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Some uncommon pediatric urological problems managed at the Urology Institute include the following: urinary tract infections (UTIs), hematuria, hydronephrosis, kidney stones, circumcision, voiding dysfunction, bed wetting, undescended testis, hypospadius, hernias, hydroceles, acute scrotal swelling, meatal stenosis, urethral strictures, adolescent varicoceles, and minor trauma.
Doctor Green answers some important questions about pediatric urology.
Q. What are the common reasons for requesting imaging studies in children?
Dr. Green: The most common reasons for requesting imaging studies in children include urinary tract infection, hematuria, abdominal masses, wetting problems, antenatal hydronephrosis, and abdominal trauma. These clinical problems represent more than 95% of relevant issues in pediatric urology.
Q. What are some common imaging studies used to evaluate pediatric urological problems?
Dr. Green: 1. Conventional voiding cystourethrography remains the method of choice to examine the urethra, document the degree of vesicourethral reflux, and define the causes of secondary reflux.
2. Renal sonography is non-invasive, requires no contrast agent, and delivers no radiation. However, it provides only an anatomic depiction of the urinary tract with no functional information. This is currently the modality of choice for screening children with documented UTIs.
3. Renal scintigraphy is used to evaluate renal parenchyma and follow reflux.
4. Excretory urography (IVP) remains the procedure of choice for renal colic.
5. Abdominal masses are usually evaluated for precision with computerized tomography (CT) or magnetic resonance imaging (MRI) or after initial sonography.
6. Computed tomography is the study of choice in the evaluation of blunt trauma.
Q. My eight year old child urinated blood. Is this serious and what caused it?
Dr. Green: The discovery of blood in a child's urine is alarming to the child, parents, and physician. It is serious and warrants a urologic evaluation. The numerous causes for hematuria can be divided into two major categories based on the red cell morphology: glomerular and non-glomerular. Nonglomerular hematuria is usually urologic in origin, e.g., kidney stones, tumors, infections, obstructions, and trauma. Some examples of glomerular bleeding are bleeding disorders and glomerular disease.
Q: What is gross and microscopic hematuria?
Dr. Green: Gross hematuria is blood in the urine that is visible to the naked eye. Microscopic hematuria is blood in the urine that is not visible to the naked eye. The finding of more than 3 red blood cells per high-power field in a centrifuged specimen is considered abnormal. Only a small quantity of blood (1 ml blood to 1000 ml of urine) is necessary to make the urine appear red.
Q: What is the most common operation performed on males in the United States?
Dr. Green: Circumcision.
Q: What factors predispose a child to urinary tract infections (UTIs)?
Dr. Green: Increased periurethral colonization. The reason for this increased colonization is unknown. It may be related to blood group associated antigens. This colonization decreases during the first five years of life and is unusual after age 5.
Q: When should a child be placed on prophylactic antibiotics?
Dr. Green: For children with normal urinary tract anatomy, prophylactic antibiotics are indicated if the child has two or more UTIs over a six-month period.
Q: What is enuresis?
Dr. Green: The persistence of involuntary voiding beyond age 4 is called enuresis. Bed wetting is referred to as nocturnal enuresis. Diurnal enuresis refers to daytime wetting.
Q: What causes enuresis?
Dr. Green: Diverse factors can cause or influence nocturnal enuresis, including: maturational lag or developmental delay, abnormal sleep patterns, psychopathology, environmental stress, urinary tract disease, abnormalities of normal circadian rhythm, or antidiuretic hormone (ADH) secretions.
Q: How do you treat uncomplicated enuresis?
Dr. Green: Individual treatment must be tailored to the attitudes of the parents and child toward enuresis, the social structure, and the home environment. The therapeutic options for uncomplicated nocturnal enuresis include various techniques of behaviour modification, pharmacologic therapy, and miscellaneous treatment modalities such as diet and hypnotism.
Q: If a child experiences acute scrotal or testis pain and swelling, what should a parent do?
Dr. Green: Proceed to your doctor or nearest emergency room immediately.
Reason: Acute scrotal swelling is a potential urologic emergency and requires immediate evaluation and possible surgical management. Many diagnostic entities present with acute scrotal swelling, but torsion of the testis and spermatic cord is the single diagnosis that must be ruled out or treated as an emergency.
Q: Is it true that there is a risk of developing cancer in an undescended testis?
Dr. Green: Yes. Undescended or cryptorchid testes have a greater risk of malignancy than do normally descended testes. The chance of a cryptorchid patient developing testis tumor is 7.3 - 9.7 times that of the general male population. Six to ten percent of all testis cancers originate in cryptorchid testes.
Q: What is hypospadius and how do you treat it?
Dr. Green: Hypospadius is a congenital abnormality that results from incomplete development of the urethra. It occurs in 1 out of 300 male births. This condition is treated with surgery.
Q: Do children develop inguinal hernias?
Dr. Green: Yes, inguinal hernias occur in children -- approximately 15 per 1000 live births. Prematurity and low birth weight increase the risk.
Q: A friend has a baby with a very large scrotum at birth... the pediatrician said that it was a "hydrocele" and would probably go away. What is a hydrocele and do they just go away?
Dr. Green: Hydroceles are fluid collections around the testis with or without communicating to the abdomen. Most hydroceles disappear before age 1. Those that do not disappear may require surgery.
Q: What is "reflux"? Is reflux significant?
Dr. Green: Vesicourethral reflux is the retrograde flow of urine up to the kidneys. Reflux in conjunction with a urinary tract infection can cause damage to the kidneys and requires medical and in some cases surgical treatment.
Q: My son is 16 and has been diagnosed with a varicocele... does he need treatment?
Dr. Green: Because varicoceles (varicose veins of the testis) can induce testis injury and infertility, we recommend surgical repair of varicoceles in adolescents when semen analyses are abnormal, the volume of the left testis is 3 ml or more than the right, and there are bilateral detectable varicoceles or a large symptomatic varicocele.
Q: Do children get urinary cancer? If so, what type of cancer?
Dr. Green: Yes. Children develop cancers of the kidney, e.g., Wilms' Tumor, sympathetic nerves (neuroblastoma), testis (yolk-sac); and bladder, prostate, vagina, uterus, and spermatic cord (rhabdomyosarcomas). |
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