tests are normally performed by an attending Paediatrician. Genital abnormalities are the most common abnormality particularly in boys, where hypospadias and undescended testicles are often diagnosed. More rare abnormalities, with additional long-term consequences to the longstanding function of the urinary tract can also be seen at this time, to include bladder exstrophy, cloacal exstrophy and spina bifida. Female genital abnormalities are much less common, though occasionally, via either mal-development of the penis in a genetic male, or overdevelopment of the clitoris in the genetic female, there may also be uncertainty as to the sex of the genitalia – (disorders of sexual differentiation).
Acquired conditions of childhood include urinary tract infection, which may occur in isolation, or in association, with underlying urinary abnormalities. Due to this, full investigations of children who present with symptoms of urinary tract infection, are required, in order for the underlying problem to be treated. More unusually, infection can affect the testicles, and severe infection can affect the kidneys, causing children to be very unwell. The latter often requires an operation to achieve resolution.
Although quite uncommon in children, tumours of the kidneys and bladder do occur. Kidney tumours, often the result of a Wilm’s tumour, present in early childhood, with a lump in the abdomen. They can also cause high blood pressure, anaemia and abdominal pain, and require treatment by Surgeons and Oncologists, with a combination of operations and chemotherapy in the majority of cases. The curative rate for these tumours is excellent with modern treatment. Much less commonly bladder tumours also occur, which are likewise treated in a similar fashion – i.e. with a combination of chemotherapy and surgery; radiotherapy is sometimes used additionally. The implications for continence and long-term outcome may clearly be severe, although modern management is again usually successful.
An understanding of the normal development of the child’s genitalia and urinary tact is necessary in order to determine the appropriate treatment for various conditions. A tight, non-retractile foreskin for example, is quite normal in early childhood, though uncommon, and probably requiring treatment, towards the teenage years. A child who wets at the age of 2 is clearly expected to be wet, however a child who continues to wet during the day at the age of 5 and then again at the ages of 7 and 10, might have an underlying abnormality requiring treatment. Similarly, nighttime wetting, which can be quite a normal phenomenon in older children, may be related to underlying abnormalities, and the behavioural approach to managing this is often a challenge.
Whichever the child’s condition, the particular approach of a Paediatric Urologist is likely to assist in rationalising the situation and starting on the path to resolution. Although I am a Surgeon, I prefer not to operate unless absolutely necessary; this conservative approach has borne fruit for many abnormalities treated. Surgery is conducted in a specialised environment, with paediatric anaesthesia and specialist nursing staff, with all facilities required for the provision of excellent care for children. Paediatric patients therefore tend to recover from surgery much more quickly than most adults.