CHILDREN'S HEALTH

Children need special care for urology issues. The team at Western Michigan Urological Associates is specifically trained and experienced in all pediatric-related urology issues. We offer a full range of treatment options for all conditions affecting infants to adolescents.

• Circumcision

  Circumcision - Routine circumcision is usually performed within 10 days of birth. In some cases, the procedure may be delayed. We perform circumcision on infants as well as older children and adults.

  Complication risks are relatively low. If a problem does occur, we are trained and experienced to treat it.

  There are several advantages to circumcision. Circumcised infants are less likely to develop urinary tract infections, especially their first year of life. Later, circumcised men are at a lower risk for penile cancer. What's more, circumcision may protect against sexually transmitted diseases, including HIV.

  Want more information about circumcision? Click here.

  Circumcision

  Circumcision, removing the penis foreskin, has some potential medical benefits and advantages. You should understand what's involved to ensure you are making the right decision for your son. In infants, the procedure takes about five to 10 minutes. A local anesthetic is given to less the pain.

  The penis goes through a rapid growth spurt during the first few months of life and may quickly become too large to safely remove the foreskin. It becomes more complicated and riskier in infants older than two months and in boys and men. For older children, the procedure is usually performed in an operating room under general anesthesia.

  Health benefits

  Circumcision may help prevent:

  • Urinary tract infections in infants.
  • Penile cancer in adult men. However, this cancer is rare in all men, whether or not they have been circumcised.

  Risks

  • Bleeding
  • Infection and penile injury
  • Buried penis
  • Meatal stenosis
  • Skin bridges
  • Chordee
  • Poor cosmetic appearance
• Distal Hypospadias

  Distal Hypospadias - Sometimes males are born with their urethral meatus (the external opening for urine) on the underside, rather than on the tip, of the penis. Someone with this condition may have to sit while urinating and be more prone to urinary tract infections and suboptimal fertility later in life.

  Distal hypospadias can be repaired with surgery. We will explain the procedure so you can determine whether it's right for your child.

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  Distal Hypospadias

  Hypospadias is a congenital defect of the penis that happens when the urethra, corpora cavernosa and foreskin do not develop completely. The condition does not cause significant urinary symptoms other than a more downward urine stream. This defect occurs in one in 300 live male births.

  Treatment

  • Surgery can often correct the defect. Surgery is best performed between ages six and 18 months, prior to toilet training and during a time when a boy is still unaware of his genitals. We perform the procedure under general anesthesia and use a penile nerve block to reduce post-surgery discomfort.
  • The focus of surgery is to reconstruct the defect
  • Create a normal urethral meatus and glans penis
  • Straighten the penis
  • Create a normal urethra
  • Correct the scrotum position in relation to the penis
• Hematuria

  Hematuria (blood in urine) — Although blood in a child's urine can be alarming, it is often not a sign of significant disease. Between 9 to 18% of normal individuals have some hematuria. However, blood in the urine can be a sign of other medical conditions requiring treatment so seek care.

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  Hermaturia

  Hermaturia, or blood in urine, can happen for many reasons. In fact, there are at least 50 different causes of hermaturia in children. Blood in the urine is often not a sign of significant disease. In many patients, no specific cause is found; however, hematuria may be a sign of infection, stone disease or urinary tract cancer.

  Hematuria can start from any place along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra.

  Symptoms

  Hermaturia itself does not have any symptoms other than red urine, in some cases. The conditions that cause the blood in the urine may produce symptoms.

  Diagnosis

  • Urine dipstick test — If test is positive, the amount is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per high power field on two of three specimens, we may recommend further testing to determine a cause.
  • Medical history
  • Physical examination
  • Laboratory analysis
    • Evaluate for protein (a sign of kidney disease)
    • Check for evidence of a urinary tract infection
    • Determine blood cell shape, which helps to determine the bleeding's origin
    • Measure serum creatinine (a measure of kidney function)
  • X-rays of the kidneys and ureters to detect kidney masses, tumors of the ureters and urinary stones

  Treatment

  Treatment is based on the condition, symptoms and medical history along with the cause of the hematuria.

