The specialist field of childhood urology (also called pediatric urology) deals with the diagnostics, treatment and management of diseases and developmental disorders occurring in infancy and childhood and congenital malformations of the urogenital tract. The urogenital tract includes the urethra, bladder, ureter and renal pelvis and the external and internal sexual organs. Pediatric urologists are responsible for both girls and boys.

Overview

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Pediatric urology - Further information

What training does a pediatric urologist have?

A pediatric urologist has specialist training in pediatric surgery or urology and generally has also completed courses of further training. In Germany, specialist pediatric urologists work in centers for pediatric urology in large hospitals. Also, many urological practices offer consultation times for pediatric urological conditions. Also, registered pediatric surgeons sometimes perform operations on the urogenital tract.

The commonest problems which prompt parents to consult a pediatric urologist or be referred by a pediatrician to a pediatric urologist are phimosis (narrowing of the foreskin) in the penis and bladder control problems (micturation disorders).

Furthermore, pediatric urologists are confronted very often with congenital malformations of the urethra or ureter. Such suspected malformations are often detected today during pregnancy because of routine ultrasound diagnostics.

Also, the pediatric urologist deals with numerous other, generally less common urological conditions and malformations.

Summary of the services performed by pediatric urologists

Urinary tracts:

  • diagnosis and management of persistent enuresis (involuntary wetting) during the night and/or day
  • diagnosis and treatment of severe or chronic urinary tract infections
  • diagnosis and treatment of urine transport and bladder evacuation disorders, e.g. because of congenital malformations of the urethra and ureter (narrowings — stenosis, urethral valves, hypospadias and epispadias — wrong position of the mouth of the urethra)
  • diagnosis and treatment of stone disorders of the urinary tracts
  • surgical treatment of rare malformations of the bladder (e.g. bladder exstrophy - protrusion of the urinary bladder)
  • diagnosis and treatment of tumors of the urogenital system (e.g. Wilms's tumor - a rare kidney tumor occurring in infancy)

Sexual organs:

  • assessment, treatment and if necessary surgical correction of foreskin narrowing (phimosis)
  • diagnosis and treatment of undescended testicles (cryptorchism) and hernias 
  • treatment of fusion of the labia (synechia of the labia)
  • diagnosis and treatment of disorders of the external sexual organs
  • diagnosis of intersexuality, follow up and treatment of patients with physical gender ambiguities 

Diagnostic techniques in pediatric urology

To enable assessment of urological disorders and malformations, the pediatric urologist makes use of a range of imaging procedures and others. Firstly, there is ultrasound diagnostics, which allows internal organs to be investigated straightforwardly and without radiation exposure.

A further, frequently performed urological examination is cystoscopy (bladder examination). Using a minute video device inserted through the urethra, the urologist can inspect the urethra and bladder internally.

Although X-ray examinations entail a certain amount of radiation exposure for the body, they are nevertheless sometimes necessary because they deliver more precise images. A CT (computed tomography scan) is a special X-ray examination which creates high resolution sectional images of the interior of the body. An MRT (magnetic resonance tomography scan) also generates high resolution sectional images by means of a strong magnetic field.

Scintigraphy enables statements on kidney function. In this procedure, a briefly weak radioactive substance is introduced into the bloodstream and then a special camera films the distribution of the radioactivity in kidney tissue, the renal pelvis and the draining urinary tracts.

Examinations which are unpleasant for the little patients or for which they must lie still for a relatively long time (bladder examination, MRT) are generally carried out under sedation.

Treatment techniques in pediatric urology

As well as conservative treatments with drugs applied either internally or externally, pediatric urology is a specialist field featuring both routine and also extremely delicate or highly specialized surgical procedures. Foreskin constrictions, undescended testicles, urine flow blockages and other congenital malformations needing correction are generally treated surgically in the first years of life. Pediatric urologists perform many interventions in minimally invasive procedures as standard ('key-hole surgery') by means of laparoscopy or cystoscopy (bladder examination) so that only very small or no visible scars are created.

Most urological disorders and malformations occurring in childhood are relatively easy to treat with routine interventions or widely tested conservative therapies. Often, children simply grow out of phimosis, urine transport disorders etc. even without any treatment at all - but whether watchful waiting is a sensible strategy can only be decided by the pediatric urologist.

Children with rare and complex disorders and malformations of the urogenital tract are in the best hands if they are in the pediatric urological centers in large hospitals. Where necessary, the specialist staff working here act in close collaboration with pediatric nephrologists (for kidney problems), pediatric neurologists (e.g. for neurological bladder function disorders), pediatric oncologists (for tumor conditions) and pediatric endocrinologists (e.g. for disorders affecting sexual development).