Pediatric urology deals with the urologic problems of children, which can be organized into congenital anomalies (abnormally-developed organs from birth) and acquired problems, which develop or become apparent after birth.
Congenital Anomalies & Treatments - External Conditions
Phimosis - tight foreskin
This is usually treated with steroid creams to try to expand the skin, which if it fails will likely require circumcision. Circumcision can prevent infections of the penis, help reduce the transmission of HIV/AIDS virus, and the development of penile cancer.
Hypospadias - underdeveloped penis
There are varying degrees of this condition. The minor type may need no treatment, but the moderate to severe types require surgery to make the penis functional for urination and sexual activity later in life. Read more hypospadias >>
Undescended Testis - unable to feel the testis
This condition is found in less than 1% of newborn boys, and is more common in prematurity. Surgical repair is helpful to prevent testicular damage, which can result in lower sperm production and the development of testicular cancer. Read more about undescended testis >>
Hydrocele - bulge in the scrotum caused by an open communication to the abdomen
These conditions often resolve roughly 50% of the time in the first year of life (unless the hernia sac is large and wide open). Correction prevents progression and enlargement of the hernia later in life. Read more about hydrocele >>
Spina Bifida - open lower spinal cord
This is a complex problem, which can involve many other different pediatric specialties in addition to urology (neurosurgery, orthopedic surgery, child life specialist, nephrology). Pediatric urologists deal with preserving kidney function by treating complications caused by the neurologic dysfunction of the bladder. A secondary goal is to achieve social continence (dryness) as the child ages. Surgeries may include fixing the valves in the bladder, enlarging the bladder with borrowed bowel, connecting the appendix to the bladder as a channel to drain it, and many other more typical procedures. Read more about spina bifida >>
Congenital Anomalies & Treatments - Internal Conditions
The use of prenatal ultrasonography has led to the earlier discovery of many internal problems of the urinary system. Almost all start with hydronephrosis (water of the kidney), which may lead to the following diagnoses:
Ureteropelvic Junction Obstruction - blockage of the proximal ureter, i.e., the tube from the kidney
This may improve, remain partially blocked, or worsen, which requires correction surgically to preserve kidney function.
Vesicoureteric Reflux - urine backing up to the kidney
This condition may often improve as the valve in the bladder matures with aging. However, recent advances in treatment have changed the approach to management of this condition. Read more about vesicoureteric reflux >>
Ureterocele - blockage of the distal ureter near the bladder
This is often associated with duplication of the ureters (see the next condition, Duplication Anomalies). These are usually incised (opened up) in the bladder with a telescope. Most need some subsequent treatment and may be very complex.
Duplication Anomalies - more than one ureteral tube coming from a kidney to the bladder
This condition often has a combination of vesicoureteric reflux and possible ureterocele associated with it. Treatment depends on the presence or absence of reflux or obstruction.
Posterior Urethral Valves - blockage in the boy's penis
This condition is usually severe and often life threatening in the newborn boy. It requires early intervention, often with a urinary diversion (vesicostomy) of the bladder to the abdominal skin to bypass the penis and allow the bladder and kidneys to drain.
Horseshoe Kidney - both kidneys joined at their lower ends
This is one of many types of "fusion anomalies" in which the kidney may not look normal or be in the usual "anatomic" position. It may not need any intervention, but usually is followed to detect an acquired ureteropelvic junction obstruction or stones.
Physical Acquired Conditions
Kidney Tumors - Wilms tumor
This is often treated by pediatric surgeons, who need to do vascular access for the needed chemotherapeutic treatments. Read more about kidney tumors >>
Bladder Tumors - rhabdomyosarcoma
This is a condition requiring a collaborative effort with pediatric surgery, as the patient will often also need chemotherapy and vascular access to fully treat.
Testicular Tumors - often yolk sac tumor
These are very rare, and some testicular tumors are benign.
Stones - kidney and bladder
Kidney stones in children are treated much like the adult population. Read more about kidney stones >>
Strictures - narrowing of the urethra, or rarely the ureter
At the tip of the penis, the opening can narrow after circumcision or hypospadias repair. This requires a revision of the opening (meatotomy). The bulbous male urethra (under the scrotum) is susceptible to trauma and is the most common site for narrowing, which may require dilatation, incisions, or even open operative repair.
Functional Acquired Conditions
Nighttime Incontinence - leaking urine, also known as “bed wetting”
Nighttime (enuresis) is usually treated by pediatricians or a nephrologist, yet urologists still see a lot of medical "failures". These children often then are "worked up", especially if there is persistent daytime wetting. Behavior modification plus or minus medication is often effective. Read more about nighttime incontinence >>
Recurrent Urinary Tract Infections – UTIs
This is a condition which must be fully evaluated in the infant and in all boys. Most pediatricians may grant a young, potty-trained girl an initial bladder infection, but recurrent infections or pyelonephritis (kidney infections) must be explored with a renal ultrasound and VCUG (voiding cystourethrogram) to rule-out all of the previously-discussed conditions, which could jeopardize kidney and bladder function. Read more about recurrent urinary tract infections >>
Pediatric Urology - Contact Information
Maine Medical Partners Urology
100 Brickhill Avenue
South Portland, ME 04106
Brian M. Jumper, MD
Director, Pediatric Urology
Thomas Kinkead, MD
Dr. David Chalmers