• Hydronephrosis

  Hydronephrosis — Obstruction of the urethra can produce dilation of the kidney(s). We may monitor the condition or recommend surgery, depending on the severity.

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  Hydronephrosis

  Hydronephrosis is swelling of one (unilateral) or both (bilateral) kidney(s) due to urine backup. Hydronephrosis is a condition that occurs with a disease. It is not a disease itself. Unilateral hydronephrosis occurs in about 1 in 100 people. If hydronephrosis is left untreated, the affected kidney may be permanently damaged.

  Conditions often associated with unilateral hydronephrosis

  • Acute unilateral obstructive uropathy
  • Chronic unilateral obstructive uropathy
  • Reflux (backflow of urine from bladder to kidney)
  • Kidney stones

  Conditions associated with bilateral hydronephrosis

  • Acute bilateral obstructive uropathy
  • Bladder outlet obstruction
  • Chronic bilateral obstructive uropathy
  • Neurogenic bladder
  • Posterior ureteral valves
  • Prune belly syndrome
  • Retroperitoneal fibrosis
  • Uteropelvic junction obstruction
  • Reflux

  Symptoms

  • Side pain
  • Abdominal mass
  • Nausea and vomiting
  • Urinary tract infection
  • Fever
  • Painful urination
  • Increased urinary frequency
  • Increased urinary urgency
  • Sometimes no symptoms

  Diagnosis

  Unilateral hydronephrosis is usually identified with tests such as:

  • Abdominal MRI
  • CT scan of the kidneys or abdomen
  • Intravenous pyelogram (IVP)
  • Isotope renography (special scan of the kidneys)
  • Ultrasound of the kidneys or abdomen
  • Pregnancy (fetal) ultrasound

  Treatment

  Treatment and prognosis for unilateral hydronephrosis depend on the cause of the kidney swelling. Treatment may include:

  • Urethral reconstruction or surgical treatment of the bladder or urethra.
  • Preventative antibiotics may be prescribed to decrease the risk of urinary tract infections in patients who have long-term hydronephrosis.
• Hernias/Hydrocele

  Hernias/Hydrocele -- Hernias and hydroceles are similar problems. They most commonly affect boys, although girls can develop issues, too. The conditions may be hereditary.

  A hydrocele is a collection of fluid in the scrotal sac of male infants. A baby's scrotum may appear swollen or large. Sometimes the fluid will go away within six to 12 months. If it doesn't, surgery may be required to prevent additional complications.

  Want more information about hernias/hydrocele? Click here.

  Hernina/Hydrocele

  Testicles develop near kidneys and descend to their normal position in the scrotum just before a boy is born. For the testicles to leave the abdomen, a muscle ring in the groin on each side opens, allowing the testicles to drop. As the testicles descend, the abdominal lining also drops to line the scrotum. This channel usually closes.

  If it remains open, or reopens, fluid can leak to the scrotum, resulting in hydrocele. If the channel remains opens or reopens widely, some of the intestine can pass down toward the scrotum, leading to a hernina.

  Hydroceles can also develop from inflammation or injury within the scrotum. Hernias can also result from increased pressure that forces part of the intestines through a weak spot in the abdominal wall.

  Hernias and hydroceles are common. Although several family members may experience them, there is no evidence that they are inherited or that a parent could have prevented them. Girls do not develop hydroceles. They can develop hernias. Because of their anatomy, girls are 10 times less likely than boys to develop hernias.

  Symptoms

  • Hydrocele — About 10% of male infants have a hydrocele at birth. Seldom causing symptoms, this swelling of the scrotum does not bother a baby. It usually disappears in the first year, even though the appearance may worry parents. In older males, a hydrocele usually remains painless but may cause discomfort due to the increased size of the scrotum.
  • Hernina — Only about 25% cause pain or discomfort. However, you may be able to see and feel the bulge. About 1% of boys develop hernias with premature infant males having a higher incidence.

