Pediatric urologists provide complete urologic care for children, performing not only the initial evaluation and diagnosis but also the medical and surgical therapy for diseases of the genitourinary system. Pediatric urology encompasses a spectrum of congenital and acquired disorders ranging from complex congenital anomalies such as bladder exstrophy to more routine, but nevertheless important, problems such as daytime wetting in a school-aged child. The basic approach to the pediatric patient requires taking a complete history, executing a thorough physical examination, and obtaining appropriate imaging as indicated.
In most cases, the pediatric urologist's initial contact with the patient is through an outpatient referral from a primary care physician or obstetrician seeking prenatal evaluation. However, some patients are seen in the emergency room or urgent care, and immediate consultation is requested. The pediatric urologist must efficiently assess patients and triage those requiring urgent evaluation versus those who are best cared for nonacutely by referral to the office setting
This chapter introduces the pediatric urologic evaluation, focusing on the history and physical examination with emphasis on common clinical entities, examination techniques, and adjunct investigations such as radiographic imaging and select laboratory testing that are relevant to pediatric patients. The management of a pediatric patient with a urologic problem is often complex. The reader may find further details about specific conditions in other chapters.
Why does your child need pediatric urologists?
Unlike most adults, children are not always able to say what is bothering them or effectually respond to medical questions or in certain cases, not cooperative or communicative enough during the medical examination. You may be able to give your child the best treatment for any health issues but if the need for the treatment is missed due to lack of timely diagnosis, urogenital problems may leave your child to suffer the greatest long-term harm. However, you do not have to worry about it because Dr. Alap is trained to care for the special needs of your children and walk you through any sensitive subjects concerning urogenital problems. Dr. Alap is here to provide the best treatment options using equipment that is designed specially to provide the environment comfortable enough to ensure they remain relaxed and cooperative.
Causes
Bacterial Infection: In abnormal conditions, bacteria in rectal areas, urine or stool may travel up to the urethra to multiply and infect the urogenital organs. This could either be due to bladder or kidney infection. In case of bladder infection, it causes swelling and pain in the organ called cystitis. With kidney infection, bacteria travels from bladder through ureters and infect the organ, the infection called pyelonephritis which is highly susceptible in children.
Vesicoureteral Reflux: In this case, instead of urine flowing from the kidney to the bladder, the urine flows backwards from bladder to ureters and to the kidney carrying bacteria which leads to kidney infection, pyelonephritis.
Urinary Obstruction: When any blockage occurs in the urinary tract caused by multiple reasons such as abnormal narrowing in the urinary tract which hampers normal flow of urine out of the body, the chances of reflux and infection increase.
Signs & symptoms
Although not visible externally, the most common symptoms include red and swollen linings of the bladder, urethra, ureters and kidneys which lead to children complaining of pain in the lower stomach and frequent urination. Your infant may be too young to explain the pain, making the signs unnoticeable but here are some common ones to look out for:
- Pain or burning sensation during urinating
- Trouble controlling urine or bed wetting
- High or low-grade fever
- Loss of appetite
- Runny nose or ear ache in case of bacterial infection in the kidney
- Foul-smelling urine that may look murky or with blood in it
- Pain in the lower back or around the bladder
- Fussiness or restlessness
Diagnosis
The diagnostic method our specialists provide will depend on your child’s age, maturity and health history. Here are the most significant diagnostic procedures our experts recommend:
Urine Testing: Also called urinalysis, this process involves taking a sample of your child’s urine for lab test to check red blood cells, white blood cells, bacteria, protein and any other sign of infection. To develop the best medicinal treatment, the sample is sent for a culture and sensitivity to examine the type of bacteria causing the infection.
Voiding Cystourethrogram (VCUG): This is a type of X-ray of the urinary tract wherein the bladder is filled with a liquid dye and a flexible tube is used to drain urine from the bladder to the urethra. X-ray images of the process are taken which show whether or not there is any reverse flow or reflux into the kidney
Kidney Ultrasound: This process of painless imaging test uses sound waves and computers to create images of blood vessels, tissues and internal organs which enable doctors to observe and analyse the functioning of the organs. It is highly useful for children below 6 years.
Treatment
For the most effective treatment for your child, our Pediatric Urologists collaborate with other pediatric subspecialists and thoroughly examine your child, review medical records, make appropriate prognosis, take various tests and recommend the right therapy or surgery according to the diagnosis. These are the treatments that our specialists recommend for urogenital cases in children:
Antibiotics: Depending upon the type of bacteria causing the urogenital infection, our specialists will prescribe specific antibiotics with varying doses. Although most antibiotics are taken by mouth, if your child is too sick to drink, it may be given by shots. Intake of any antibiotics are supervised by the doctors and unless full treatment is taken, your child many get another infection.
Surgeries: Surgery for groin conditions in childhood and adolescence via certain invasive and robot assisted surgery and surgery under spinal anesthesia may be given.
Cancer Management: It involves surgical management of tumours and malignancies of the kidney, bladder and testis.
Reconstruction: It deals with the surgical reconstruction of organs such as kidneys, ureters and bladder including genital abnormalities and disorders of sex development.
Precautionary Treatment: It involves thorough examination and management of the urinary tract infections, vesicourteral reflux and kidney stone disease.
Fetal Surgery: For unborn babies with spina bifida and lower urinary tract obstruction (LUTO), early detection of urological tract problems before birth is recommended.
Stay Hydrated: Drinking plenty of fluids and urinating often can be effective remedies to help your child fight infection.
Proton Beam Therapy: This is specially for treating children with cancer.