Some urologic conditions in kids are congenital – or present at birth – and some may even be diagnosed prenatally. Others develop as children age. While some conditions can be managed or lived with, it’s important to seek an early diagnosis and treatment plan to help minimize the risk of more extensive issues as the child ages.
Dr. Kristin Ebert, pediatric urologist with Marshfield Children’s, shares five common urologic conditions seen in children, what to watch for and treatments available.
Undescended testicles
Testicles form during fetal development. During the last few months of normal development, the testicles gradually descend into the scrotum. An undescended testis is defined as a testicle that does not descend fully into the scrotum. The testicle can be located anywhere within the abdomen or the groin. A physical exam can confirm the diagnosis shortly after birth, however, they may move on their own within the first few months of life.
Prematurity and a family history of undescended testicles are common risk factors.
“If the testicle hasn’t descended by six months, surgery is recommended,” said Dr. Ebert. “Left untreated, this can cause issues with fertility and a slightly increased risk for testicular cancer.”
While some conditions can be managed or lived with, it’s important to seek an early diagnosis and treatment plan to help minimize the risk of more extensive issues as the child ages.
Hydronephrosis
Hydronephrosis is a condition where urine collects in a part of the kidney called the renal pelvis, before it reaches the bladder. This can lead to enlargement or swelling of the kidney.
Babies with hydronephrosis often have no symptoms. In older children, you may notice blood in the urine, a urinary tract infection, or vomiting. In some children, the condition is congenital, meaning it’s something they are born with. For others, the cause may be due to a kidney stone or constipation, among others.
Hydronephrosis can be diagnosed on ultrasounds or CT scans. Further imaging studies may be needed to determine the cause of the hydronephrosis.
“Treatment is highly-dependent on what the cause is. Sometimes it’s just monitoring the condition with imaging and watching for changes. Some patients may need surgery,” she said.
Voiding dysfunction
This means your child has abnormal urinary patterns compared to other children.
This condition can present itself in several ways. Urinary frequency and urgency, burning when needing to urinate, holding urine for a long time and accidents during the day and night are all common signs.
Voiding dysfunction may be the result of a learned problem, such as a child being too busy to use the bathroom, not ready for potty training or being afraid to urinate. It’s often related to bowel dysfunction, particularly constipation. There also may be structural problems with the bladder, such as an overactive bladder muscle.
It is typically diagnosed by taking a history of your child’s voiding patterns. A physical exam, urinalysis and ultrasound of the bladder may be needed to see if the child is completely emptying their bladder.
Behavioral modification and treatment of constipation often are the first steps in treatment. Urinating on a schedule and making sure they take the time to fully empty can often help your child work through the problem. In some children, medication may be necessary to help with voiding habits.
Circumcision complications
Circumcision complications can come in many forms. In some cases following a circumcision, extra foreskin can be left behind. Penile adhesions or skin bridges – when the penile skin gets stuck to the head of the penis – also can form. Narrowing of the hole at the tip of the penis, or meatal stenosis, also can occur.
“Sometimes, kids can have redness or irritation of extra skin or adhesions. The extra skin also can cause difficulty with hygiene. If a skin bridge is left untreated, it can cause pain with erections in older children. Meatal stenosis can present as a deviated urinary stream,” Dr. Ebert said.
Depending on the complication, treatment will vary. Steroid creams can be recommended and in some cases, office-based procedures or surgical revisions may be needed.
“Some cases are benign and resolve on their own, and some won’t. It’s best to have a pediatric urologist examine your child,” Dr. Ebert said.
Hypospadias
With hypospadias, the hole where urine exits isn’t at the tip of the penis. This is usually diagnosed when babies are born and may be a result of a family history or the use of fertility drugs for conception.
“Left uncorrected, this can cause spraying with urination as the child ages,” Dr. Ebert said.
If parents choose not to correct, it also may cause fertility issues.
“If they have spraying of the urinary stream, they also will have spraying of semen, which can cause difficulties with successful paternity. The farther down the hole is, the more likely the child is to have symptoms,” Dr. Ebert said.
Some children with hypospadias also have a downward curvature of the penis, which could cause issues with penetrative sexual intercourse in the future.
This condition often requires surgery. The goal of surgical repair is to reconstruct the urethra, or urine tube, so that urine can exit from the tip of the penis. If curvature is present, surgery will correct it.
Contact your pediatrician if you notice signs or symptoms
“The sooner you are able to do this, the better. Your pediatrician can help determine how urgent the concern is and the best treatment plan, which may involve referring to a pediatric urologist,” Dr. Ebert said.