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Main Genitourinary Disorders in Children

Hypospadias, urinary reflux, undescended testicle (cryptorchidism and testicular ectopia), and enuresis (involuntary urinary leakage in children) are the most common disorders found in children, with appropriate ages for correction.

Cryptorchidism

Cryptorchidism is a condition where one or both testicles fail to descend into the scrotum, remaining in the abdominal cavity or the groin area. This anomaly can occur due to genetic, hormonal, or environmental factors that affect the testicular descent process during fetal development.

In many cases, the issue resolves naturally within the first few months of life. However, if the testicle has not descended by the first year, medical intervention is recommended. The treatment typically involves surgery to reposition the testicle into the scrotum. To prevent complications such as infertility or an increased risk of testicular cancer, it is important for the surgery to be carried out before 18 months of age.

Nocturnal Enuresis

Nocturnal enuresis is the involuntary loss of urine during sleep in children over five years old, occurring at least twice a week. It can affect the child’s behaviour, well-being, and social life, causing stress for the family. The condition is more common in boys and tends to decrease with age. The causes are not fully understood but may involve social, psychological, and anatomical factors, along with a possible genetic predisposition.

Diagnosis involves taking a clinical history, medical examination, and tests to exclude organic problems. Treatment includes medications, behavioural interventions, and the use of alarms. It is important to avoid punishing the child and instead encourage them with rewards. There is no specific form of prevention, but strategies exist to reduce the impact of the condition.

For more information read the article “Nocturnal enuresis (bedwetting)
Not a case of laziness or sloppiness” HPA Magazine 11.

Hypospadias

Hypospadias is an abnormal opening of the urethra at one or more points along the front part of the penis. It affects about 4 in every 1000 births and is often of unknown cause, although it may be hereditary or related to hormonal exposure during pregnancy. There are four types of hypospadias, classified according to the location of the opening. Surgical treatment should be performed before the first year of life, aiming to correct the position of the urethral meatus, prevent penile curvature, and ensure normal urinary and sexual function. The involvement of parents in the postoperative period is essential for the success of the surgery.

Late treatment can lead to chronic genitourinary issues. Early diagnosis and timely correction are crucial for the full resolution of this condition.

Urinary Reflux

Urinary reflux, also known as vesicoureteral reflux, is a condition where urine flows back up the ureters to the kidneys, against the normal flow. This phenomenon can occur due to a congenital defect in the valve between the bladder and the ureters, allowing urine to flow back to the kidneys.

In many cases, urinary reflux shows no obvious symptoms, but it can be associated with recurrent urinary tract infections, fever, abdominal or lower back pain. When the condition is more severe, it can lead to kidney damage.

The treatment of urinary reflux should be tailored according to the severity of the condition and the child’s age. In less severe cases, the condition can be monitored with periodic exams, and antibiotics may be prescribed to prevent infections. In more complex situations, surgical intervention may be required to correct the anatomical defect responsible for the reflux.

Urology Exams

Ultrasound-guided Biopsies 

These biopsies are performed with special semi-automatic needles and allow for tissue samples to be collected for histological and bacteriological examinations.

Urological Ultrasound 

This is an ultrasound examination that allows the evaluation of the kidneys, ureters, bladder, and urethra. In men, it also enables the analysis of the prostate. It is used to detect issues in the urinary tract and related structures.

Urological Endoscopy 

This is an examination that allows the visualization of the interior of the urinary tract, including the bladder, urethra, and kidneys, using an instrument called a cystoscope, which is used to diagnose and treat various urological conditions.

Urodynamic Studies 

Urodynamic studies are tests performed by a urologist to investigate the functioning of the lower urinary system. Based on the patient's symptoms, the specialist may suggest different types of urodynamic tests.
To learn more, visit: https://www.grupohpa.com/en/medical-specialties/urology/urodynamic-study/

These tests are performed on patients who present urinary symptoms such as:

• Frequent urination;
• Sudden urge to urinate;
• Increased nighttime urination;
• Urinary retention;
• Weak and fine urine stream;
• Interrupted urine stream;
• Incomplete bladder emptying.

Procedures/Treatments:

Aquablation 

This is an innovative treatment for Benign Prostatic Hyperplasia (BPH), performed using a robot that automates the procedure with a high-speed, high-pressure water jet, achieving millimetric precision.

Learn More

Laser Endoscopic Surgery

This is a minimally invasive procedure that uses laser technology to treat urinary tract conditions such as kidney stones, obstructions, or tumours, through small incisions or even without the need for cuts.

Laser Endoscopic Lithotripsy 

This is also a minimally invasive procedure that uses a laser to fragment stones in the urinary tract, such as in the kidneys or ureters, through an endoscope, facilitating their removal without large incisions.

Extracorporeal Shock Wave Lithotripsy 

This non-invasive procedure uses shock waves to fragment stones in the kidneys or bladder, making it easier for them to be eliminated through urine.

Low-Intensity Shock Waves 

This is a non-invasive treatment used for erectile dysfunction. It involves the application of low-intensity sound waves that generate small microtraumas in the tissues of the region. These microtraumas stimulate the creation of new blood vessels (neovascularisation) from existing capillaries, improving blood flow and consequently enhancing erection and penile rigidity.

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Vasectomy – Fertility Control 

This is a simple surgical procedure performed on an outpatient basis under local anaesthesia, allowing safe control of reproduction without affecting the man's sexual function. While it is a safe option, a vasectomy should not be performed on individuals under 25, and it should be a well-considered decision by the couple. Although it is irreversible in many cases, reversal is possible, though the results are not always successful. If there is an intention to have children in the future, it is advisable to discuss this decision with a doctor beforehand.

Medical team
HPA Urologists