Pediatric Urology

Pediatric urology is a specialized surgical branch that undertakes the diagnosis, medical, and surgical treatment of congenital or acquired diseases involving the kidneys, ureters, bladder, urethra, and genital organs in the age group from birth to the end of adolescence. Urogenital system diseases in children show significant differences from those in adults; the organs are in a developmental process, surgical techniques differ, and long-term growth effects must be considered. For this reason, evaluation by physicians specialized in the field of pediatric urology is of vital importance.

Scope of Pediatric Urology

The pediatric urology department deals with a wide range of diseases such as congenital kidney and ureter anomalies, hypospadias, undescended testis, vesicoureteral reflux, bladder dysfunction, urinary incontinence, circumcision complications, varicocele, hydrocele, inguinal hernia, kidney stones, and urogenital tumors. Postnatal follow-up and treatment planning of urinary system anomalies detected during the prenatal period also fall within the scope of this department.

Pediatric urologists apply different surgical techniques such as open surgery, laparoscopic surgery, and endoscopic interventions, selecting them according to the child's age and the nature of the disease. Minimally invasive methods offer the advantages of shorter hospital stays and faster recovery.

Common Childhood Urological Diseases

Urological problems in children can be congenital or acquired. Timely diagnosis and appropriate treatment of these diseases are critical for protecting kidney health and maintaining the child's normal development.

• Hypospadias: A condition in male children where the urinary opening (meatus) is located on the underside of the penis rather than at the tip. It is one of the most common congenital genital anomalies. It can be seen in varying degrees, from mild forms to severe proximal types. Surgical repair is usually performed between six and eighteen months of age.
• Undescended testis (cryptorchidism): The failure of the testis to descend into the scrotum at birth. It can be unilateral or bilateral. Spontaneous descent can be expected up to six months; if it does not descend, surgical intervention (orchiopexy) is recommended. Untreated undescended testis increases the risk of infertility and testicular tumor in the future.
• Vesicoureteral reflux (VUR): The backward flow of urine from the bladder to the kidneys. It is one of the most common causes of recurrent urinary tract infections. While it may resolve spontaneously in mild cases, surgical treatment may be required in severe cases. Regular monitoring is essential to prevent kidney damage.
• Hydronephrosis: The dilation of the kidney's collecting system. It is the most common urinary system anomaly detected on prenatal ultrasonography. It can be caused by obstructions such as ureteropelvic junction obstruction, ureterovesical junction obstruction, or posterior urethral valves. While mild cases are followed up with observation, surgical correction is performed for severe obstructions.
• Posterior urethral valve: A congenital membranous structure in the urethra of male children that obstructs urine flow, potentially causing bilateral hydronephrosis and kidney damage. Early diagnosis and endoscopic ablation treatment are critical for preserving kidney function.
• Bladder dysfunction: Overactive bladder, voiding dysfunction, and neurogenic bladder can cause urinary incontinence, frequent urination, and urinary tract infections in children. Following diagnosis via urodynamic evaluation, medical treatment, behavioral therapy, or clean intermittent catheterization is planned.
• Enuresis (bedwetting): Nighttime bedwetting (nocturnal enuresis) should be evaluated if it persists after the age of five. There are monosymptomatic and non-monosymptomatic forms. Behavioral therapy, alarm therapy, and medical treatment are applied when necessary.
• Hydrocele and inguinal hernia: Fluid accumulation around the testis (hydrocele) and the protrusion of intra-abdominal organs through the inguinal canal (hernia) are common surgical problems in children. Communicating hydrocele and hernia require surgical treatment.
• Varicocele: A condition of enlargement in the veins that nourish the testis. It emerges during adolescence and is more common on the left side. Surgical correction is performed if it affects testicular development.
• Kidney stones: Stones can form in the kidneys and urinary tract in children due to metabolic disorders, insufficient fluid intake, and infections. Shock wave lithotripsy (ESWL), ureterorenoscopy, and percutaneous nephrolithotomy are treatment options.
• Circumcision and its complications: Circumcision is one of the most frequently performed childhood surgical procedures. Phimosis, paraphimosis, and complications developing after circumcision are evaluated within the scope of pediatric urology.

Diagnostic Methods

In pediatric urology, accurate diagnosis is vital for determining the appropriate treatment strategy and preventing unnecessary surgical interventions. Thanks to modern diagnostic methods, diseases can be detected accurately and at an early stage.