  Treatment

  • Hydroceles — Require surgical repair if they cause symptoms, such as growing large or changing size significantly during the day.
  • Hernias - Do not go away on their own and may cause problems with digestion leading to emergency surgery. We usually recommend surgery to repair the muscle ring that did not close properly. In infants and children, a small incision is made in the groin through which we suture or sew the channel shut and repair the muscle ring. This procedure can be done in an outpatient setting. In teenagers, laparoscopic surgery may be considered.

  Recovery

  • Discomfort requiring pain medication.
  • Restriction on full activity for a couple of weeks, depending on your son's age and whether both sides were treated.
  • Testicles and scrotum may remain swollen for several weeks after surgery before returning to normal. After surgery, less than 1% of cases have a hernina or hydrocele return.
• Labial Adhesions

  Labial Adhesions — Sometimes, the labial skin around a girl's vagina becomes irritated and sticks together. Adhesions may be mild, closing only part of the vaginal opening, or cover the complete vaginal opening, blocking urine or vaginal secretions.

  Labial adhesions are usually not concerning, but should be treated. We may prescribe a cream to help adhesions heal.

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  Labial adhesions

  Labial adhesions occur mostly in girls between 3 months to 6 years of age. The adhesions can continue until puberty.

  Symptoms

  • Pain in the genital area
  • Difficulty urinating
  • Frequent urinary tract (bladder) infections
  • No symptoms

  Causes
  It is not clear why some young girls develop labial adhesions. The condition may be associated with:

  • Low levels of estrogen (that girls normally have during childhood). Infant girls who have just been born don't have labial adhesions because of high levels of estrogen passed from the mother during pregnancy. High levels of estrogen from puberty make it unlikely for menstruating girls to develop adhesions.
  • Vulvar irritation can result in the labia sticking together.

  Diagnosis

  • Evaluation of the vulvar area and vaginal opening

  Treatment

  • Small or mild adhesions (those that do not cover the vaginal opening) may separate by themselves when your daughter reaches puberty.
  • Slightly larger or moderate adhesions (those covering the lower part of the vagina) may be treated with a mild emollient along with gentle separation twice a day for several weeks.
  • Significant adhesions (those covering the vaginal opening and often the urinary opening) are typically treated with an estrogen-containing cream. Significant adhesions may prevent normal vaginal secretions drainage, as well as impair urine flow.
• Reflux

  Reflux — Some children are born with vesicoureteral reflux, in which urine "backwashes" up the ureters toward the kidneys. Many children grow out of their reflux with age.

  Alone, reflux is not dangerous. However, a simple urinary infection can turn into a kidney infection if bacteria wash up to the kidney.

  The goal of treatment is to prevent kidney infections and kidney damage. We may recommend taking low-dose antibiotics to keep urine sterile. In severe cases, surgery may be required.

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  Reflux

  Reflux is a relatively rare condition, only affecting about 1% of children. Many children will grow out of this reflex as they get older. However, it is important to monitor the issue and take antibiotics to prevent kidney infections and kidney damage.

  During infancy, the disease is more common in boys. In older children, reflux is more common in girls. It affects more Caucasian children than African-American children.

  Symptoms

  • By itself, usually no symptoms
  • Most often diagnosed after a child has a urinary tract infection (UTI). Common UTI symptoms include:
    • Fever
    • Pain or burning with urination
    • Strong or foul odor to the urine
    • Sudden onset of frequent urination or wetting accidents
    • Abdominal or side pain

  Risk Factors

  • Reflux is common among children and siblings of people with reflux. There is a strong genetic component, although no specific genes have been identified.
  • Abnormal bladder function from nerve or spinal cord problems, such as spina bifida.
  • Other urinary tract abnormalities such as posterior urethral valves, bladder exstrophy, ureterocele or ureter duplication.
  • Children with dysfunctional voiding — bladder and bowel problems, including accidents, frequent urination or constipation.

