Paediatric urology - information and specialized paediatric urologists

What diseases does a pediatric urologist treat?

The specialist field of pediatric urology deals with the diagnosis, treatment and management of diseases that occur in infancy and childhood.

• diseases that occur in infancy and childhood,
• injuries,
• functional disorders and
• congenital malformations

of the urogenital tract. The urogenital tract includes

• Urethra,
• bladder,
• ureter and
• renal pelvis and
• the external and internal genital organs.

The location of the kidneys and bladder in children © SciePro | AdobeStock

Pediatric urologists most frequently treat foreskin constrictions of the penis(phimosis) and problems with bladder control (micturition disorders) in children.

Congenital malformations of the urethra or ureter are also among the most frequently treated conditions. Today, such malformations can often be detected during routine ultrasound examinations during pregnancy.

In addition, pediatric urology deals with numerous other, mostly rarer urological diseases and malformations as well as injuries to the urinary tract and internal and external genitalia. In most cases, injuries are caused by traffic, sports and leisure accidents.

The following list provides a rough overview of the range of services offered by a pediatric urologist. In the area of the urinary tract, for example, this includes the diagnosis and treatment of the following conditions:

• Enuresis (persistent wetting at night and/or during the day)
• Severe or chronic urinary tract infections
• Urinary transport and bladder emptying disorders
• Stone diseases of the urinary tract(urinary stones)
• rare malformations of the bladder, for example bladder exstrophy (bladder open to the outside)
• Tumors of the urogenital system, for example Wilms' tumor (a rare kidney tumor that occurs in infants)
• Diseases of the kidney, such as hydronephrosis (water-sac kidney)

Urinary transport and bladder emptying disorders include, for example

• Dilatation or narrowing (stenosis) of the urethra and ureters (such as megaureter, ureteral stricture),
• Urethral valve disease,
• displacement of the urethral opening downwards (hypospadias) or upwards (epispadias),
• vesicoureteral reflux (backflow of urine into the ureters and/or urine and
• a neurogenic bladder

In the area of the genitals , this includes, for example, the diagnosis and treatment of

• narrowing of the foreskin (phimosis)
• undescended testicles (cryptorchidism) and inguinal hernias
• hydrocele (hydrocele, accumulation of fluid in the scrotum) and varicocele (varicose vein in the testicles)
• acute scrotum (pain in the scrotum)
• Adhesive labia (labial synechia)
• diseases of the external genital organs
• ambiguities of the physical sex (so-called Dysorder of Sex Development (DSD), formerly known as intersexuality)

Diagnostics in pediatric urology

Due to the child's young age, the doctor usually conducts the medical history interview with the parents. He asks about the symptoms, such as pain, fever or difficulty urinating.

This is followed by a detailed physical examination. The pediatric urologist will carry out the examination carefully and confidentially, taking into account any feelings of shame. Small children can be held in their parents' arms or on their lap if necessary.

Pediatric urologists handle their young patients' fears and shame with care © gpointstudio | AdobeStock

The physical examination includes

• Palpation of the abdomen,
• assessment of the genitals and
• determination of heart rate and blood pressure.

As part of the laboratory diagnostics, the urine and blood are occasionally examined, especially if a urinary tract infection is suspected.

Ultrasound as the most important diagnostic tool

The pediatric urologist can use imaging techniques to assess urological diseases and malformations.

Ultrasound diagnostics (sonography) is the most important of these, as it can be used to examine internal organs and the urinary tract without any complications. Ultrasound does not cause any radiation exposure. State-of-the-art technology is used, such as

• high-resolution ultrasound,
• color-coded duplex sonography (to determine the direction of blood flow) or
• three-dimensional sonography

This allows not only anatomical changes but also functional disorders to be detected. The majority of pediatric urological conditions can be diagnosed with an ultrasound examination.

Other imaging procedures

In contrast to adults, children are ten times more sensitive to radiation. This also means that there is a significantly higher risk of developing a so-called radiation-induced tumor. This is why computed tomography(CT), which is associated with high radiation exposure, only plays a subordinate role in pediatric urology.

In contrast, magnetic resonance urography (MRI), a special magnetic resonance imaging(MRI) procedure, has established itself as a non-radiation-inducing method. With the help of a strong magnetic field, high-resolution cross-sectional images are also generated, which can be used to assess both the anatomy of the entire urogenital tract and kidney function.

Despite a certain radiation exposure, micturating cysturethrography (MCU) is still one of the most important examinations in pediatric urology due to its high informative value in terms of anatomy and function.

In this examination, the bladder is filled with contrast medium either via a bladder catheter inserted through the urethra or by puncturing the bladder through the skin and then X-rays are taken.

There are also other imaging procedures that can be used for specific issues, such as

• Pyelography (imaging of certain areas of the renal pelvis),
• laparoscopy (abdominal endoscopy) or
• scintigraphic methods (use of radioactively labeled substances to visualize the function of the kidneys).

Cystoscopy

Another relatively frequently performed urological examination iscystoscopy. The pediatric urologist can assess the inside of the urethra and bladder by means of a tiny video lens inserted through the urethra. As part of bladder pressure measurement(urodynamics), the functioning of the bladder can be examined using pressure probes and electrodes.

Examinations that are uncomfortable or that require young patients to lie still for a relatively long time are usually carried out under a short anesthetic.

Treatment methods

Pediatric urologists often resort to conservative treatments. This involves the use of internal or external medication.

Surgical procedures are also often used in pediatric urology to treat diseases or malformations. The complexity ranges from routine to very delicate or highly specialized surgical procedures.

• Foreskin constrictions,
• undescended testicles,
• blockages of the urinary flow and
• other congenital malformations requiring correction

are usually operated on in the first few years of life. Many procedures are performed by pediatric urologists using minimally invasive techniques (so-called keyhole surgery) via laparoscopy or cystoscopy. This results in no or only very small visible scars.

Most of the urological diseases and malformations that occur in childhood can be treated with routine interventions or tried and tested conservative therapies. Phimosis, urinary dysfunction and other disorders often "grow out" without any treatment at all. However, only a pediatric urologist can decide whether a wait-and-see approach is a sensible strategy.

Pediatric urologists treat bladder emptying disorders, among other things © Tomsickova | AdobeStock

Children with rare and more complicated disorders of the urogenital tract are best treated in the pediatric urology centers of the major hospitals.

The specialists working here work closely with

• Pediatric nephrologists (for kidney problems),
• pediatric neurologists (e.g. for neurological bladder dysfunction),
• pediatric oncologists (for tumor diseases) and
• pediatric endocrinologists (e.g. for disorders of sexual development (DSD))

together.

What training does a pediatric urologist have?

A pediatric urologist has specialist training in pediatric surgery or urology. As a rule, they have also completed appropriate further training. At European level, there is an official additional qualification for this special training (Fellow of the European Academy of Peadiatric Urology (FEAPU)).

In Germany, specialized paediatric urologists work at the centers for paediatric urology at major hospitals. In addition, many urology practices offer pediatric urology consultations. Pediatric surgeons in private practice also sometimes perform operations on the urogenital tract.