Pediatric Urology Overview, Examination, Diagnostic Tests

Introduction to Pediatric Urology

Pediatric urology is the diagnosis and treatment of congenital (i.e., present at birth) and acquired urological conditions and diseases in children. Pediatric urologists treat conditions of the male reproductive tract (e.g., undescended testicle) and the male and female urinary tracts (e.g., urinary tract infection).

The urinary tract consists of the organs that filter the blood and form urine (kidneys), the tubes that carry urine from the kidneys (ureters), the organ that stores urine (bladder), and the tube that carries urine from the bladder and removes it from the body (urethra).

The most common condition treated by pediatric urologists is urinary tract infection (UTI).

Other conditions include the following:

• Abnormally located urethral opening (hypospadias)
• Backup of urine from the bladder into the ureter (vesicoureteral reflux [VUR])
• Bedwetting (nocturnal enuresis)
• Distention of the kidney in utero (antenatal hydronephrosis)
• Ureteropelvic junction obstruction (UPJ obstruction; may cause kidney damage)

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Pediatric Urological Examination

Most children under the care of a pediatric urologist are school-aged and younger. UTIs (e.g., cystitis) are most common in young girls and pediatric urological conditions are usually congenital and treated at a young age. Conditions such as vesicoureteral reflux and antenatal hydronephrosis are frequently diagnosed during prenatal ultrasound and hypospadias is usually diagnosed during infancy.

The pediatric urological examination includes a medical history and a comprehensive physical examination. A history of symptoms, illnesses, injuries, medications, prenatal ultrasound, and family history are documented. A urinary catheter may be inserted into the bladder through the urethra to withdraw urine.

Diagnostic tests include the following:

• Blood tests
• Cystometrogram, which measures bladder pressure at various stages of filling
• Cystoscopy, which is an examination of the bladder and ureter
• Intravenous pyelogram, which is a series of x-rays of the ureter and renal pelvis taken after injecting a contrast agent
• Magnetic resonance imaging (MRI scan)
• Renal scan
• Ultrasound (to detect blockage in the urinary tract)
• Urinalysis and urine culture (to detect UTI)
• Urodynamic studies, which measure the storage and rate of movement of urine from the bladder)
• Uroflowmetry, which measures urine flow
• Voiding cystourethrogram (VCUG; used to observe the urinary tract before, during, and after urination)

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