  Diagnosis

  • Blood tests
  • Urinalysis and urine culture — These tests can indicate microscopic blood or protein in the urine, other chemicals, or evidence of a UTI. In children who are not toilet trained, urine may sometimes be collected with a catheter to ensure the sample is clean and pure.
  • Cystogram — A catheter is placed in the bladder and the bladder is filled with fluid. This allows us to see the reverse flow of urine toward the kidney.
  • Voiding cystourethrogram - An x-ray test to examine your child's urinary tract. The bladder is filled with contrast using a catheter. X-ray images will show if there is any reverse urine flow into the ureters and kidneys.
  • Renal ultrasound — Used to establish kidney size and shape and identify scars, kidney stones, cysts or other obstruction/abnormalities.
  • Urodynamics - Measures bladder volume, pressure and emptying. It is performed to determine how your child's bladder function may be contributing to the reflux.

  Treatment

  • To prevent infections, some children take low-dose antibiotics once a day to keep urine sterile.
  • Some children may need surgery too if they experience kidney infections despite preventive antibiotics or if the reflux does not resolve on its own. If surgery is necessary, we will use minimally invasive techniques.
• Stones

  Stones - More children are developing kidney stones, some as young as five or six. There may be several contributing factors such as food additives, salt and not drinking enough water. 50 to 60% of children with stones have a family history of the disease.

  We may try to let the stone pass, providing medicine to reduce pain. If we believe large, difficult or multiple stones could block urine flow or cause infection, we may use ultrasonic shockwave lithotripsy. This non-invasive procedure breaks stones into fragments so they more easily pass.

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  Stones

  Treating kidney stones in children is challenging because they can result from various underlying problems. Genetic risk is common, but many factors can contribute to stone development.

  Diagnosis

  Stones can lodge in any part of the urinary system. To locate them, we will use imaging tests such as:

  • X-rays
  • Ultrasound
  • Computerized tomography (CT) scan

  Treatment

  Treatment for kidney stones depends on their size and whether they are causing pain or blocking the urinary tract. Most stones pass on their own.

  • Small stones can sit in the kidney for months or even years without causing pain or damage.
  • Once stones grow larger, we may treat them even if they are not painful. Stones of this size can move into the ureter and block urine flow, causing severe pain.
  • Stones usually can be removed with either minimally invasive or non-invasive treatment.
  • Shock-wave lithotripsy — A non-invasive treatment using focused shock waves from outside the body on the kidney stone. The waves break larger stones into tiny fragments. The particles can easily pass in the urine.
  • Ureteroscopic laser lithotripsy - Some stones cannot be treated with shock-wave lithotripsy because of size, location, composition or other medical conditions. With ureteroscopic laser lithotripsy, while the patient is under anesthesia, we pass a tiny, pediatric-sized, fiber-optic camera into the urinary tract through the urethra to the stones' location in the bladder, kidney or ureter. The laser breaks the stones into tiny pieces, which are flushed from the body.
  • Percutaneous Lithotripsy (Percutaneous Nephrolithotomy) - Used to treat very large stones or those that can't be treated with other methods. We make a tiny incision through which we pass a camera into the kidney. We can then fragment the stones using ultrasonic or laser lithotripsy.

  Prevention

  To determine the underlying cause of reoccurring stones we perform:

  • A metabolic evaluation
  • Blood work
  • Urine studies

  To help lower the chance of developing stone, we recommend

  • Hydration — Drinking plenty of fluids can reduce the risk of urinary tract infections, a major cause of some stones.
  • Dietary Changes — Depending on the stone's composition and laboratory test results, we may suggest eating less meat and table salt.
  • Medication — Some patients benefit from medications. We may prescribe diuretics to decrease calcium excretion. Potassium citrate binds calcium and helps to remove it safely.
• Testicular Masses

  Testicular Masses - Growths on testicles are rare. When they do occur, it's most often in boys under age 5 or those who experience puberty early. Although most masses are benign and do not spread, they still require surgery.

  Any abnormalities to a boy's testicles need to be checked.

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  Testicular Masses

  Testicular masses (or tumors) are growths on the testicle. The cause is unknown, although researchers know that most masses start in the germ cells - the cells in the embryo that become the cells that make up the male reproductive system. The masses can be benign or malignant.

