Pediatric Urology

Dr. F. Michael Rommel is our urologist who specializes in Pediatric Urology. He realizes that the patient is the child, but attention must be given to the parents as well as the grandparents. Dr. Rommel spends considerable amount of time with each family giving them the attention that is necessary to answer questions as well as to quiet fears.

Some of the more prevalent childhood problems are:

Bedwetting

The best cure for bedwetting is time - time to let your child's body mature and develop. Most children eventually grow out of bedwetting. But the doctor may recommend some things to help your child become dry more quickly. Some of the solutions for bedwetting are the self-awakening routine, bedwetting alarms, medications, changes in your child's routine.

Undescended Testicle

The testicles are the male sex organs that produce sperm and the male hormones. They form near the kidneys. As the fetus grows in the mother's womb, the testicles move down through the groin into the scrotum. Normally they are in the scrotum before birth. Sometimes a testicle doesn't fully descend into the scrotum before birth. Instead, it stops somewhere along the normal pathway between the kidney and the scrotum. Or it may stray from this pathway. What causes this isn't known. An undescended testicle is most common in premature babies and most often only one testicle is affected. Treatment is important, because the testicle doesn't descend on its own, it should be treated. The longer a testicle remains outside the scrotum, the more likely it is that it will produce fewer sperm. An undescended testicle has a higher risk of cancer. This is true even after the testicle is brought down into the scrotum. Bringing the testicle down makes a problem easier to find. An undescended testicle can leave a small tear or hernia in the wall between the abdomen and the groin. The hernia needs to be treated to prevent future problems.

Hypospadias

Hypospadias is a birth defect found in boys in which the urinary tract opening is not at the tip of the penis. When we see a boy with hypospadias there is a 20% chance of finding this in another family member such as father or a brother. There are different degrees of hyposadias, some minor and others more severe. It is recommended that the child has surgery to correct hypospadias at about six to nine months of age.

Chordee

Bending of the penis on erection may be associated and is known as chordee. Chordee is a congenital downward curvature of the penis due to a strand of connective tissue between the urethral opening and the glands. Chordee can be caused by a short urethra, fibrous tissues connecting the urethral opening, or both. Symptoms of chordee include the penis curving downward during erection, a dorsal hood deformity, and incomplete foreskin development. A chordee may be surgically repaired anytime after six months of age. The goals of surgery are to improve the appearance of the penis for psychological reasons, to construct an organ that allows the patient to void in a standing position, and to produce a sexually adequate organ.

Hydrocele

A hydrocele is a collection of watery fluid around the testicle. This is a common problem in newborn males and usually goes away within the first year of life. When the testicle drops into the scrotum, a sac from the abdominal cavity travels along with the testicle. Fluid can then flow to the scrotum to surround the testicle. This sac usually closes and the fluid is absorbed. When the sac closes and the fluid remains, this is called a noncommunicating hydrocele. This means that the scrotal sac can be compressed and the fluid will not flow back into the abdomen. This type of hydrocele is often found in newborns and the fluid will usually be absorbed with time. If the scrotal sac is compressed and the fluid slowly goes back up into the abdomen or if the hydrocele changes size, this is called a communicating hydrocele. This type of hydrocele usually appears smaller in the morning when the child wakes up and larger in the evening after activity.

