Pediatrics Urology

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Specific Diagnosis and Treatments

Hydronephrosis, vesicoureteral reflux, cryptorchidism, and hypospadias are disorders which occur relatively frequently. Below we explain each disorder.

Congenital Hydronephrosis

Hydronephrosis is a condition where the renal pelvis is swollen. There are thought to be two main causes. One is stagnation of the flow of urine due to narrowing of the urethra, leading to swelling of the renal pelvis. This case of hydronephrosis typically results from stenosis of the ureteropelvic junction, but may also be caused by narrowing of the central ureter, stenosis of the ureterovesical junction, ureterocele or ureteral ectopic opening, or urinary tract passage disorder occurring in the periphery of the urinary bladder, for example, at the urethral valve. The other main cause is backflow of urine accumulated in the bladder via the ureter into the renal pelvis, resulting in hydronephrosis and hydroureter. This vesicoureteral reflux will be explained in the following section. Next, we will explain stenosis of ureteropelvic junction, which is the most common form of urinary tract obstruction. Because hydronephrosis caused by stenosis of the ureteropelvic junction often spontaneously recovers postnatally, medical treatment is not required in some cases. However, when swelling gradually progresses to the point that renal function is impaired, or there are symptoms such as pain and vomiting, surgery (pyeloplasty) may be necessary.

Vesicoureteral reflux

Urine is produced by the kidneys and passes through the renal pelvis and ureter, accumulating in the bladder before being excreted from the urethra. Normally, the passage of urine is one-way, but weakness of the junction between the ureter and the bladder can result in vesicoureteral reflux. Narrowing of part of the urethra will exacerbate the vesicoureteral reflux. When vesicoureteral reflux occurs, bacteria which have entered the bladder may enter the renal pelvis along with the urine backflow, leading to pyelonephritis and high fever. The repetition of pyelonephritis weakens renal function, so the primary purpose of our treatment of vesicoureteral reflux is to prevent pyelonephritis. Vesicoureteral reflux may spontaneously disappear as the patients grow. The rate of disappearance varies depending on factors such as the degree of backflow, age, and sex. If spontaneous disappearance of the symptoms is likely, we will observe the progress. In order to prevent pyelonephritis during observation, oral antibiotics may be prescribed. In the case there is no prospect of spontaneous recovery, or antibiotics are not effective, reflux prevention surgery will be performed.

Cryptorchidism

The testicles are initially in the fetal abdomen, and descend into the scrotum as the fetus grows inside the mother's body. Usually the testes are already in the scrotum at birth, but the descent may take three to six months in preterm infants or children born underweight. A state in which descent of the testes stops midway and the testes do not reach the scrotum is called ‘cryptorchidism’. If cryptorchidism is left untreated, spermatogenesis may be impaired, increasing future risk of infertility. Furthermore, this condition is also reported to increase incidence of cancer, and thus surgery to fix the testes in the scrotum is necessary.

Hypospadias

In hypospadias, the penis does not erect straight because of a downward curve due to inadequate urethra formation. In the future, this condition may interfere with sexual intercourse. It is difficult to urinate in the standing position because the external urethral meatus (exit of urine) is not in the tip of glans (the tip of the penis). The only method of treatment is surgery.