Urinary problems in children
 Dr Ramesh Babu, MS, MCh, FRCS Glas, FRCS Edin, FRCS Paeds, is a paediatric urologist and laparoscopic surgeon at the
Sri Ramachandra Medical College and Research Institute
(DU), Porur, Chennai. The following is his article on urinary problems in children:
Children do get problems in
kidneys and urinary tract. They are different from adults in that most of them are birth defects and are correctable. But birth defects of kidneys still continue to be the major cause of
kidney failure in young
children. The main problem with children is that they cannot express their symptoms clearly and it is easy to miss them. When treatment is not provided at the right age, long-term consequences develop.
 Some urinary problems are very obvious at birth. The urinary opening in some baby boys is not at the tip but on the
under surface. This is called 'Hypospadias'. Older boys with this problem cannot pass urine in standing position; but need to sit down like girls. Their penis may be bent and this might cause them problems in later life. These children need an operation between 6 months–2 years. Only when corrected at the right time, they can be
toilet trained like other children and avoid
sexual problems in later life.
Another problem obvious at birth is the testis not being fully down. This is known as ‘Undescended Testis’. Such boys are at risk of twisting of the testis, tumour in testis and infertility. A surgery is required to bring the testis down, and this is ideally done before the age of one. If the operation is not done at the right time, they can become infertile.
Kidney problems can be detected even before they are born. Most
pregnant women undergo
ultrasound scan during pregnancy. During this time, the baby's kidneys are checked. When the kidneys swell with urine it is called ‘hydronephrosis’. This can be seen easily on ultrasound scan even before birth. These children need careful check-up after birth. Regular ultrasound and nuclear scans are performed to assess the severity. If things get worse, a surgery called ‘pyeloplasty’ is recommended.
 Older children with urinary problems can experience frequent urination, pain or burning sensation during urination. Small children cannot express these but simply refuse feeds or get fever. Only a urine test highlights the urinary infection. These children need careful evaluation. Sometimes, the urine may go upstream towards the kidneys from the bladder. This is called ‘Reflux’. Often, it is treated with medicines. But, if severe, they need a surgery called ‘reimplantation’. In some children ‘Reflux’ can be corrected by an endoscopic treatment called STING.
Endoscope is a small pencil-like instrument with a camera at the tip. With this the surgeon can view inside the urinary tract. Sometimes a small tube or laser wire is passed through. Many urinary problems, even in children, are treated with the help of an endoscope.
Some children with urinary infection and pain are found to have a
‘kidney stone’ on
ultrasound scan. They can also benefit from endoscopic surgery. The stones can be broken with the help of ‘lithhotripsy’. In some situations, stones can be broken without any surgery or endoscope with the help of a stone-breaking machine called ESWL. This breaks stones with the help of sound waves, completely from outside.
Some children develop a small tissue growth in the urine pipe causing blockage. This is called ‘Posterior urethral valves’. They may simply not pass urine at birth and develop severe infection or renal failure. Children with milder a form of this may just have dribbling of urine. This problem can be corrected with endoscopic surgery.
 Children also can undergo laparoscopic surgery for many urinary problems. Laparoscope is a small tube with camera through which the surgeon can see. Instruments like scissors or stitches can be passed through this to do the surgery. The surgeon watches the procedure on TV. Because there is no cut, healing is fast and pain is less. They can go home and get back to school quickly. It is cosmetic and cost-effective.
In some children the kidneys are very small; made of waster bubbles with no function. This is called ‘Multicystic Dysplastic Kidney’. In some children the kidneys do not function but only cause infection. In some girls the kidneys are poorly developed but the pipe draining urine opens outside, making them leak urine all the time. They can benefit from a laparoscopic removal of the poorly formed kidney.
In children with ‘Undescended Testis’ when the testis is inside the belly, it needs a staged operation with the help of a laparoscope. Adolescent boys can develop a problem called ‘varicocele’ where the veins around the testis are big. They are prone to infertility. They too can benefit from laparoscopic surgery.
Often, parents worry about operation in a small child. Even newborn babies and pre-term babies can be treated surgically. With modern anaesthesia facilities, there is no need for concern at all. The benefits of performing the surgery at the right age far outweigh the risks of leaving them untreated.
Dr Ramesh Babu Srinivasan,
Paediatric Surgeon,
SRMC, Porur.
Ph: 91-44-23701427 / 24761546
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