• Ultrasonography: The first-choice imaging method for evaluating the kidneys, bladder, and genital organs. Being radiation-free and repeatable provides a great advantage in children. Hydronephrosis, kidney stones, bladder wall thickness, and residual urine measurement are evaluated with ultrasonography.
• Voiding cystourethrography (VCUG): Imaging of the bladder and urethra with contrast material. It is the gold standard method for diagnosing vesicoureteral reflux, posterior urethral valves, and urethral anomalies.
• Nuclear medicine studies: DMSA scintigraphy shows renal parenchymal damage and functional distribution. MAG-3 scintigraphy evaluates drainage function to determine the degree of obstruction. Differential kidney function ratios play an important role in surgical decision-making.
• Magnetic resonance urography: An advanced, radiation-free imaging method that provides anatomical and functional information together. It provides detailed evaluation in complex urinary anomalies.
• Urodynamics: The objective measurement of bladder functions. Bladder capacity, pressure-flow relationship, and sphincter activity are evaluated. It is the fundamental examination in the diagnosis of neurogenic bladder and voiding dysfunction.
• Cystoscopy: Endoscopic imaging of the bladder and urethra. It can be applied for both diagnostic and therapeutic purposes.
• Laboratory examinations: Urinalysis, urine culture, kidney function tests, measurement of stone-forming metabolites in 24-hour urine, and hormone tests are the basic laboratory methods used in diagnosis.

Treatment Approaches

In pediatric urology, treatment is planned in a wide spectrum ranging from conservative methods to advanced surgical techniques. The treatment decision is made according to the type and severity of the disease and the child's general condition.

Conservative treatment and follow-up: In cases such as mild hydronephrosis, low-grade vesicoureteral reflux, and non-communicating hydrocele, a "wait and see" strategy with regular ultrasonography follow-up can be applied. Spontaneous resolution is observed in many cases.

Medical treatment: Antibiotic treatment for urinary tract infections, anticholinergic drugs for bladder dysfunction, desmopressin for enuresis, and metabolic regulation for kidney stones constitute the medical components of treatment. Prophylactic antibiotic use may be applied to protect the kidneys in patients at risk of recurrent infections.

Endoscopic interventions: Posterior urethral valve ablation, endoscopic injection therapy for vesicoureteral reflux, ureterocele incision, and ureterorenoscopy for stone treatment are minimally invasive endoscopic methods. These techniques can be safely applied even in small children.

Laparoscopic and robotic surgery: Laparoscopic and robot-assisted surgical techniques are applied in nephrectomy, pyeloplasty, ureteral reimplantation, and undescended testis surgery. They offer the advantages of smaller incisions, less pain, and faster recovery.

Open surgery: Many procedures such as hypospadias repair, orchiopexy, inguinal hernia repair, pyeloplasty, and kidney stone surgery are successfully performed using open surgical methods. In pediatric urology, excellent cosmetic and functional results are achieved by using microsurgical techniques and fine suture materials.

Behavioral therapy and urotherapy: Bladder training, timed voiding programs, fluid intake regulation, and constipation treatment are effective approaches for functional urinary incontinence problems. With biofeedback therapy, the child is taught the skill of using pelvic floor muscles correctly.

When Should You Consult Pediatric Urology?

A pediatric urology specialist should be consulted if any of the following conditions exist:

• Kidney or urinary tract anomaly detected on prenatal ultrasonography
• Recurrent urinary tract infections
• Urinary incontinence problem, day or night
• Difficulty during urination, interrupted urination, or weak urine stream
• Testes not felt in the scrotum or asymmetry
• Swelling or pain in the genital area
• Change in urine color or blood in the urine
• Problems or complications related to circumcision
• Urinary complaints accompanied by abdominal or flank pain
• Suspicion of kidney stones
• Pain or swelling in the scrotum during adolescence

Prenatal Diagnosis and Postnatal Approach

Today, many urinary system anomalies can be detected with ultrasonography performed during pregnancy. Prenatal hydronephrosis, multicystic dysplastic kidney, renal agenesis, and posterior urethral valve are the main pathologies that receive prenatal diagnosis. Prenatal diagnosis provides a great advantage in terms of planning the postnatal approach, informing the family, and performing the birth in an appropriate center when necessary.

In postnatal evaluation, the diagnosis is confirmed with ultrasonography and VCUG when necessary, and a treatment plan is created. The initiation of prophylactic antibiotics, surgical timing, and follow-up protocol are determined individually for each patient.

Why Koru Hospital?

The Koru Hospital pediatric urology department offers modern and safe surgical solutions to pediatric patients with its surgeons specialized in their fields. With advanced operating room technologies, pediatric anesthesiologists, and intensive care support, all kinds of urological surgical interventions are performed safely. Thanks to the effective use of minimally invasive surgical techniques, our patients' recovery processes are accelerated.

In our hospital, a multidisciplinary approach is adopted by working in coordination with pediatric nephrology, pediatric radiology, and nuclear medicine departments. Our patients' health is under guarantee with long-term follow-up programs starting from the prenatal period. With our child-friendly hospital environment and family-oriented service approach, we aim to make treatment processes as comfortable as possible for both the child and the family.

At the Koru Hospital Pediatric Urology department, our specialist physicians are by your side, applying the most up-to-date diagnostic and treatment methods for your child's urogenital health. You can contact us to make an appointment and get detailed information.