Therapies for Pediatric Conditions

The three major urological conditions that affect children are:

• • • Hypospadias;

• • • Vesicoureteral reflux (VUR); and

• • • Undescended testicles.

PRE-TREATMENT GUIDELINES

Hypospadias. Circumcision should be avoided before hypospadias surgery occurs.

For other procedures, pre-treatment guidelines depend on the physician or the facility where the procedure is being performed. A physician will provide a patient with any necessary instructions.

WHAT TO EXPECT

Hypospadias. Surgery should be performed when a boy is between 6 and 18 months old and prior to toilet training. A surgeon will remove or cut any stiff tissue on the underside of the penis, which can cause curvature of the penis (chordee). Next, the physician will relocate the urinary tract opening. The surgery takes several hours and requires general anesthesia.

VUR. Mild reflux may resolve naturally in the boy’s first 5 years. During this time, children must take antibiotics daily to prevent urinary tract infections. Children with severe VUR often need surgery to reposition the ureter at the proper angle and length in the bladder.

Undescended testicle. If the undescended testicle is near the scrotum, physicians may treat the condition with hormone injections. However, most boys will require surgery. An incision is made and the testicles are either removed (if not fully formed) or moved to the scrotum.

Depending on the procedure, surgery takes from 30 minutes to 90 minutes with the patient under general anesthesia. Surgery should be performed when a child is between ages 1 and 2.

POST-TREATMENT GUIDELINES

Hypospadias. Following hypospadias surgery, urine may be drained for several days through a catheter. A stent is inserted to support the urethra.

The patient should rest for a few days and not be allowed to use straddle toys. The physician will recommend or prescribe a painkiller and the child will also be given antibiotics.

VUR. Following surgery for VUR, most children remain in the hospital for 1 to 5 days and may have a catheter implanted to help drain urine. After surgery, children require regular urine tests and other tests.

Undescended testicle. Older boys should not ride a bike for at least the first 6 weeks of their recovery, and should wear a cup while playing sports. Boys are also taught how to perform a testicular self-examination.

POSSIBLE COMPLICATIONS

Hypospadias. Up to 10 percent of boys having surgery for hypospadias may need a second surgery.

The complications from hypospadias surgery can include:

• • • Bleeding;

• • • Bladder spasms;

• • • A recurrence of chordee;

• • • Meatal retraction;

• • • Fistula;

• • • Stricture; and

• • • Stenosis.

VUR. The most common complications of surgery are infection, bleeding, blockage of the ureter, and continued reflux.

Undescended testicle. Complications that can result from surgery include atrophy, bleeding, and infection. Once the child returns home, his parents should immediately contact the physician if any of the following occur:

• • • Drainage or bleeding from incisions;

• • • Severe or worsening pain;

• • • Swelling around the scrotum; and

• • • High fever.