Common paediatric urological conditions

What are the most common paediatric urological conditions, and how can parents recognise the signs and symptoms?

Paediatric urological conditions refer to medical conditions affecting the urinary tract, bladder and kidneys of children.

Some of the most common paediatric urological conditions include:

Urinary Tract Infections (UTIs):

A UTI is a bacterial infection that affects the urinary tract, which includes the kidneys, ureters, bladder, and urethra.

UTIs often result in painful or frequent urination, urine with an unpleasant odour, fever, and abdominal pain.

Vesicoureteral reflux (VUR)

This occurs as a result of urine flowing back from the bladder, into the ureters and kidneys.  It can cause repeated UTIs, urinary incontinence and high blood pressure.

Hydroceles

Hydroceles occur when fluid begins to collect around the testicles. It can cause swelling In the scrotum and a dragging sensation.

Undescended testicle (cryptorchidism)

This is a condition in which one or both testicles fail to descend into the scrotum. It can result in an empty scrotum, swelling around the groin and an unusually small/ a smaller-than-normal scrotum.

Phimosis

Phimosis is when the foreskin cannot be retracted from the head of the penis. It can cause pain during urination and infection.
 

Hypospadias

Hypospadias occurs when the pee tube opens on the underside of the penis rather than at the tip.  In more severe cases, the penis may be bent over.

Varicocele

This is when the spermatic cord veins become enlarged and swollen.  It can result in the testicle not growing and a dull aching pain or discomfort in the testicle.

Bedwetting (nocturnal enuresis)

Nocturnal enuresis is a condition where children wet the bed involuntarily. It occurs frequently in younger children and usually resolves on its own.

Hydronephrosis

Hydronephrosis is where one or both kidneys are enlarged and is a result of urine backup. Signs and symptoms may include abdominal pain, nausea and vomiting.

If parents begin to notice any of these symptoms in their child, they should seek medical attention from a specialist, such as a paediatric urologist.

It is essential to diagnose and treat paediatric urological conditions properly, in order to prevent long-term complications and to ensure optimal outcomes for the child.

What factors should parents consider when choosing a treatment approach?

Parents must consider the following factors when deciding on a treatment approach for their child’s urological condition.

Age

The child’s age may affect the type of treatment that is recommended. Younger children may be treated with less invasive approaches, while older children may require more complex surgical procedures.

The severity of the condition

Treatment choice may depend on the severity of the condition. Some cases can be treated with conservative management, such as antibiotics but in more severe cases, surgery may be necessary.
 

The natural history of the condition

It is important to observe the child for the development of the medical condition. Some conditions may resolve spontaneously without treatment, while others may worsen without treatment conditions.

Potential risks and benefits

Parents should weigh the potential risks and benefits of each treatment option and speak to the child’s healthcare provider before making a decision.

Recovery time

The recovery time associated with each treatment option should be considered, as some surgical procedures may require a longer recovery than others.

The child's preferences and comfort

It is important to consider the child’s treatment preference, ensuring they feel comfortable.

Long-term effects

It is important to the long-term effects of each treatment option. Parents must discuss these with the child's healthcare provider to ensure that they make an informed decision.

How can parents best support their child's recovery from paediatric urological surgery, and what are some common complications to watch out for?

Parents can play a crucial role in supporting their child's recovery from paediatric urological surgery. It is recommended that they:

Follow the doctor's instructions

It is essential to follow the doctor's instructions for post-operative care.

Provide comfort and support

Parents should provide a comfortable environment and emotional post-operative support.

Encourage physical activity

Physical activity, within the limitations of the post-operative instructions, can aid healing and reduce the risk of complications such as blood clots.

Monitor for signs of infection

Parents should look out for signs of infection, such as fever, redness, or swelling around the area where surgery was performed.

Attend follow-up appointments

It is essential to attend all scheduled follow-up appointments to monitor the child's progress and ensure that any complications are detected and treated promptly.

Complications which may occur due paediatric urological surgery include bleeding, infection, and urine leakage. Parents should contact their child's healthcare provider immediately if they notice any signs of complications such as increased pain or fever.

What steps can parents take to prevent paediatric urological conditions from developing or worsening?

Some paediatric urological conditions cannot be prevented, however, there are several steps parents can take to reduce the risk of their child developing or worsening certain condition, which include the following:

Encourage good hygiene practices

It is crucial to teach your child good hygiene practices, including wiping from front to back after using the bathroom and cleaning the genital area thoroughly.

Stay hydrated

You should encourage your child to drink plenty of fluids in order to help prevent urinary tract infections and other urological conditions.

Manage constipation

Constipation can contribute to urinary tract problems, therefore you should  ensure that your child eats a healthy diet rich in fibre, drinks enough water and exercises regularly.

Ensure your child is up-to-date on vaccinations

Certain vaccines, such as the HPV vaccine, can help prevent certain urological conditions, such as genital warts and some types of cancer.

Promote good toilet habits

Encourage your child to go to the bathroom regularly and not hold their urine for extended periods of time because this can contribute to urinary tract problems.

Seek prompt treatment for urinary tract infections

If your child develops symptoms of a urinary tract infection, seek immediate treatment to prevent the infection from spreading and causing further complications.

Monitor your child's development

You should regularly bring your child to visits a paediatrician, to help ensure that your child's urological system is developing normally and to detect and treat any problems.

By following these tips, parents can help reduce the risk of their child developing or worsening certain paediatric urological conditions.

What are some key questions that parents should ask their paediatric urologist during appointments?

The following are questions parents can ask the paediatric urologist during an appointment:

• What is the diagnosis?
• What caused this condition?
• What treatment options are available?
• What is the recommended course of treatment and why?
• What are the potential complications of the treatment, and how likely are they to occur?
• What are the long-term implications of this condition and its treatment?
• How can the condition be prevented from recurring, and what lifestyle changes may be necessary?
• What can we expect during recovery, and what are the signs of complications to watch for
• What will happen in the future?  (Some conditions may resolve without treatment, and others may worsen if you do not treat them).

It is important for parents to ask these questions, in order to understand their child's condition, treatment options, and how to support their child's health and recovery.