Pediatric Urology Diseases and Conditions
Hydronephrosis refers to extra urinary fluid in the kidney. It is not a separate disease, but a physical phenomenon that occurs with many diseases. Its symptoms, treatment, and prognosis are those of the disease that caused it.
Tumors of the Kidney
Tumors of the kidney require surgical excision as well as combined management with pediatric oncology. They include:
- Wilms’ tumor (the most common)
- Mesoblastic nephroma
- Neuroblastoma (found commonly on the adrenal gland, but can be located anywhere along the sympathetic nervous system)
Signs/symptoms of kidney tumors include:
- Abdominal pain
- Abdominal mass
- Blood in the urine
- Failure to thrive
The prognosis for these tumors has improved greatly with the combination of surgery, chemotherapy, and radiation.
Kidney stones in children are far less common than in adults. The first step in treatment is to find out what type of kidney stone is present. Kidney stone types include:
- Calcium oxalate
- Uric acid
- Cystine stones
- Struvite stones
Once the type of stone has been discovered, the cause of the stone formation must be identified. Kidney stones are frequently caused by abnormal function of the metabolism, reflux, and obstruction.
Urinary Tract Infections
Often urinary tract infection (UTI) is the first sign of a congenital bladder or kidney anomaly. These UTIs may go undiagnosed if there is not a proper examination of the urine. If a true UTI exists, a renal and bladder ultrasound, as well as a Voiding Cystourethrogram (VCUG) are recommended to rule out any kidney or bladder anomalies. Thirty to forty percent of children with a UTI accompanied by a high fever have some type of urological anomaly from birth.
Signs and symptoms of a UTI are:
- Dysuria (burning on urination)
- Urinary frequency
- Urinary urgency
- Foul smelling, cloudy urine
- Incontinence (bed wetting episodes)
Vesicoureteral reflux (VUR) is an abnormal movement of urine back from the bladder into the kidneys. There are five grades of vesicoureteral reflux: 1 is the mildest and 5 is the most severe.
Most children develop grades 1-2 reflux, which fortunately resolves itself over time in the majority of cases. Grade 3 will resolve in approximately 50 percent of the time. Grade 4 and 5 only resolves on its own in a minority of cases.
The surgery to correct VUR essentially lengthens the path of the ureter as it travels from the kidney into the bladder. The surgery is successful approximately 98 percent of the time.
Prune Belly Syndrome
Prune belly syndrome is a highly unusual condition. It occurs in males who have a wrinkled abdominal wall as a result of the absence of abdominal musculature, bilaterally undescended testes, and other urinary tract anomalies. Prune belly syndrome is diagnosed at birth.
Exstrophy is an uncommon congenital bladder anomaly. It results when the tissue making up the abdominal wall is deficient and the bladder is a flat sheet on the abdominal wall instead of a sphere inside the pelvis. Urine will leak out of the abdominal wall from the exposed ureteral orifices. This is associated with pubic separation and epispadias, which is a severe congenital curvature and foreshortening of the penis.
Posterior Urethral Valve
Posterior urethral valves are wisps of tissue in the prostatic urethra (the tube running through the prostate) preventing the release of urine out of the bladder. The obstruction they cause ranges from mild to severe (the latter can result in renal failure, bladder dysfunction, or even death). When diagnosed by prenatal ultrasound, the goal is to destroy the valves via cytoscopy within the first week of life. Physicians will direct attention to possible electrolyte abnormalities and pulmonary hypoplasia (underdevelopment of the lungs) that can develop secondary to the decrease in amniotic fluid (oligohydramnios).
Neural tube Defects
Neural tube defects occur when the bones of the spine do not form correctly, causing the spinal cord and its nerves and coverings to protrude through the skin or lie just beneath it. The use of folate vitamins during pregnancy has decreased the incidence of neural tube defects; however, many children still suffer from myelodysplasia (which includes myelomeningocele and occult spina bifida). Since the bladder and the urinary sphincters function under neurologic control from the spinal cord, damage can result in lower urinary tract dysfunction which, if untreated, can lead to kidney damage.
Frequent infections, incontinence, and urinary frequency are common symptoms of neural tube defects.
Pediatric Genital Abnormalities
Hypospadias – The most common genital abnormality seen by pediatric urologists are hypospadias. In this condition the urethral opening is not at the tip of the penis but further down on the ventral surface (that is, between the head of the penis and the scrotum). Often this abnormality is associated with chordee, a curvature of the penis down towards the scrotum. Surgical repair is recommended for those children whose hypospadias will affect fertility, sexual intercourse, cosmesis (appearance), and the ability to void in the standing position. The cause of hypospadias is not exactly known.
Epispadias – Epispadias includes a severe dorsal curvature of the penis up towards the abdominal wall as well as the urethral opening near the surface of the abdomen. It is usually associated with bladder exstrophy.
Chordee – A chordee is a curvature of the penis. Some children are born with a chordee without associated hypospadias or epispadias.
Male/Female Genitalia – During development, both the male and female external genitalia arise from the same common structures. Their growth into clearly recognizable male and female organs can be disrupted by any abnormalities of chromosomes, gonadal problems or enzymatic disorders. Therefore children with XY genes can appear to have female genitalia and children with XX genes can appear to have male genitalia.
Undescended testicles – One of the most common conditions that the pediatric urologist manages is the undescended testicle. Originally forming in the retroperitoneum (the back part of the abdomen) and then descending to the iguinal canal and then into the scrotum, the undescended testicle occurs in nearly 3 percent of all children born. A good portion of these children will have the testes descend into the scrotum within the first year of life.
Inguinal hernia – Inguinal hernias appear quite frequently in the pediatric age group. These hernias differ from adult hernias in that the peritoneum (the sack that encompasses the intestines) fails to seal, allowing an interface between the abdomen and scrotum. Signs of a hernia are a bulge in the groin or in the scrotum that often changes in size.
Hydrocele – A hydrocele is a collection of fluid along the membrane covering the front and sides of the testicle.
We Can Help
Mount Sinai’s Department of Urology is ranked among the nation’s best in the 2014-2015 "Best Hospitals" issue of U.S. News & World Report. At Mount Sinai’s Division of Pediatric Urology, our team’s priority is to provide you and your child with expert and compassionate care.
For additional information or to make an appointment, please call us at 212-241-4812.
Department of Urology
5 East 98th Street, 6th Floor
New York, New York 10029
Robotic Kidney Surgery
425 West 59th Street
New York, New York 10019