It was a distressing situation for Ashish Gowda’s (name changed) family when the six-year-old boy from Bangalore was rushed to a private hospital after complaints of severe pain in his right abdomen. An ultrasound revealed swelling in his kidneys. Further examination — including an EC (ethylene cysteine) renal scan to evaluate kidney function — revealed narrowing of his ureter, causing blockage where it meets the kidneys.
Known as ureteropelvic junction (UPJ) obstruction, the condition is characterized by a partial or complete impediment in the area where a part of the kidney connects to the ureters, which helps transport urine to the bladder, says Dr Sreeharsha Harinatha, senior consultant, department of urology, robotic surgery and renal transplant, Kauvery Hospitals, Bangalore.
The child underwent a robotic pyeloplasty (a surgical procedure) to rectify the obstruction and is currently recovering. A follow-up scan will be conducted after six months to evaluate his progress, he adds.
Common urological conditions in children
Urological issues are becoming increasingly prevalent in children. “While some conditions are readily identified during routine checkups, others may present as emergencies, causing significant distress for the child and their parents,” says Dr Manjiri Somashekhar, lead & senior consultant, pediatric surgery, Aster CMI Hospital, Bangalore.
Dr Radhakrishnan C N, HOD & consultant, pediatric surgery and pediatric urology, Manipal Hospitals, Bangalore, shares, “Urological problems in children can be classified into two categories: disorders present at birth and those arising due to infections or other reasons.” He also urges parents to be aware of the early signs of such issues, which include increased urination frequency, foul-smelling urine, a high fever and difficulty gaining weight.
Some common urogenital issues seen in children include:
♦ Urinary tract infections (UTIs)
Dr Harinatha says UTIs are one of the most common urological problems faced by children. Highlighting the incidence of such infections, Dr Radhakrishnan points out that around three percent of children experience UTIs, with their prevalence being three times higher among girls. Early intervention is crucial, as such infections can lead to scarring of the kidneys, causing kidney failure in the long run.
♦ Hydronephrosis
This is a condition where one or both kidneys become swollen due to the buildup of urine. The symptoms include nausea, vomiting, fever and painful urination, notes Dr Somashekhar. A review study cited UPJ obstruction as the leading cause of fetal hydronephrosis, which in turn is associated with UTIs and urinary stone disease.
♦ Vesicoureteral reflux (VUR)
VUR, colloquially known as reflux, is a congenital condition where the urine flows backward from the bladder to the kidneys (through the ureter) instead of the other way around, says Dr Harinatha. According to Dr Radhakrishnan, the condition is more prevalent in girls, where some amount of urine flows back into their kidneys, causing infections. “VUR can range from mild to severe, and the resulting infections can damage the kidneys without timely intervention,” he adds.
♦ Cryptorchidism
In this case, one or both testicles stay in the groin or abdominal region instead of descending into the scrotum. If they don’t fall into the scrotum on their own after six months, medical intervention is required. “Surgery is recommended to treat the condition, as delayed intervention may damage the sperm. In addition, there’s an increased risk of testicular cancer,” informs Dr Radhakrishnan.
♦ Hypospadias
This is a birth defect in boys, where the opening of the urethra (in the penis) is at an abnormal location. “It is present further down the penis, sometimes even lower than the scrotum in severe cases. The condition can range from mild to severe and even lead to downward bending of the pelvis,” shares Dr Radhakrishnan.
Causes of pediatric urological conditions
Dr Somashekhar says that unlike minor bruises that may heal readily, urological conditions require comprehensive evaluation to devise appropriate treatment plans.
The primary causes of urological issues include:
- Infrequent voiding (holding urine for long periods) or incomplete bladder emptying
- Hormonal imbalances
- Poor hygiene
- Injuries to the urinary tract
- Autoimmune disorders
Preventing pediatric urological conditions
While measures like behavioral therapy (for issues like bedwetting), medications and surgical interventions can be implemented to address serious complications, children should also adopt certain lifestyle modifications to keep urological problems at bay. They include:
- Maintaining proper hygiene
- Ensuring adequate hydration
- Having a healthy diet
- Regular checkups with the pediatrician
- Open communication with parents for early detection of symptoms
Takeaways
- Parents should be aware of the signs of urological issues in children, which include increased urination frequency, foul-smelling urine and a high fever.
- Some common urological conditions in children include UTIs, hydronephrosis, undescended testicles and hypospadias.
- The primary causes of urological conditions include infrequent voiding, hormonal imbalances, poor hygiene and autoimmune disorders.
- A healthy diet, adequate hydration, proper hygiene and regular health checkups can keep such issues at bay.
