Children’s Urinary Conditions
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.
Blood in Urine: Hematuria in Children
Discovering blood in your child’s urine can be alarming, however rest easy knowing that it is often not a sign of a significant disease. Though not extremely common, between nine and 18 percent of normal individuals have some form of hematuria. Since blood in the urine may be an indicator of other medical conditions that require treatment, we suggest speaking with a medical professional right away.
Hematuria, or blood in urine, can happen for a variety of reasons. In fact, there are at least 50 different causes of hematuria in children. Blood in the urine often not a sign of significant disease. In many patients, there is no specific cause found; however, hematuria may be a sign of infection, stone disease or urinary tract cancer so it’s best to speak with an expert. Hematuria can start in any place along the urinary tract, including the kidneys, ureters, bladder, prostate, and urethra.
Hematuria itself does not present any symptoms other than in some cases patients producing red urine. However, the conditions that cause the blood in the urine may produce symptoms, including:
- Weakness
- High blood pressure
- Body swelling, including puffiness around the eyes
Testing for blood in the urine will usually involve several different types of testing to determine the specific condition that you may be experiencing, including:
- Urine dipstick test — If your test is positive, the amount of blood present is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per the 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 origin of the bleeding
- 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
We know it can be confusing to discuss a treatment plan for possible blood in the urine because the condition may produce a variety of symptoms. Our doctors are here to help make you to feel at ease throughout the treatment process. Treatment is based on the condition, symptoms, and medical history along with the cause of the hematuria.
Hydronephrosis What You Need to Know
Hydronephrosis is the swelling of one (unilateral) or both (bilateral) kidney(s) due to urine backup. Hydronephrosis is a condition that typically occurs with a disease and is not a disease itself. Though fairly uncommon, unilateral hydronephrosis occurs in about one in 100 people. If hydronephrosis is left untreated, the affected kidney may be permanently damaged. Obstruction of the urethra can produce dilation of the kidney(s). We may monitor the condition or recommend surgery, depending on the severity.
The conditions that are typically associated with Unilateral Hydronephrosis include:
- Acute unilateral obstructive uropathy
- Chronic unilateral obstructive uropathy
- Reflux (backflow of urine from bladder to kidney)
- Kidney stones
The conditions that are typically associated with Bilateral Hydronephrosis include:
- 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
- Side pain
- Abdominal mass
- Nausea and vomiting
- Urinary tract infection
- Fever
- Painful urination
- Increased urinary frequency
- Increased urinary urgency
- Sometimes no symptoms
Testing for unilateral or bilateral hydronephrosis usually involves several different types of tests to determine the specific condition that you may be experiencing, including:
- 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 for unilateral or bilateral hydronephrosis depends on the cause of the kidney swelling so speaking to one of our specialists will more accurately describe your treatment plan which 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.
Coping with Urinary Tract Infections in Children
As many as 6 percent of girls and approximately 2 percent of boys can potentially develop a Urinary Tract Infection (UTI) but rest assured knowing that these infections are easily treated. Normal urine is sterile and contains no bacteria; however, even under normal conditions bacteria covers the skin and are present 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 and unless the body gets rid of the bacteria, they can cause an UTI.
Babies and children with urinary tract abnormalities may experience frequent urinary tract infections that require special attention. Determining the cause of the infection can prevent more serious complications, such as kidney infections that can lead to kidney scarring.
Typically, UTIs can be treated with antibiotics and 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.
There are several types of UTIs based on the symptoms your child may be experiencing, including:
- 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
One symptom of a UTI that may be difficult to detect includes the lining of the bladder, urethra, ureters, and kidneys becoming red and irritated. However, in most children, some common symptoms may become apparent, including:
- 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
Typically, there is one way that we diagnose a UTI, which only takes a few minutes. The method will depend on your child’s age. A Urinalysis (urine test) includes:
- Toddlers that are 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.
The primary treatment plan for children experiencing Urinary Tract Infections includes:
- Antibiotics
- Plenty of fluids
- Frequent urination
Once the infection clears, we may recommend additional tests, particularly if your child has been treated for a kidney infection. We want to ensure that 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 indicates if urinary flow is normal during bladder emptying.
- Renogram – Assesses the drainage rate of each kidney.
Vesicoureteral Reflux In Children
Some children are born with vesicoureteral reflux, which refers to a condition where urine “backwashes” up the ureters toward the kidneys. Many children grow out of their reflux with age. During infancy, the disease is more common in boys and in older children, reflux is more common in girls. It affects more Caucasian children than African-American children.
Reflux is a relatively rare condition, only affecting about 1 percent of children; however, many children will grow out of this reflux as they get older. It is important to monitor the issue and take antibiotics to prevent kidney infections and kidney damage.
Alone, reflux is not dangerous, however, a simple urinary infection can turn lead to kidney infection if bacteria washes 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.
In many cases vesicoureteral reflux does not display symptoms. However, it is 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
One symptom of a UTI that may be difficult to detect includes the lining of the bladder, urethra, ureters, and kidneys becoming red and irritated. However, in most children, some common symptoms may become apparent, including:
- Reflux is common among children and siblings of people with reflux. While there is a strong genetic component, 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 such as bladder and bowel problems, including accidents, frequent urination or constipation.
Testing for vesicoureteral reflux in children usually involves a variety of testing to determine the cause for your child’s specific symptoms, including:
- 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.
We understand that dealing with vesicoureteral reflux with your child may be difficult, however our doctors are here to help. Here is a look at different treatment options that may be utilized:
- To prevent infections, some children take low-dose antibiotics once a day to keep urine sterile.
- Some children may need surgery 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.
Understanding Voiding Dysfunction in Children:
Voiding dysfunction refers to a child’s inability to completely empty their bladder. During normal voiding, the external urethral sphincter muscle should completely relax, to allow the urine to flow smoothly and completely as the bladder empties itself.
It is not uncommon for children to have voiding problems. This broadly defined condition may be the result of a variety of factors from behavioral problems, or poor voiding habits, to infections and diseases. Additionally, some children are born with, or acquire, physical problems that lead to voiding dysfunction.
In order to accurately treat the dysfunction, we need to understand the underlying cause. Our process includes documenting medical and social histories, conducting a physical exam, and ordering lab tests. Once we know the underlying cause, we can recommend treatment options.
In most children, common symptoms of voiding dysfunction may become apparent, including:
- Incontinence (lack of bladder control)
- Urinary Tract Infection (UTI)
- 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
In some cases, neurological problems from a spinal cord or brain abnormality affect how the nerves control bladder and urinary sphincter function. However, in most cases the cause is 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, including:
- Some may be routinely too busy to take bathroom breaks
- 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
Upon discovering that your child is suffering from voiding dysfunction, there are a variety of options for diagnosis, including:
- Reviewing medical history
- Keeping and reviewing a voiding diary
- A thorough physical examination
- Urinalysis and urine culture tests
- Radiologic and urodynamic evaluation (a detailed study of bladder function)
In some cases, 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 is used 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
Typically treatment options for children experiencing voiding dysfunction includes:
- Creating and tracking 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.
We understand the frustrations that arise while dealing with Urinary Conditions, but our team of professionals are here to make this process as simple as possible. We aim to work side-by-side to ensure the accurate diagnoses of your child’s symptoms and to tailor a unique treatment plan to fit your specific needs. We at Western Michigan Urological Associates want to work with you to find the best option for you and your family. Ask Your Primary Care Provider for a Referral.
