April 22nd, 2014
Pediatric urology conditions in pediatric aged children are often hard to diagnose due to complexity of symptoms and lack of subjective complaints. It has been reported that prevalence of congenital urological conditions is as high as 0.2-0.9% (1). Most urological issues are related to genital malformation or other related issues that may require surgical correction for complete resolution of symptoms. It is very important to identify and manage these issues at an early age.
Hypospadias is a congenital condition that reportedly affects one in 250 male babies with the primary complaints of malpositioned urethral opening. Most babies have urethral opening at the base of penis (instead of terminal end of penile head), or anywhere along the penile or scrotal region.
In most cases of pediatric urology conditions, health care providers and pediatric surgeons perform corrective surgery at the age of 6 months (or ideally in the first year of postnatal life).
Parents should know that circumcision should not be attempted in such babies mainly because the foreskin is used for reconstructive surgery to create the new urethral opening.
Mal-development of fetal kidneys can lead to antenatal hydronephrosis (a condition marked by enlargement of fetal kidneys due to excessive urine production or abnormal urinary drainage). Most cases are identified before birth (during antenatal assessments and ultrasono logical examinations).
Hydronephrosis is the most common pediatric urology conditions anomaly (50% of all the reported urological issues in this age group) as suggested by the report published in British Medical Journal (1).
Some cases, of pediatric urology conditions, may respond to non-invasive treatment after birth while others may require surgical intervention for resolution of symptoms. A delay in management can increase the risk of permanent destruction of kidneys.
Most children achieve bladder control by the age of 5 to 6 years; but some encounter difficulty in achieving continence at night. According to a study conducted by BJU International (3) the prevalence of nocturnal enuresis at the age of 7.5 years is 5.5%.
The overall prevalence of undescended testis in full-term babies is 3.4% to 5.8%; however, in most cases testes descend by 1 year of age. The overall prevalence of undescended testes at the age of 1 year is only 0.8%. Most common site of undescended testes is inguinal canal (in about 80% cases).
Urgent management by procedures like orchidopexy is needed to minimize the risk of testicular malignancy and permanent sterility.
Ureteral is naturally constricted at the ureteropelvic junction (where ureter enters the kidney); but in about 1 in 500 live births (1), the UPJ is completely or partially obstructed. The resultant effect is a higher propensity of the baby to develop hydronephrosis (before or after birth).
Fluid collection between the two layers of tunica vaginalis (visceral and parietal) is referred to as hydrocele. Prevalence of congenital hydrocele is 4.7% that may resolve spontaneously in 84-90% cases (5).
Although untreated or poorly managed urological problems in pediatric urology conditions aged children lead to complications (as discussed above); often time deleterious complications can also result from diagnostic and treatment procedures. A report published in The Journal of Urology (4) suggested that the rate of complications during laparoscopic procedures is as high as 2.7%.
It is therefore suggested by healthcare providers and pediatricians to keep up with periodic pediatric examinations in order to optimize the health of children for pediatric urology conditions.
1. Prem, A. R. (2006). Common paediatric problems. BMJ, 333(7566),486-489.
2. Koff SA, Mutabagani KH. Anomalies of the kidney. In: Adult and Pediatric Urology, 4th ed, Gillenwater JY, Grayhack JT, Howards SS, Mitchell ME (Eds), Lippincott Williams and Wilkins, Philadelphia 2002. p.2129.
3. Butler, R. J., Golding, J., & Northstone, K. (2005). Nocturnal enuresis at 7.5 years old: prevalence and analysis of clinical signs. BJU international, 96(3), 404-410.
4. Esposito, C., Lima, M., Mattioli, G., Mastroianni, L., Centonze, A., Monguzzi, G. L., … & Jasonni, V. (2003). Complications of pediatric urological laparoscopy: mistakes and risks. The Journal of urology, 169(4),
5. Osifo, O. D., & Osaigbovo, E. O. (2008). Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria. Journal of pediatric urology, 4(3), 178-182.