An Overview of Pediatric Urologic Illnesses
Pediatric urological illnesses refer to conditions involving the kidney, bladder, and urinary tract. Some urological illnesses are temporary, while others can be chronic issues. These illnesses can be related to urological embryological development and can have familial etiology.
In what follows, we’ll be focusing on some specific types of pediatric urologic conditions and discussing their characteristics and causes, potential treatment options, and long-term outlooks.
Types of Pediatric Urologic Illnesses
Some of the various types of pediatric urologic illnesses include vesicoureteral reflux, phimosis, undescended testes, and Wilms tumor. Others include pyelonephritis, ectopic kidney, staghorn calculi, and polycystic kidney disease.
The following is a discussion of some of the most common and recognizable pediatric urologic illnesses.
Vesicoureteral Reflux
Often diagnosed in infants, vesicoureteral reflux is the irregular flow of urine back from the bladder through the ureters to the kidney. The normal pattern is for urine produced by the kidney to flow only in the descending pattern down to the bladder and be released externally during micturition.
This is a condition that can usually be managed conservatively, and with time, the condition will improve. Children or adolescents with this condition will need to have urinalysis monitored and subsequent treatment with appropriate antibiotics in order to prevent infection of the kidneys (pyelonephritis).
In cases where the condition does not improve over time, surgical treatment by a urologist will be necessary. Surgery consists of the repair of the valve at the attachment of the ureter to the bladder. This is a highly successful treatment, and in some cases, the repair can be done endoscopically.
Phimosis
Although not as common a condition in modern times, it’s estimated that about 1% of the population still experience it.
A condition that is normally seen in male adolescent children, phimosis is a condition whereby the individual has difficulty retracting the foreskin of the penis. This is often because of adhesions that have been formed between the foreskin and the underlying glans penis.
With several potential causes, phimosis can usually be prevented through proper hygiene, infection avoidance, and injury avoidance. Certain skin conditions can also be a potential cause of phimosis.
Phimosis can be treated with steroidal topical creams, manual therapies, and surgical excision of the foreskin. Those diagnosed with phimosis at a very young age tend to do very well with conservative management, and surgical treatment is rarely needed.
Undescended Testes
In male newborns, undescended testes is a circumstance in which the testes fail to descend into the scrotum, a process that normally occurs before birth. An idiopathic condition, undescended testes, or cryptorchidism is the most common congenital abnormality of the genitourinary tract. In some cases, the testes remain in the abdominal cavity, and in others, they partially descend and may be palpable in the inguinal canal. A suggested reason for the condition has been gonadotropin deficiency during pregnancy development of the fetus.
Because it’s quite an evident condition, undescended testes are diagnosed immediately upon the first examination after birth. Once diagnosed, the doctor will convey to the family that, in most cases, the testes will descend naturally. After six months, if the testicles have not descended into the scrotum, further intervention will be required, typically via surgical intervention. Surgical intervention is quite successful, and children have excellent outcomes from this process.
Other types of treatment include hormonal therapy to induce the process of natural testicular descent. Studies have not shown that this method has been as effective as surgical treatment.
Wilms Tumor
Wilms tumor is a malignant tumor that forms in the kidneys in childhood. It is known as the most common type of pediatric kidney cancer, with about 500 new cases each year. A genetic correlation in the formation of Wilms tumor is likely and has been widely studied. Most of the cases of Wilms tumor involve only one tumor, but in rare cases, children can develop two or more tumors making it a more complex condition for management.
The tumor is identified as an abdominal mass on examination, and CT scan or MRI imaging will help clarify the diagnosis. Tissue biopsy will then identify the specific cell type, and treatment options will be based on staging of the neoplasm. The treatment will include operative resection of the tumor and chemotherapy. The five-year survival rate of Wilms tumor has improved to over 90% over recent years due to advancements in treatment.
Final Thoughts
Once the symptoms of a pediatric urologic illness have been identified, it’s important to seek medical guidance regarding treatment and management. Diagnosis by a medical professional will ensue, and the timely institution of effective therapy can proceed.
It’s pleasant to know that the possibility of conservative management for many pediatric urologic illnesses is likely. Yet, advanced intervention, when necessary, has been very effective in attaining excellent outcomes.