  Certain inherited defects have been associated with an increased risk for germ cell tumors. Boys with undescended testicles have an increased risk of developing testicular germ cell tumors.

  Symptoms

  • Swollen testicles
  • Hard testicles
  • Abnormal shape, or irregularity in testicular size
  • Testicular pain (although some tumors are painless)

  Diagnosis

  Most testicular tumors are identified by a parent or health-care provider as non-tender swellings in a boy's scrotum. Most scrotal masses are due to far more common problems, such as:

  • Hernina
  • Hydrocele
  • Infection of the epididymis
  • Testicular torsion

  We will determine a mass from these more common conditions by how it feels and if a light shines through it. In addition to a complete medical history and physical examination, we may also perform:

  • Ultrasound — To identify what the mass is and whether more tests or surgery is needed. We use ultrasounds to view internal organs as they function and to evaluate blood flow.
  • Computerized tomography scan (CT or CAT scan) — Shows detailed images bones, muscles, fat and organs.
  • Magnetic resonance imaging (MRI) — A diagnostic procedure using a magnet, radiofrequencies and a computer to generate detailed images of organs and structures within the body.
  • Biopsy — A sample of tissue is removed from the mass and examined under a microscope.
  • Complete blood count (CBC) — A measurement of the size, number and maturity of different blood cells in a specific amount of blood.

  Treatment

  • Surgical or medical correction of benign masses.
  • Orchiectomy - Testicular masses, if malignant, are usually removed along with the entire affected testicle. If the tumor is malignant, your son may also need to receive one or more of the following treatments:
    • Chemotherapy — S drug treatment that interferes with the cancer cell's ability to grow or reproduce. Chemotherapy may be used alone or with other therapy.
    • Radiation therapy — A treatment using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.
• Testicular Injury

  Testicular Injury - Testicles, because they are outside the body, aren't protected by muscles and bones. This makes it easier for testicles to be struck, hit, kicked or crushed.

  Loosely attached to the body and made of a spongy material, testicles can usually absorb collisions without permanent injury. However, when the tough covering is torn or shattered, blood can leak, stretching the scrotum until tense. This can lead to infection.

  If swelling does not go away or extreme pain lasts longer than an hour, the injury needs to be checked.

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  Testicular Injury

  Testicular injuries are relatively uncommon, but you should be aware that they can happen. They most often occur in boys who play sports or are more active.

  If your son's testicles are struck or impacted some way, he will feel pain or might feel nauseated for a short time. With a minor injury, the pain and any other symptoms should gradually cease in less than an hour.

  Treatment for minor injuries

  • Pain relievers
  • Rest
  • Gently support the testicles with supportive underwear
  • Apply ice packs to the area
  • Avoid strenuous activity for a few days

  When to see a doctor

  • Pain doesn't subside or your son experiences extreme pain lasting longer than an hour
  • Swelling or bruising of the scrotum or a puncture of the scrotum or testicles
  • Nausea and vomiting that doesn't go away
  • Fever

  Serious Testicular Injuries

  • Testicular torsion — The testicle twists around, cutting off blood supply.
    • This can occur from serious trauma to the testicles, strenuous activity, or for no apparent reason.
    • Testicular torsion isn't common. When it occurs, it's most often occurs in ages 12 to 18.
    • If it happens, see a doctor as soon as possible — within six hours. After six hours, there is a much greater possibility that complications could result. We may fix the problem by manually untwisting the testicles. If that treatment fails, surgery may be necessary.
  • Testicular rupture — A rare type of testicular trauma that can happen when the testicles receives a forceful direct blow or when the testicles are crushed against the pubic bone (the bone forming the front of the pelvis), causing blood to leak into the scrotum. Testicular rupture causes extreme pain, swelling in the scrotum, nausea, and vomiting. Surgery is necessary to repair the ruptured testicle.

  Prevention

  If your son plays sports, exercises frequently or lives an all-around active life, he should take precautions to avoid testicular injuries. Wear an athletic cup or athletic supporter.

