Pediatric Urology

Testicular torsion

A testicle rotates enough to twist its blood vessel, stopping blood flow to the testicle. This causes sudden, severe pain in (and sometimes around) the testicle. Urgent medical attention is necessary to preserve testicular function.

Urologic injuries

Damage to kidneys, bladder, or genitals due to an injury, such as a fall, car crash, sports injury, or other traumatic event.

These conditions are already present at birth. They are usually diagnosed either on a fetal ultrasound or immediately after your child is born. They include:

Bladder exstrophy

The abdominal wall doesn’t fully close during fetal development, which causes the bladder to form outside the belly.

Epispadias

The urethra doesn’t fully form during fetal development and the urethral opening (the small hole where urine exits the body) is placed further forward or upward (closer to the belly) than it should be. For example, it often appears on the upper side of the penis for males and between the clitoris and labia for females.

Hypospadias

In this condition, which affects boys, the urethral opening (the small hole were urine exits the body) is located along the underside of the penis rather than at the tip.

Inguinal hernia

This is a small opening in the lower belly that does not close all the way. A soft lump can stick out near the groin because of this opening. You might see the lump more when a baby cries, coughs, or laughs.

Penile chordee and torsion

The penis appears excessively curved (chordee) or twisted (torsion) at birth.

Undescended testicles (cryptorchidism)

One or both of a boy’s testicles haven’t moved all the way down from the lower belly (where they form during fetal development) to the scrotum by the time of birth. If the testicle still hasn’t descended by the time a boy is 6 months old, treatment may be required.

Disorders of sex development (DSD)

This is when a child’s genitals or reproductive organs fail to develop as expected. In other words, a child’s chromosomes (XX for female, XY for male), gonads (ovaries for females, testicles for males), and visible genitals may not all “match” one another in appearance or function. Some DSDs result in genitals that appear to have both male and female characteristics (ambiguous genitalia). In other cases, children appear physically normal at birth, and the DSD may not be identified until after puberty.

Labial adhesion

The labia (inner lips of the vulva in girls) stick together and cover all or part of the vaginal opening. Some cases get better on their own, while others may require treatment.

Micropenis

This refers to a penis that is abnormally small, but otherwise has a normal structure and usually normal function.

Phimosis and paraphimosis

These conditions can occur in an uncircumcised boy with an abnormally tight foreskin, which either cannot be retracted beyond the head of the penis (phimosis) or gets stuck behind the head of the penis and cannot be drawn back over it (paraphimosis). Phimosis is fairly common in newborns and may resolve on its own in early childhood, while paraphimosis is a medical emergency that should be treated as soon as possible.

Varicocele

Enlarged veins within a boy’s scrotum caused by blood pooling rather than being pumped efficiently back to the heart.

These conditions primarily affect the health and functioning of the lower urinary tract, which includes the bladder and the urethra (the tube the carries urine out of the body). They include:

Neurogenic bladder

Bladder dysfunction (such as loss of bladder control or sudden urges to pee) caused by problems that originate in the nervous system (nerves, spinal cord, or brain).

Posterior urethral valves

In this congenital birth defect, excess tissue blocks the urethra (the tube that carries urine out of the body) in males. This can cause urine to back up in the bladder or even further up the urinary tract.

Urinary incontinence

Inability to control bladder, such as daytime wetting or regular bedwetting (enuresis), after an age when the vast majority of children are able to control these functions.

Urinary tract infection (UTI)

Infections in the urinary tract can cause a variety of uncomfortable symptoms for kids, including painful or frequent urination, pelvic pain, or discolored urine. Most UTIs are caused by bacteria that enter the body through the urethra and infect the lower urinary tract. However, untreated UTIs can eventually infect the upper urinary tract, including the kidneys.

Tumors are abnormal growths of tissue that form in the body. They may be benign (non-cancerous) or malignant (cancerous).

Paratesticular masses

These are growths or tumors that form near the testicles, but not on the testicles themselves. These are rare and require evaluation.

Testicular tumors

Masses of tissue that form in the testicles. Although many testicular tumors are benign (especially in children who have not reached puberty), testicular cancer is treatable with high cure rates.

Wilms tumor (nephroblastoma)

These tumors are the most common form of kidney cancer in children, especially in children under age 5. Early signs may include a swollen or hard lump in the belly, abdominal pain, or blood in urine.

These conditions involve the kidneys and ureters (the tubes that carry urine from the kidney to the bladder). They include:

Ectopic ureter

This is a ureter that does not connect to the bladder correctly. In many cases the ureter bypasses the bladder entirely and connects directly to the urethra, the tube that carries urine out of the body. However, some ectopic ureters connect to other organs and structures.

Hydronephrosis

This occurs when urine collects in the kidney, causing it to swell. This can correct itself without treatment but can also put the kidney at risk in some patients. It can be caused by a variety of medical problems.

Kidney stones

These are solid deposits of minerals, salts, or acids that form in the kidneys. Large kidney stones can get stuck in a ureter and cause pain, blood in urine, and urine backup in the ureter and kidney.

Ureterocele

This is a swollen bulge in the lower end of the ureter. It can block urine from draining normally into the bladder.

Ureteropelvic junction (UPJ) obstruction

This can refer to any restriction or blockage that stops urine from flowing freely through the renal pelvis, which is a funnel-shaped structure where the kidney and ureter connect.

Ureterovesical junction (UVJ) obstruction or megaureter

This refers to a blockage in the area where the ureter connects with the bladder. A buildup of urine stuck in the ureter may cause it to swell and widen (megaureter).

Vesicoureteral reflux (VUR)

This occurs when urine flows backward into the ureter, and in severe cases, all the way up to the kidney. This can lead to scarring and damage to the kidney, which is known as reflux nephropathy.