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Pediatric Urology

Circumcision
Hypospadias
Urinary Tract Infections
Undescended Testes
Vesicoureteral Reflux

Circumcision

Circumcision is the surgical removal of the foreskin from the penis. The procedure takes less than an hour and the infant is asleep. The benefits of circumcision include reduced risk of penile cancer, fewer urinary tract infections, and decreased risk of contracting venereal diseases. Many parents choose to circumcise for cosmetic reasons. Making the decision to circumcise can be difficult, because circumcision is currently a topic of debate. Opponents of circumcision argue that the majority of the sensation is felt in the foreskin, so circumcision decreases sexual pleasure.

Circumcision should not be performed on infants with hypospadias, since the foreskin may be needed for the repair of hypospadias. If circumcision is not performed shortly after birth, it is recommended to wait until the child is twelve months old.

Hypospadias

Hypospadias affects approximately 1/200 boys. It is a defect of the penis in which the urethra opens on the underside of the penis. Boys with hypospadias should not be circumcised, since the foreskin may be necessary for the repair of the defect. Surgical repair is recommended between the ages of 6 months and 15 months.

Urinary tract infections

Urinary tract infections (UTI's) in children are most frequently caused by bacteria. During the first few months of life, boys are more likely to get UTI's. Because the urethra is much shorter in girls than it is in boys, girls are more prone to getting infections as they get older, as are children who have anatomic abnormalities in the urinary tract. These infections can affect the bladder, ureters, or kidneys and if left untreated, may actually damage the kidneys. Signs and symptoms of a urinary tract infection can include pain on urination, frequent urination, foul-smelling urine, fever, nausea, vomiting, and flank pain. In order to diagnose a urinary tract infection a physician will have to exam the child and analyze the child's urine. UTI's are usually treated with antibiotics, and the physician may request to see the child again in a few months to make sure the infection is gone.

In order to determine why the child got a UTI, the physician may order tests to see if urine flows from the bladder back into the ureters, whether there are abnormalities in the kidneys or the ureters, and how the kidneys and the urinary tract fill with fluid. If an abnormality of the urinary tract is found, the child may be placed on low-dose antibiotics for a long period of time or surgery may be needed to correct the abnormality.

Links

National Kidney and Urologic Diseases Information Clearninghouse
American Foundation for Urologic Diseases

Undescended testes

An undescended testis is one that fails to complete its descent from the abdomen into the scrotum before birth, and are more common in premature infants. Most undescended testes will descend into the scrotum during the first year of life. If the testis fails to descend on its own, the child may be treated with hormone injections to make the testis descend. If that is unsuccessful, he will need to have a surgical procedure, called orchiopexy, to bring the testis into the scrotum.

Vesicoureteral reflux

Vesicoureteral reflux occurs when urine moves backwards from the bladder up into the ureters (which connect the kidneys to the bladder). Normally, the ureters enter the bladder at an angle, which serves as a one-way valve to prevent the backwards flow of urine. If this angle is not correct, urine is able to return into the ureters. Children with vesicoureteral reflux are at an increased risk for urinary tract infections and renal damage. In order to determine if a child has reflux, the physician may perform tests in order to watch the kidneys, ureters, and bladder while the bladder is filled and emptied.

Treatment of vesicoureteral reflux depends upon the severity of the reflux. Since many cases of reflux resolve spontaneously before the age of 10,hild on daily antibiotics in order to prevent urinary tract infections. The child should see the doctor regularly to be certain that there is no infection, and to monitor the degree of reflux as the child ages. In the most severe cases of reflux or if antibiotic management fails, surgery is indicated in which the ureters are re-implanted into the bladder.

Links

National Kidney and Urologic Diseases Information Clearninghouse

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