Pediatric Urology includes the study, diagnosis and treatment, both medical and surgical, of conditions that affect the adrenal gland, kidneys, ureters (tubes that drain the kidneys), bladder, penis and vagina, the testicles and groins in both male and female children.
Areas of Special Expertise
The section of Pediatric Urology includes nine pediatric urologic surgeons, all of who are fellowship trainees and who devote 100% of their professional time to the diagnosis and treatment of children with pediatric urologic problems. Each member of the team is fully qualified to perform all of the techniques and surgical treatment in all of the pathologic entities listed. However, the large size of our group allows each surgeon to subspecialize in a particular area of interest. Difficult clinical problems in a particular area are "inter-referred" to the surgeon within our group who has the most experience in that particular pathologic entity. These areas of interest include; laparoscopic urologic surgery, calculus (stone) treatment, hypospadias, bladder exstrophy and epispadias reconstruction, treatment of urinary incontinence, urodynamic evaluation of voiding and bladder dysfunction and incontinence with bladder stimulation and biofeedback treatment, neurogenic bladder, intersexuality and ambiguous genitalia reconstruction, perinatal urology, hydronephrosis and megaureters, vesicoureteral reflux, prune belly abdominal wall reconstructions, undescended testes and treatment of varicoceles.
Important Conditions Diagnosed and Treated
Urinary Tract Infections
Burning on urination, frequency, hematuria (blood in the urine), urinary incontinence (day and nighttime wetting), pyelonephritis (kidney infection), cystitis (bladder infection), urethritis (infection of urethral tube - which is the tube through which your child urinates).
HEMATURIA (Blood in the urine)
This can be caused by many conditions. These may be conditions that affect the kidney, the ureter (tube draining the kidney), the bladder or the urethra (tube through which we urinate). These conditions include infections, blockages in the kidney or ureter or urethra, cysts of the kidney, kidney stones or kidney tumours. Special tests such as ultrasounds, voiding cystourethrograms (x-rays of the bladder and urethra), CAT (Computerized Axial Tomography) scans, intravenous s urograms (IVU's) and MRI'S (magnetic resonance imaging) allows the specific diagnosis to be made and the treatment can then be selected.
Kidney Stones (Calculi)
These usually cause back pain or abdominal pain together with hematuria (blood in the urine) and in some children fever also occurs.
Vesicoureteral Reflux (VUR or Reflux)
Urine going back up to the kidneys from the bladder. This is an abnormal condition that is frequently discovered in children who develop urinary infections. It is found during the evaluation of the cause of the urinary tract infections. In some children antibiotic treatment and observation is all that is required for treatment, whereas in other children surgery is the best course of treatment.
Undescended Testes
Failure of complete decent. Failure to recognize this condition or to treat it in a timely fashion can result in later infertility (inability to father one's own child). Hormone treatment, groin surgery or laparoscopy are all used to treat this condition depending upon its severity.
Hernia - Hydrocele
Communication between the abdomen and scrotum or in girls between the abdomen and labia resulting in fluid or abdominal content moving through the groin into the scrotum or labia in female children.
Varicocele
Abnormal swollen scrotal veins. This condition is usually discovered just before puberty or during puberty. The increased temperature in the scrotum caused by these large veins can sometimes affect the growth and maturing of the testicles resulting in infertility (inability to father one's own child) as well as cause scrotal discomfort. Treatment may simply require observation in order to monitor growth of the testicle. In more severe cases, surgery is the procedure of choice.
Urinary Incontinence or Enuresis
Failure to gain control of urination beyond the age that this is expected. This condition may only be a problem at nighttime or it may occur both during the day and at nighttime.
Ambiguous Genitalia or Intersexuality
Inability at birth to be certain whether the child is a male or a female. The genital appearance is confusing in that the penis may look less well developed than that of a normal boy or the clitoris may be overdeveloped for a normal girl. In addition, the scrotum may be split and this lack of fusion (joining) could represent underdevelopment of the normal scrotum or over development and "masculinization" of the labia majora (female vaginal lips). Special genetic tests and hormone studies as well as ultrasounds and x-rays are required to diagnoses this condition properly and to assign the proper sexual identify to the baby. Surgery is usually required to correct the genital appearance.
Hypospadias
Failure of the urethral tube in boys to develop all the way to the tip of the penis. It is frequently associated with a downward bend of the penis (Chordee) and less penile skin on the undersurface of the penis. It is important not to circumcise these boys because the skin that would normally be removed by the circumcision is used to surgically correct this deformity.
Phimosis
Inability to retract (pull back) the penile skin back over the glans penis (head of the penis). This condition may require "freeing up" of the excess penile skin or circumcision (removal of the extra skin).
