Pediatric Urology

Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children’s genitourinary systems.

Pediatric Urology is a highly specialized branch of medicine which deals with surgical diseases of Genitourinary System (kidneys, ureters, bladder, sexual & reproductive organs) in children from newborn age to 15 years of age.

Pediatric urologists provide care for both boys and girls ranging from birth to early adult age.

The most common problems are those involving disorders of urination, reproductive organs and testes:

  • Bladder control problems such as bedwetting and daytime urinary incontinence
  • Undescended testes (cryptorchidism)
  • Hypospadias
  • Epispadias
  • Urolithiasis (bladder and kidney stones)
  • Chordee and other minor malformations of the penis
  • Phimosis
  • Urinary obstruction and vesicoureteral reflux
  • Neurogenic bladder (e.g., associated with spina bifida)
  • Antenatal hydronephrosis
  • Tumors and cancers of the kidneys
  • Repair of genitourinary trauma
  • Genitourinary malformations and birth defects

Pediatric urological disorders are very different from adult urological disorders as most of these problems are congenital (present from birth or birth defects) in nature.
The way the kids respond to medicines and surgery is also different to adults.

DECISION MAKING is the key concept of Pediatric Urology -which diseases to operate and when to operate is the most important factor.
Some of the diseases which were very aggressively operated earlier on are now managed medically or tackled with less aggressive surgery now.
Advances in technology and instrumentation have led to more and more Laparoscopic and Endoscopic surgeries in children
The basic issue in a Pediatric Urologist mind is not to harm the child by doing unnecessary surgery.

Common symptoms of Pediatric Urological disorders

  • Disorders diagnosed during pregnancy on ultrasound of mother
  • Pain during passing urine- dysuria
  • Thin stream
  • Straining to pass urine
  • Urinary retention or failure to pass urine
  • Frequent passage of urine
  • Hematuria or blood in urine
  • Pyuria or pus in urine
  • Urinary tract infection
  • Fever
  • Pain in belly
  • Abnormal looking penis or genitalia
  • Undescended testis
  • Testicular swelling or pain

Common disorders

  • Urinary tract infection
  • Antenatal hydronephrosis
  • Antenatally diagnosed renal anomalies
  • Undescended testis
  • Testicular torsion
  • Testicular cysts or tumours
  • Tight foreskin or Phimosis
  • Hypospadias
  • Posterior urethral valves
  • Vesico-ureteric reflux
  • Pelviureteric junction obstruction
  • Vesico-ureteric junction obstruction (primary megaureter)
  • Intersex
  • Duplex system (or double ureters)
  • Ectopic ureters
  • Cystic kidney diseases
  • Calculus disease
  • Epispadias
  • Prune belly syndrome
  • Ureterocele
  • Stricture urethra
  • Genital injuries
  • Horseshoe kidney
  • Absent kidney or renal agenesis

Reconstructive Urology

Reconstructive urology is a highly specialized field of urology that restores both structure and function to the genitourinary tract.
Prostate procedures, full or partial hysterectomies, trauma (Road Traffic accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate require reconstructive surgery.
The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology.

Conditions treated

A highly specialized, tertiary service for conditions such as urethral strictures, post prostatectomy and post radiotherapy complications, congenital urological abnormalities such as exstrophy, external trauma and incontinence.

Surgeries Performed

Urethroplasty, artificial urinary sphincters, complex reconstruction of urinary tract, mitroffanoff procedure, ileal conduit formation, hypospadias repair and ureteric reimplantation

Adolescent Reconstruction

  • Bladder extrophy
  • Congenital uro-genital anomolies
  • Neuropathic bladder
  • Spina bifida

Female Urology

Comprehensive female and reconstructive urology service including primary, recurrent and complex urinary incontinence, prolapse, vesicovaginal and vesicourethral fistulae and urethral diverticulae management

Conditions treated

Incontinence, prolapse, bladder pain, bladder over activity and instability, female urethral diverticulm, urogenital fistula repair, neurogenic bladder dysfunction and neurourology

Surgeries Performed

Assessment includes simple, video and ambulatory Urodynamics, specialist bladder and pelvic floor rehabilitation, diversion nurses and nurse specialist acupuncture. A wide number of treatment options are offered including: TVT (transvesical tape), TOT (transobturator tape), rectus fascia sling, colposuspension, anterior and prosterior and sacrocolpopexy, artificial urinary sphincters and male slings
Urinary diversion including cystecomy, continent diversion; neo bladder, mitrofanoff and ileal conduit
Botox to the bladder, urethral sphincter, peripheral and sacral neuromodulation and augmentation cystoplasty
Male urethral reconstruction and Urethroplasty, female urethral diverticulectomy, urogenital fistula repair

Diseases treated include urethral stricture disease, curvature of the penis from Peyronie’s disease and other causes, erectile dysfunction, also called ED and impotence, including penile prosthesis (also called a penile implant) placement or revision, hypospadias, complications from prostate cancer treatment with radiation or surgery, and other disorders of the male external genitalia such as scrotal lymphedema and hidradenitis.

Conditions-

Bladder neck contracture
Congenital penile
curvature Erectile dysfunction

Hypospadias
Scrotal lymphedema
Urethral stricture disease

Treatment

Correction of penile curvature
Hypospadias repair
Penile implant and penile prosthesis surgery

Peyronie’s repair
Scrotal lymphedema surgery
Urethroplasty, Urethral reconstruction