CHENNAI: Genitourinary disorders are among the most common surgical issues in children, comprising over 40 per cent of paediatric surgical cases seen in clinical practice. Many of these conditions stem from congenital defects present at birth, while others are acquired. The critical factors in managing these disorders are early diagnosis, appropriate treatment, and meticulous follow-up.
Urological issues in children
Paediatric urology addresses conditions such as fetal kidney swelling (fetal hydronephrosis), urine flow blockages (PUJ obstruction), backward urine flow (vesicoureteral reflux), and urinary tract infections (UTIs). It also includes undescended testicles, abnormal urethral openings (hypospadias), voiding disorders, and nerve-related bladder problems (neurogenic bladder).
Timely therapy and careful monitoring are critical because organs like the kidneys, ureters, urinary bladder, and testes are still maturing during the early years of life. Any adverse events during this developmental phase can have lasting effects on their structure and function.
Treatment for hypospadias
Hypospadias, a condition involving abnormal urethral openings, is one of the most common birth defects, affecting up to 1 in 200 newborns. Treatment typically involves surgery, ranging from a straightforward single-stage procedure to more complex multi-stage reconstructions. The timing and type of surgery are crucial to achieve optimal functionality and appearance.
The initial surgery offers the best opportunity for success, as performing corrective procedures later or reoperating after a failed initial surgery poses significant challenges.
Treatment approaches
It is important to note that not all conditions in paediatric urology require surgery. Some improve naturally or respond well to medical management. Decisions regarding endoscopic or surgical intervention are made during follow-up.
Surgery is typically recommended only when the condition worsens or begins to impair kidney function. However, certain conditions, such as hypospadias, PUV (posterior urethral valves), and UDT (undescended testes), invariably require surgical correction to ensure normal development and functionality.
The author is a senior consultant (Paediatric Surgery) at SP Medifort Hospital, Kerala.
