Urology

Pediatric urology [yoo-ROL-uh-jee] is a medical specialty that treats problems with the genitals or urinary tract in infants, children, and adolescents. A pediatric urologist is doctor who specializes in treating children with these types of conditions. Pediatric urologists treat urology problems such as bladder infections, kidney stones, and problems with peeing (urinating). They also treat problems with the genitals and groin, such as hernias and sex development.

Children’s bodies are different than adult bodies. A pediatric urologist is trained to understand and treat their unique problems. Pediatric urologists also understand how to diagnose problems even though a child may not be able to talk or express what is wrong. These doctors know how to work with children and their parents to make diagnosis and treatment go as smoothly as possible.

What Problems Does a Pediatric Urologist Treat?

A child’s doctor may recommend a pediatric urologist for any problem related to a child’s genitals or urinary tract. The urinary tract includes the two organs (kidneys) that filter blood and make urine; the tubes that carry urine from the kidneys to the bladder (ureters); the organ where urine is stored (bladder); and the tube that carries urine from the bladder to the outside of the body (urethra). Urinary tract problems include:

• Bladder control and bedwetting (urinary incontinence). Daytime and nighttime wetting are common and normal in young children as their bladders develop. It is normal for some children to develop this control later than others, especially at night. If a child has trouble with bladder control when most other children are able to stay dry, a pediatric urologist can help figure out why.
• Urinary tract infection. A urinary tract infection is when germs (bacteria) — usually from the bowels — get into the urethra [yoo-REE-thruh]. This is more common in girls than boys because a girl’s urethra is so close to the anus where bowel bacteria can be found. Also, a girl’s urethra is short and the bacteria don’t have far to travel to cause an infection.
• Vesicoureteral (ves-uh-koh-yoo-REE-tur-uhl) reflux (VUR). This is when pee (urine) backs up from the bladder into ureters (yoo-REE-ters) and back toward the kidneys. Urine is supposed to flow out of the body from the bladder through the urethra, not flow back into the ureters. This is most common in infants and young children, but can happen to older children. It can be caused by a blockage in the urinary tract or by a ureter that didn’t develop properly and can’t close when it should.
• Kidney stones. A kidney stone is like a pebble that can form in the kidney when there are too many minerals in the urine. Very small ones may not cause any symptoms, but larger ones can be painful as they try to pass through the small tubes in the urinary tract that are meant for liquid.
• Urinary tract or genital development. Sometimes the urinary tract or genitals don’t develop normally.
• Hernia and problems with the testes. A child may have an inguinal hernia, in which the intestine comes through the wall of muscle in the lower belly. It looks like a bulge. In girls, it can bulge into the labia, the tissue around the opening of the vagina. In boys, it can bulge into the the sac that holds the testicles (scrotum). A swelling or bulge in the testes can also be caused by a hydrocele (HAHY-druh-seel), which is fluid in the testes. This is common in infants. Swelling can also be due to a varicocele (VAR-i-koh-seel). This is like getting a varicose vein in the testes. It’s more common in older boys and men.
• Cancers of the urinary tract or genitals. Pediatric urologists remove tumors and treat these rare cancers in children.

What Procedures Does a Pediatric Urologist Do?

Pediatric urologists offer treatments for problems of the urinary tract and genitals, including:

• Urodynamic testing. The doctor may use different tests to look at how well the bladder is holding and emptying urine. These tests may also show if the bladder muscles are moving to release urine when they shouldn’t. The type of testing depends on the child and the problem. Sometimes the doctor just wants to see how long it takes a person to start their flow of urine and how much urine they have at one time. The doctor may use instruments to record how much pressure is in the bladder or check the muscle and nerve activity there.
• Surgery. Surgery may be used to repair problems or remove growths in the urinary tract or genitals. Surgery is one treatment option for disorders and differences in sex development, but other therapies may be used. The pediatric urologist is part of the care team that may also include an endocrinologist, who specializes in hormones.
• Lithotripsy. With this treatment, shock waves are used to break up kidney stones into pieces that are small enough to pass through the small tubes of the urinary tract. Sometimes a child will need surgery to remove the kidney stones instead.

NIH National Institute of Diabetes and Digestive and Kidney Diseases

• “Bladder Control and Bedwetting in Children”
• “Urodynamic Testing”

American Academy of Pediatrics

• “Explaining Disorders of Sex Development & Intersexuality”
• “Inguinal Hernia”