Children's Congenital Urologic Anomalies

Some of the most common pediatric urological problems occur during fetal development. The conditions often require surgery at Children's of Mississippi to correct the abnormality and restore full kidney, bladder and urinary functions.

Bladder exstrophy

A malformed bladder is one of the many congenital abnormalities that can affect a child’s urologic health. Rather than being its normal round shape, the bladder may be flattened and exposed on the abdominal wall and pelvic bones may be widely separated. The lower urinary tract also may be affected, causing abnormal formation of the prostate, penis or female genitalia.

There are many types of exstrophy, depending on its severity and organ involvement. Several surgeries may be required to reconstruct the bladder, penis or female genitalia. A rare congenital condition called epispadias can produce an abnormal-shaped penis or vagina that performs inefficiently. It is usually accompanied by a bladder exstrophy.

Services

• Evaluation and diagnosis
  • Physical examination
• Surgical management

Vesicoureteral reflux

The anomaly, usually detected in a prenatal ultrasound, causes urine to back up in the ureter, the tube that takes urine from the kidney to the bladder. The reflux into the renal pelvis can cause distention and kidney damage. There are two types of VUR: primary, a congenital problem; and second, caused by an infection or obstruction. The reflux is graded according to its severity. Surgery may be required to prevent kidney damage.

Services

• Evaluation and diagnosis
  • Urinalysis and urine culture
  • Voiding cystourethrogram
• Non-surgical management
  • Antibiotics and observation
• Surgical management
  • Ureteric re-implantation
  • Endoscopic procedure to inject bulking agent

Undescended testes

Testicles form in the abdomen and during the last few weeks of pregnancy, they pass through the abdominal wall muscles and groin to their normal local. The condition occurs in 3 to 5 percent of full-term boys. Many times the testicles will descend to a normal position within the first six months of life. A testicle missing at birth may be the result of abnormalities in testicular blood vessels or testicular torsion in utero, a twisting and subsequent loss of blood supply to the area.

Services

• Evaluation and diagnosis
  • Physical examination
• Non-surgical management
  • Manipulation
  • Hormonal therapy
• Surgical management

Hydronephrosis

An obstruction can prevent the flow of urine from the kidney, causing the organ to be filled with fluid. The condition, usually detected with a prenatal ultrasound, can range from mild to severe. Associated disorders may include, but are not limited to, idiopathic hydronephrosis, ureteropelvic junction obstruction, posterior urethral valve (PUV) disorder and multicystic dysplastic kidney.

Services

• Diagnosis and evaluation
  • Ultrasound
  • Diuretic renal scan
  • Voiding cystourethrogram
• Non-surgical management
  • Observation
• Surgical management
  • Blockage removal (pyeloplasty)
  • Ablation of PUV or vesicostomy

Hypospadias

Hypospadias is the congenital abnormality caused by the incomplete development of the urethra in utero. It occurs in one of about 150 to 300 boys, according to the American Urological Association Foundation. The tube that carries urine and semen is located on the underside of the penis. There may be associated bending of the penis, known as chordee. Degrees of hypospadias are classified according to location, including anterior, middle and posterior. Without surgical correction, severe hypospadias may cause urination problems and infertility.

Services

• Evaluation and diagnosis
  • Physical examination
• Surgical management
  • Penile reconstruction

Spina bifida

Spina bifida is a condition in which the lower part of the spinal cord does not form normally. Remnants of the abnormal cord are enclosed in a sac on the child’s back. Even as newborns, some patients may have difficulties emptying their bladder. Oftentimes, nerves and muscles that tighten or release the bladder do not function properly. UMMC pediatric urologists often help empty the bladder by inserting a tube to drain the urine, prevent bladder or kidney damage and prevent urinary tract infections.

Services

• Evaluation and diagnosis
  • Renal ultrasound
  • Voiding cystourethrogram (VCUG)
• Non-surgical treatments
  • Intermittent catheterization
  • Medications
• Surgical treatment

Posterior urethral valve (PUV) disorder

The abnormal congenital membrane forms an obstruction in the male urethra, creating a valve that prevents normal bladder emptying. The degree of obstruction varies, but in severe cases, it can lead to renal failure if left untreated. Associated disorders include, but are not limited to, hydronephrosis and vesicoureteral reflux.

Services

• Diagnosis and evaluation
  • Renal ultrasound
  • Voiding cystourethrogram

Eagle-Barrett syndrome (prune belly)

Newborn babies often are born with this condition, in which the baby has no abdominal muscles. The stomach looks like a shriveled prune. Known as a triad syndrome, it has a set of anomalies including: absence of abdominal muscles; undescended testicles; and an abnormal, expanded bladder and problems in the upper urinary tract.

Services

• Diagnosis and evaluation
  • Renal ultrasound
  • Voiding cystourethrogram
  • Intravenous pyelogram
  • Blood tests
• Non-surgical treatment
• Surgical treatment
  • Vesicostomy (small opening made in the bladder through to the abdomen)
  • Orchiopexy (advance the testes into the scrotum)
  • Abdominal wall reconstruction
  • Ureteral re-implantation