Pediatric urology is a specialty that focuses on genitourinary problems in children. The most common issues include hypospadias, undescended testicles, vesicoureteral reflux, varicoceles, and hernias.
A hernia is a condition in which part of an organ, usually the intestines, protrudes though a weakness or defect in the abdominal wall. This produces a soft, usually painless bulge. In children, the two most common hernias are umbilical (at the belly button) and inguinal (near the groin). A hernia must be repaired through surgery to prevent “incarceration,” trapping of the intestines that can have serious consequences. Treatment depends on the type of hernia, the child's age, health, and medical history, and the parents’ preferences. Inguinal hernias must be repaired through either conventional or minimally invasive laparoscopic surgery to prevent incarceration.
Hypospadias is a congenital condition in which the opening of the penis is on the underside of the tip. This abnormality is estimated to occur in one out of every 100 newborn boys. Surgery with the goal of making the penis more functional and cosmetically acceptable is the treatment of choice.
As a baby boy grows inside his mother's womb, his testicles typically form inside his abdomen and descend into the scrotum shortly before birth. Undescended testicles, also known as cryptorchidism, refer to testicles that fail to reach the scrotum. In roughly half of the baby boys with this condition, the testes descend during the first six months of life. If this fails to happen, the boy should undergo evaluation by a pediatric urologist. If surgery is called for, a small cut is made in the groin, and the testicle is brought down into the scrotum where it is fixed in place. This procedure is called on orchiopexy and can typically be performed on an outpatient basis.
Vesicoureteral reflux, called VUR or reflux, is a condition in which urine flows back into one or both ureters, and sometimes even the kidneys. The condition can occur in both sexes and is probably hereditary. When a child is born with a ureter that is too short, this is called primary VUR. In secondary VUR, the reflux is caused by a blockage in the ureter. Primary VUR tends to go away on its own and surgery is often postponed until the child is at least four, to see if the condition resolves. Secondary VUR usually requires surgery.
Seventeen percent of boys and young men between 13 and 25 have varicoceles—large, swollen veins in the scrotum. They tend to develop in the left testicle during or after puberty. Surgery used to be the treatment of choice, when there was a marked difference in the size of the testicles or concerns about potential fertility. However, our urologists now use a painless, minimally invasive procedure called varicocele embolization. During this outpatient procedure, a tiny catheter is inserted into a groin vein and guided up into the abdomen and into the varicocele. A dye is injected to create an x-ray map (venogram) of the vein and embolizing substances are inserted through the catheter to block the blood flow to the vein. No stitches are needed after the catheter is removed. Patients can go home the same day.