Pediatric urology

In children, frequent urination may be related to infection, a functional bladder disorder or, more rarely, anatomical causes, and it requires a urological evaluation.

There is no single method that can give a specific diagnosis; every condition has its own specific test. In neurogenic bladder dysfunction, neither MRI, CT nor ultrasound will make the diagnosis — in such cases, a urodynamic study is needed. In other words, when a functional disorder is suspected, ordinary imaging may not be enough, and the test is chosen to match the complaint.

The principle is always the same: a specific test is chosen to match the complaint, a diagnosis is made, and treatment is prescribed according to that diagnosis.

Urinary incontinence has different causes, and it is not right to name an exact cause without an examination. How long treatment takes also depends on the cause and on whether the complaint is acute or chronic.

Acute conditions and acute syndromes can be treated in a short time. Chronic conditions, however, sometimes require several courses. With urinary incontinence in children, for example, sometimes one course of treatment is enough for it to go away, while in other cases several courses, or even an extensive course of treatment, may be needed.

That is why parents play a very important role here too — their way of thinking and their attitude. If they trust the doctor and the doctor’s experience, they should continue the treatment patiently. Then it is possible to overcome the condition and its complaints.

Sometimes a single medication forms the basis of treatment; the expectation that “there should be four or five medications” is mistaken — prescribing many medications may not be effective. The length of the course and the choice of medication are determined only at the appointment, on an individual basis.

Every medication can have side effects; do not stop or change a prescribed medication without consulting the doctor who is treating your child. If one course does not bring results, that does not mean the treatment was wrong; decide on the next step together with the doctor.

Once a urinary tract infection has developed, the chance that it will clear up on its own is low; if it is not treated, there is a risk that the infection will spread. If it spreads, the kidneys can be affected and permanent damage can occur.

This infection sometimes settles in the body in childhood, even in infancy, and flares up from time to time in adulthood as well; such chronic cases may require long-term treatment. Signs include frequent urination, pain or burning when urinating, fever, fatigue, dark or red urine, pain in the abdomen or side, nausea and vomiting, and passing only small amounts of urine despite the urge. A young child cannot always describe these complaints clearly — what the parent observes is important information for the doctor.

To confirm the diagnosis, additional tests such as cystoscopy and multiphase CT imaging are sometimes needed; the doctor decides which test is necessary based on the complaint. The choice of antibiotic and the length of the course are determined individually and are not the same for every child. Antibiotics can have side effects, and an unfinished course can cause the infection to come back — the course must be completed as the doctor instructs.

Dark or red urine can be a sign of blood in the urine. Visible blood in the urine always requires an examination — even without pain, even if it happens only once; cystoscopy and imaging are performed when necessary.

Hydronephrosis is the dilation of the collecting system (renal pelvis and calyces) of one or both kidneys. It can be seen at any age and can be congenital or acquired.

The causes of kidney failure are divided into prerenal, renal and postrenal, and the postrenal form is considered urological: if there is some kind of obstruction in the pathways leading out of the kidney, this counts as one of the urological causes. An obstruction such as a stone blocking the urinary tract can cause the kidney to become dilated; timely intervention in such cases can help protect kidney function.

The cause of hydronephrosis and whether intervention is needed can only be determined after an examination; the choice between monitoring and intervention is made individually, based on the child’s age and the test results. Every intervention — even one through small incisions — carries risks related to anesthesia and possible complications; the method is chosen after discussion with the parents.

Surgery may not be needed for every kidney stone. If there is a stone in the kidney, its location is very important: if it sits in the renal pelvis and is causing dilation, it should be operated on. Here, too, the approach is individual. Surgery may be considered for stones that do not pass or dissolve despite drinking plenty of water and medical treatment.

Surgery is considered in these cases: stones that cause severe pain or infection; stones that cannot pass with treatment; stones that cause bleeding; stones that could lead to loss of kidney function; stones that cause a complete blockage; stones in a solitary kidney.

In closed (incision-free) stone surgery, the main limiting factor is the size of the stone: with large stones, scattered fragments can cause problems, and a long operation increases the risk of infection. Because the operation is performed under general anesthesia, it is not used in patients who are not fit for anesthesia; any existing urinary tract infection must be treated first. Which method suits a child is decided based on the size and location of the stone and the child’s overall condition.

Whether an incision-free method is suitable is determined not by a single size figure but by the examination results; every method has its own risks, and the choice is individual.

Whenever possible, minimally invasive methods — endoscopic and laparoscopic — are preferred. The decision is based on the patient’s age, coexisting conditions and clinical findings; two children with the same complaint may be offered different methods.

A closed approach is not always possible. Robotic and laparoscopic surgery have their limits: there are operations where the robot cannot be used — with large masses. A robotic operation always needs working space, and with a large mass that space cannot be obtained, so open surgery remains the only option. When a closed approach is possible, and when open surgery has to be performed instead, is a decision that rests with the surgeon. Every intervention — even one through small incisions — carries risks related to anesthesia and possible complications; these are discussed separately with the parents at the appointment.

Robotic (Da Vinci) surgery is not offered at the appointments in Baku; suitability and the choice of method are discussed after an examination.

In urology, in most cases, no special preparation is required — including whether to come on an empty stomach. The main request is to come with a full bladder, or at least a partly full one.

If there is a mass in the bladder, or a condition called reflux, having the bladder full can help make the correct diagnosis. When reflux (urine flowing backward) is suspected, carrying out the examination under these conditions affects the result. It is also recommended to bring previous test and examination results (if any) and a list of the medications the child takes.

Diseases that damage the kidney tissue itself, such as glomerulonephritis and connective tissue (collagen) diseases, belong to the field of nephrology; in such cases the diagnosis is confirmed with appropriate tests, even a biopsy, and complex, long-term treatment is used. In these cases, the urologist refers the child to a nephrologist; a urological evaluation, meanwhile, is needed to rule out an obstruction in the urinary tract (a postrenal cause).