Conditions

General Conditions of Pediatric Urology

Urinary tract infections
UTI is believed to be one of the most common bacterial infections seen by clinicians who treat paediatric patients. It may be difficult to recognize UTI in children because the presenting symptoms and signs are non-specific, particularly in infants and children under 3 years. It has been estimated that 3% of prepubertal girls and 1% of prepubertal boys are diagnosed with UTIs. Recent estimates suggest up to 8% of girls are affected by UTI. UTI is more prevalent among boys than girls younger than 1 year of age.

Oncology
Wilms tumour is the second most common intra-abdominal malignancy after neuroblastoma. The introduction of radiotherapy and chemotherapy improved survival rates. However, with modern multimodal therapy long-term survival rates of 90% are achievable. Rhabdomyosarcoma is the third most common solid malignancy of childhood. RMS can occur with a bimodal frequency with the early peak between 2-5 years and the late peak between 15-19 years of age.

Obstructive uropathies
Hydronephrosis is a condition that can occur in the womb, where a baby’s kidneys fill up with urine and become larger. This can happen for various reasons. A blockage, which can occur between the kidney and the ureter (pelviureteric junction or PUJ), between the bladder and the ureter (vesicoureteric junction or VUJ) or in the urethra (posterior urethral valve). About 1 in every 300 people has one kidney affected by hydronephrosis. About 1 in every 600 people have both kidneys affected by hydronephrosis.

Disorders of sexual development (DSD)
Sex assignment as either male or female is instantaneous at birth for the vast majority of infants. It has been estimated that genital anomalies occur in about one in 4500 births. Female pseudo-hermaphroditism due to congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia in newborns.

Prenatal Urology
Fetal hydronephrosis is the most common anomaly detected on antenatal ultrasound examination, affecting 1–5% of pregnancies. The most common pathological processes include ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR), followed by posterior urethral valves, ureteral obstruction. Εarly postnatal evaluation of children with a history of any degree of PNH is mandatory.

Urolithiasis
Has a prevalence of 0.9 cases per 1000 hospital admissions in developed countries. Children who are born prematurely and /or have profound immobility, are at higher risk of stones. Metabolic abnormalities are the main reason for stone formation. 20 % of people who develop a renal stone do so before the age of 20 years. Boys are affected twice as frequently as girls and at a younger age.

Pediatric Urologic Gynecology
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Specific Conditions in Pediatric Urology

Antenatal Hydronephrosis
The incidence of prenatally diagnosed uropathies reported from European centers averages around 1/500 pregnancies. Approximately 50% of all children with a prenatally diagnosed hydronephrosis will have a pelviureteric junction obstruction.

Phimosis
Phimosis is a pathological narrowing of the opening of the prepuce, preventing it from being drawn back over the glans penis.

Cryptorchidism
About 4–5% of males have undescended testes at birth, but more than half of these will continue to descend in the first12 weeks postnatally. By 3 months post-term, the incidence of congenital cryptorchidism is 1–2%.

Voiding Dysfunction
Conditions and lower urinary tract symptoms which includes a firm distinction between daytime and night-time wetness and between bladder reservoir problems and voiding problems.

Nocturnal enuresis
The term “nocturnal enuresis” should, according to the International Children’s Continence Society (ICCS) standardization, be limited to conditions in which the wetness occurs during the night while the child is asleep and when no daytime symptoms are present.

Bladder Exstrophy and Epispadias
Bladder exstrophy means literally the eversion or turning inside-out of the bladder. The incidence is 1 in 300000 live births, with a male to female ratio 3:1. Male epispadias is a deformity in which the urethra opens on the dorsum of the penis instead of at its tip (1/100000). Female epispadias is a deformity in which the urethral opening extends to the clitoris, which is bifid (1/400000).

Hemorrhagic Cystitis
In pediatric oncology patients, hemorrhagic cystitis can be a life-threatening complication of bone marrow transplantation (BMT), chemotherapy, and/or radiation therapy.

Hypospadias
Hypospadias is a congenital anomaly, an abnormality of the urethra, which affects about one in 300 boys at birth. In this condition, the opening of urethra (the tube that carries urine and semen out of the body) is on the underside of the penis instead of at the end. The urethral opening may still be on the glans, or head of the penis, or it may be further down the shaft.

Meatal Stenosis
Ιs the most common complication of circumcision. After circumcision, a child who is not toilet trained persistently exposes the meatus to urine, resulting in inflammation (ammoniacal dermatitis) and mechanical trauma as the meatus rubs against a wet diaper.

Posterior Urethral Valves
Posterior Urethral Valves consist of abnormal mucosal folds between the urethral wall and the distal end of the verumontanum.

Testicular Torsion
Testicular torsion occurs when a testicle rotates on the spermatic cord, which provides blood flow to the testicle. This rotation cuts off the flow of blood and causes sudden, often severe pain and swelling. Testicular torsion is most common in males under 25, but it can occur at any age, including in newborns and infants.

Ureteropelvic Junction Obstruction
Ureteropelvic Junction Obstruction (UPJ) represents the leading cause of dilatation of the urinary tract. UPJ can result from anatomic anomalies or abnormal peristalsis.

Vesicoureteric Reflux
Vesicoureteric Reflux (VUR) results from the lack of normal valve-like mechanism of the vesicoureteric orifice.

Megaureter
“Is a descriptive term for a ureters that is wide and sometimes very tortuous.” It is not a diagnosis. Megaureter and Vesicoureteric reflux may coexist.

Tumors of the Genitourinary tract
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Myelodysplasia and Neurogenic Bladder Dysfunction
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Ureteral Duplication, Ureteral Ectopia, and Ureterocele
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Urethral Anomalies and Urethral Prolapse
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Hydrocele, Inguinal hernia,Varicocele in Adolescents
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