  • Cups are best used when participating in sports where testicles might get hit or kicked — football, hockey, soccer, or karate.
  • An athletic supporter, or jock strap, is a cloth pouch to keep testicles close to your body. Athletic supporters are best for strenuous exercise — cycling, or doing any heavy lifting.
• Undescended Testes

  Undescended Testes - Sometimes, testicles do not come all the way down into the scrotal sac. If testicles do not come down by age 1, surgery may be needed. Most boys with undescended testes also have a hernina on the affected side that needs to be repaired.

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  Undescended Testes

  Testicles (testes) typically descend or drop into the scrotal area during the latter part of pregnancy, in response to the baby's hormones. The testicles make sperm and the male sex hormone testosterone. The scrotum allows the testicles to be in a cooler environment than the body because sperm cannot develop at body temperature. If the testicles do not descend into the scrotum, sperm do not mature. The longer this lasts, the lower the chances sperm will mature normally.

  Undescended testicles occur in about 3% of newborns (and up to 21% of premature newborns). About half of these testicles will descend on their own during the first 6-12 months of life. Testicles will not descend spontaneously after 12 months of age. As a result, about 1% to 2% of boys need treatment.

  Increasingly, many boys are being diagnosed with an undescended testicle later in childhood, often between 6 and 10 years of age. These boys had normally descended testicles as infants. This condition is called an ‘ascending testicle.' Many in the medical community think the spermatic cord does not grow normally as the child grows, and the testicles gradually become undescended. These testicles need surgical treatment to move the testicle into the scrotum.

  Do not confuse undescended testicles with ‘retractile' testes. After about age six months, normal babies and male children have a reflex that pulls the testicles up to protect them when he is cold or frightened. These testicles are in the scrotum at other times and do not require any treatment.

  Causes

  • In most children, it is not known why the testicles do not descend.
  • Abnormalities to testicles
  • Mechanical problem that leads the testicles to descend or drop but miss the scrotum, and end up adjacent to the scrotum (called "ectopic testicles").
  • Insufficient hormones to stimulate the testicles normally

  Treatments

  • Recommended after six months of age
  • The time between six and 18 months of age is generally considered best
  • Only available treatment option is surgery (orchiopexy)
    • Requires general anesthesia
    • Baby can almost always go home the same day and usually acts normal within one to two days.
    • An incision about an inch long is made in the groin area.
    • The testicle is separated from surrounding tissues so it drops easily into the scrotum where it is stitched into place. In some cases, the testicle is too high for this simple operation and more complex procedures (and sometimes even two operations) are needed. Overall, the success rate with surgery is 98%.
    • If there is a hernina, it is fixed during surgery.
• Urinary Tract Infections (UTIs)

  Urinary Tract Infections (UTIs) — Babies and children with urinary tract abnormalities may experience frequent urinary tract infections requiring special attention. Certain toilet-training behaviors, such as constipation and holding urine, can also lead to infections.

  Determining the infection cause can prevent more serious complications, such as kidney infections that can lead to kidney scarring.

  UTIs usually can be treated with antibiotics. After a few doses, children may appear much better, but it may take several days for symptoms to go away completely.

  We may recommend additional tests to check for urinary tract abnormalities once the infection clears.

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  Urinary Tract Infections

  As many as 6% of girls and 2% of boys develop urinary tract infections (UTIs). Normal urine is sterile and contains no bacteria. However, even under normal conditions bacteria cover the skin and are present in large numbers in the rectal area and within bowel movements. Bacteria may get into the urinary tract and travel up the urethra into the bladder. When this occurs, bacteria multiply. Unless the body gets rid of the bacteria, they can cause an UTI.

  Types

  • Bladder infection (cystitis) - Inflammation, swelling and pain of the bladder
  • Kidney infection (pyelonephritis) - Occurs when bacteria travel up from the bladder through the ureters and infect the kidneys. Kidney infections are more serious than bladder infections

  Symptoms

  • Linings of the bladder, urethra, ureters, and kidneys become red and irritated
  • Painful, frequent urination
  • Urine with a foul odor
  • Urinary accidents, and/or bloody urine
  • With infected kidneys, children often have abdominal or back pain and fever

  Diagnosis

  • Urinalysis (urine test) — Only takes a few minutes. Method will depend on your child's age.
    • Toddlers not toilet-trained - We will attach a plastic bag to their skin to collect the sample.
    • Older children - We will catch the specimen as your child empties his or her bladder.

