What is pediatric urology?
Pediatric urology deals with conditions of the kidneys, urinary tract and genital organs in children, from the newborn period to adolescence. Some of these problems are congenital, and when they are recognised early and treated at the right time, their effect on the child’s later life can be minimised. The main conditions that families commonly encounter are summarised below.
Undescended testis
This is the absence of one or both testes from the scrotum at birth. It is particularly common in babies born prematurely. The testis may descend on its own in the first months, but after 6 months of age this is quite unlikely.
The diagnosis is usually made by physical examination. The examination distinguishes whether the testis is a “retractile testis”, that is, one that is pulled upwards by cold or touch and can come down into the scrotum on its own or be brought down by hand. For testes that cannot be felt, laparoscopy may be needed for diagnosis and treatment.
Treatment is surgical. In an operation called orchidopexy, the testis is brought down into the scrotum and fixed in place. To support healthy development of the testis and help preserve fertility later in life, surgery is ideally recommended between 6 and 18 months of age. Testicular self-examination later in life is also important for men with a history of undescended testis.
Hypospadias
In hypospadias, the urinary opening is not at the tip of the penis but somewhere on its underside. A downward curvature of the penis and a foreskin that is present only on the upper side (a “hooded” appearance) are often also present. It is noticed at birth.
Treatment is surgical and the repair is usually planned in infancy. In suitable patients, one of the commonly used methods is TIP (tubularised incised plate) urethroplasty. A child with hypospadias should not be circumcised before the repair, because the foreskin may be used as tissue during the repair. Regular check-ups after surgery are important, as problems such as narrowing of the urethra or a fistula (an extra opening) can develop.
Phimosis
Phimosis is the inability to pull the foreskin back over the head of the penis. In infancy and early childhood this is usually physiological, meaning normal, and the foreskin loosens by itself over time. During this period the foreskin should not be forcibly retracted; forcing it can cause small tears and scarring.
Treatment is needed in cases such as recurrent inflammation of the foreskin, marked difficulty passing urine, or whitening and hardening of the skin with scarring. The first step is usually a steroid cream; surgical treatment is considered in children who do not respond.
Circumcision
In Turkey, circumcision is mostly performed for religious and cultural reasons. In addition, circumcision may be needed for medical reasons such as phimosis that does not respond to treatment, recurrent inflammation of the foreskin (balanoposthitis) and, in selected patients, recurrent urinary tract infections.
Although circumcision may seem simple, it is a surgical procedure. It should therefore be performed by a doctor, under sterile conditions and with appropriate anaesthesia. An examination is always carried out beforehand: in children with congenital differences of the penis such as hypospadias or buried penis, or with a bleeding disorder, the timing and method of circumcision may change. When there is no medical necessity, the timing of circumcision is decided by considering the child’s general health, the need for anaesthesia and the family’s preferences together. See the circumcision page for more information.
Bedwetting (enuresis)
Wetting during sleep after the age of 5 is called enuresis. Although it is worrying for families, it is common and resolves by itself with age in a large proportion of children. Children who wet only at night are assessed differently from children who also have daytime wetting, urgency or frequent urination.
The assessment uses a voiding and fluid diary, a urine test and, where needed, ultrasound. Constipation, if present, is always treated. Treatment options include behavioural measures such as adjusting fluid intake before bedtime and regular toilet habits, an enuresis alarm and, in suitable children, medication. Bedwetting is not under the child’s control; punishing or shaming the child is not recommended.
Vesicoureteral reflux
Vesicoureteral reflux (VUR) is the backflow of urine from the bladder towards the kidneys. It is usually discovered while investigating children who have had a urinary tract infection with fever, or during the follow-up of babies whose kidneys were found to be dilated during pregnancy. Ultrasound and a voiding cystourethrogram are used for diagnosis. Because recurrent infections with fever can cause permanent kidney damage, it is important to assess reflux properly.
Mild reflux may resolve by itself as the child grows. Depending on the grade of reflux, the child’s age, the frequency of infections and the condition of the kidneys, treatment is chosen from observation, preventive antibiotics, endoscopic injection treatment or open or laparoscopic surgery. See the urinary tract infection page for details.
Testicular torsion: an emergency
Testicular torsion is the twisting of the testis around its own blood supply, cutting off blood flow. Although it is most common in adolescence, it can occur at any age, including in newborns.
Symptoms: sudden, severe pain in the testis, swelling, redness, abdominal pain, nausea and vomiting. The pain is sometimes perceived only as abdominal pain; for this reason, the testes should always be checked in boys with abdominal pain.
What should you do? Testicular torsion is an emergency that cannot wait. The chance of saving the testis is highest in the first hours, and the first 6 hours in particular are considered critical. A child with sudden testicular pain should be taken to an emergency department immediately, without waiting for the pain to pass and without being given anything to eat or drink.
Physical examination and Doppler ultrasound are used for diagnosis, but if torsion is strongly suspected, surgery is not delayed for imaging. During the operation, the testis is untwisted and both testes are fixed so that they cannot twist again. While preparing for surgery, the doctor may attempt to untwist the testis by hand (manual detorsion) in suitable patients; this can help restore blood flow early, but it does not replace surgery.
The surgical process and advice for families
Most urological operations in children are performed under general anaesthesia as day cases or with a short hospital stay. Before surgery, the child’s general health and fitness for anaesthesia are assessed, and the family is told separately how long the child needs to fast on the day of the operation. After surgery, written advice is given on pain control, wound care, bathing and returning to activities. In cases such as fever, increasing redness or discharge at the wound or inability to pass urine, a doctor should be consulted without delay.
Informing the child in calm, honest language appropriate to their age makes it easier for them to cope with the hospital process. For circumcision and genital operations, it is important not to frighten the child or present the procedure as a “punishment”.
When is a pediatric urology consultation needed?
It is advisable to see a urologist in the following situations:
- One or both testes cannot be felt in the baby’s scrotum
- The urinary opening is not at the tip of the penis, or the penis appears curved
- The child has had a urinary tract infection with fever, or infections keep recurring
- Kidney dilatation was found on a pregnancy ultrasound or after birth
- Bedwetting or daytime wetting continues after the age of 5
- Straining to pass urine, or recurrent inflammation together with ballooning of the foreskin
- Swelling in the groin or scrotum
Sudden testicular pain, however, is not a reason to wait for an appointment; go directly to an emergency department.
Pediatric urology in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has published scientific studies on the outcomes of TIP urethroplasty in proximal hypospadias, urinary nerve growth factor (NGF) and bladder wall thickness in children with bedwetting, and manual detorsion in testicular torsion. He sees children in Bursa (Nilüfer) at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. Families travelling from abroad, including those visiting relatives in Turkey, can book the visit in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67), and share previous reports beforehand via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