Urinary Tract Infections

Urinary Tract Infections or UTIs affect about three percent of children in the United States every year. Throughout childhood, the risk of a UTI is two percent for boys and eight percent for girls. UTIs account for more than 1 million visits to pediatricians' offices every year. They symptoms are not always obvious to parents, and younger children are usually unable to describe how they feel. Recognizing and treating urinary tract infections is important. Untreated UTIs can lead to serious kidney problems that could threaten the life of your child. The kidneys filter and remove waste and water from the blood to produce urine. They get rid of about 1- 11/2 to 2 quarts of urine per day in an adult and less in a child, depending on the child's age. The urine travels from the kidneys down two narrow tubes called the ureters. The urine is then stored in a balloon-like organ called the bladder. In a child, the bladder can hold about 1 to 11/2 ounces of urine for each year of the child's age. The bladder of a four year old child may hold about 4 to 6 ounces; an eight year old can hold 8 to 12 ounces. When the bladder empties, a muscle called the sphincter relaxes and urine flows out of the body through the urethera, a tube at the bottom of the bladder. The opening of the urethra is at the end of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls. Normal urine contains no bacteria or germs. Bacteria may, at times, get into the urinary tract and the urine from the skin around the rectum and genitals by traveling up the urethra into the bladder. When this happens, the bacteria can infect and inflame the bladder and cause swelling and pain in the lower abdomen and side. This bladder infection is called cystitis. If the bacteria travel up through the ureters to the kidneys, a kidney infection can develop. The infection is usually accompanied by pain and fever. Kidney infections are much more serious than bladder infections. In some children a urinary tract infection may be a sign of an abnormal urinary tract that may be prone to repeated problems. For this reason, when a child ahs a urinary infection, additional tests are often recommended. In other cases, children develop urinary tract infections because they are prone to such infections, just as other children are prone to getting coughs, colds, or ear infections. Or a child may happen to be infected by a type of bacteria with a special ability to cause urinary tract infections. Children who frequently delay a trip to the bathroom are more likely to develop UTIs. Regular urination helps keep the urinary tract sterile by flushing away bacteria. Holding in urine allows bacteria to grow. Keeping the sphincter muscle tight for a long time also makes it more difficult to relax that muscle when it is time to urinate. As a result, the child's bladder may not empty completely. This dysfunctional voiding can set the stage for a urinary infection. A urinary tract infection causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just like the inside of the nose or throat becomes irritated with a cold. If your child is an infant or only a few year s old, the signs of a urinary tract infection may not be clear, since children that young cannot tell you exactly how they feel. Your child may have a high fever, be irritable, or not eat. On the other hand, sometimes a child may have only a low-grade fever, experience nausea and vomiting, or just not seem healthy. The diaper urine may have an unusual smell. If your child has a high temperature and appears sick for more than a day without signs of a runny nose or other obvious cause for discomfort, he or she may need to be checked for a bladder infection. An older child with bladder irritation may complain of pain in the abdomen and pelvic area. Your child may urinate often. If the kidney is infected, your child may complain of pain under the side of the rib cage, called the flank, or low back pain. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of urinary tract infection. Your child may have difficulty controlling the urine and may leak urine into clothing or bed sheets. The urine may smell unusual or look cloudy or red. Only by consulting a health care provider can you find out for certain whether your child has a urinary tract infection. Some of your child's urine will be collected and examined. The way urine is collected depends on your child's age. If the child is not yet toilet trained, the health care provider may place a plastic collection bag over your child's genital area. It will be sealed to the skin with an adhesive strip. An older child may be asked to urinate into a container. The sample needs to come as directly into the container as possible to avoid picking up bacteria from the skin or rectal area. A doctor or nurse may need to pass a small tube into the urethra. Urine will drain directly form the bladder into a clean container through this tube, called a catheter. Sometimes the best way to get the urine is by placing a needle directly into the bladder through the skin of the lower abdomen. Getting urine through the tube or needle will ensure that the urine collected is pure. Some of the urine will be examined under a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. If the bacteria from the sample are hard to see, the health care provider may place the sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the germs have multiplied, they can then be identified and tested to see which mediations will provide the most effective treatment. The process of growing bacteria in the laboratory is known as performing a culture and often takes a day or more to complete. The reliability of the culture depends on how long the urine stands before the culture is started. If you collect your child's urine at home, refrigerate it as soon as it is collected and carry the container to the health care provider or lab in a plastic bag filled with ice. Urinary tract infections are treated with bacteria-fighting drugs called antibiotics. While a urine sample is being examined, the health care provider may begin treatment with a drug that treats the bacteria most likely to be causing the infection. Once culture results are known, the health care provider may decide to switch your child to another antibiotic. The way the antibiotic is given and the number of days that it must be taken depend in part on the type of infection and how severe it is. When a child is sick or not able to drink fluids, the antibiotic may need to be put directly into the bloodstream through a vein in the arm or hand. Other wise, the medicine, liquid or pills, may be given by mouth or by shots. The medicine is given for at least 3 to 5 days and possibly for as long as several weeks. The daily treatment schedule recommended depends on the specific drug prescribed: The schedule may call for a single does each day or up to four doses each day. In some cases, your child will need to take the medicine until further tests are finished. After a few doses of the antibiotic, your child may appear much better, but often several days may pass before all symptoms are gone. In any case, your child should take the medicine for as long as the doctor recommends. Do not stop medications because the symptoms have gone away. Infections may return, and germs can resist future treatment if the drug is stopped too soon.

Vesicoureteral Reflux (VUR)

With normal urination, the bladder contracts and urine leaves the body through the urethra. Wiith vesicoureteral reflux, some urine goes back up into the ureters and possibly up to the kidneys. Reflux exposes the kidneys to infection. In children, particularly those in the first six years of life, urinary infection can cause kidney damage. The injury to the kidney may result in renal scarring and loss of future growth potential or widespread scarring and atrophy. Even a small area of scarring in one kidney may be a cause of high blood pressure later in life. Untreated reflux on both sides can, in most severe instances, result in kidney failure. The valve system at the ureterovesical junction may be abnormal. In some children the tunnel of the lower ureter through the muscular wall of the bladder may not be long enough. For these children, there is a good chance that growth may provide the necessary difference to allow the valve to work. The ureter may enter into the bladder abnormally, usually too much to the side, resulting in a short tunnel. This type of reflux is less likely to resolve with growth.