  Treatment

  • Antibiotics
  • Lots of fluids
  • Frequent urination

  Follow up

  • Once the infection clears, we may recommend additional tests, particularly if your child has been treated for a kidney infection. We want to ensure there are no urinary tract abnormalities that might prevent your child's body from fighting infection and to assess whether the UTI has damaged the kidneys. The specific tests will depend on your child and the kind of urinary infection. Additional tests may include:
    • Kidney and/or bladder ultrasonography - To see the kidney and bladder using sound waves. This test may show shadows that indicate some abnormalities, like blockages, but cannot show all important urinary tract abnormalities. It also cannot tell how well the kidney works.
    • Voiding cystourethrogram — Shows abnormalities inside the urethra and bladder and if urinary flow is normal during bladder emptying.
    • Renogram - Assesses drainage rate of each kidney.
• Voiding Dysfunction

  Voiding Dysfunction - It is not uncommon for children to have voiding (urination) problems. This broadly defined condition may be due to several reasons - from behavioral problems or poor voiding habits to infections and diseases. Some children also are born with or acquire physical problems that lead to voiding dysfunction.

  We need to understand the cause to treat the dysfunction. We will document medical and social histories, conduct a physical exam and order lab tests. Once we know the underlying cause, we can recommend treatment options.

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  Voiding dysfunction

  Voiding dysfunction means your child is unable to completely empty the bladder. During the normal voiding, the external urethral sphincter muscle should completely relax, so the urine flows smoothly and completely as the bladder empties itself.

  An interrupted or erratic urine flow or incomplete emptying cause voiding dysfunction.

  Symptoms

  • Incontinence (lack of bladder control)
  • Urinary tract infection
  • Frequent urination
  • Urgent urination
  • Pain or straining with urination
  • Hesitancy
  • Dribbling
  • Intermittent urine flow
  • Pain in the back, side or abdomen
  • Blood in the urine

  Causes

  • Neurological problem from a spinal cord or brain abnormality that affects how nerves help control bladder and urinary sphincter function.
  • Often a learned problem — Your child may continually hold urine all day because he or she doesn't want to stop playing to go to the bathroom. Children get into this routine for different reasons:
    • Some may be routinely too busy to break for the bathroom.
    • Others may have experienced a painful urinary tract infection (UTI) and are afraid to urinate.
    • Sometimes, the problem is related to potty training or constipation.
    • A child may have developed abnormal urinating habits from the beginning.

  Diagnosis

  • Medical history
  • Review of a voiding diary
  • Thorough physical examination
  • Urinalysis and urine culture
  • Radiologic and urodynamic evaluation (a detailed study of bladder function)

  Further evaluation many be required due to the severity and symptoms. We may recommend:

  • Blood tests — To establish how well your child's kidneys are working.
  • Voiding cystourethrogram (VCUG) — An x-ray to examine your child's urinary tract. The images will show any reverse urine flow into the ureters and kidneys.
  • Radionuclide cystogram — Similar to a VCUG except using a different fluid to highlight your child's urinary tract.
  • Renal ultrasound — Used to determine the size and shape of your child's kidney, and to identify a mass, kidney stone, cyst or other obstruction or abnormalities.
  • Intravenous pyelogram — Reveals the rate and path of urine flow through the urinary tract.

  Treatment

  • A timed voiding schedule — You ask your child to go to the bathroom when he or she wakes up, every two to three hours, and before going to bed at night.
  • In some children, medication may be needed to decrease bladder hyperactivity.
  • Rarely, extensive reconstructive surgery such as bladder augmentation (adding a piece of the intestine or stomach to the bladder to increase bladder capacity) may be necessary.