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Pediatric Urology

The North Texas Center for Pediatric Urology

Pediatric Urology is dedicated to the treatment and care of problems related to the kidney, ureter, bladder, prostate, urethra, penis, vagina and testicles of children.

UANT has the largest medical staff in Tarrant County dedicated exclusively to pediatric urology. Our fellowship-trained physicians were first trained and board certified in general urology and have since received additional training in the care of the special urological problems presented by children.

The staff at the Center for Pediatric Urology wants you to fully understand your child's condition and the treatments available and to make caring for your child at this difficult time as easy as possible. Our pediatric urologists are well qualified to address the full range of urological problems, some of which are described below, and are available for questions and consultation.

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Common Conditions:



Nocturnal Enuresis (Bed wetting)

Nocturnal enuresis is defined as involuntary urination that occurs at night. There are two types of enuresis: primary and secondary. Primary nocturnal enuresis describes the condition in which an individual has wet the bed since early childhood. Secondary enuresis, describes the condition when it develops at least 6 months after an individual has already learned bladder control.

What Causes Enuresis?

Enuresis can be brought on by more than one cause. The most common causes are:

  • Hormonal Problems
    A hormone called antidiuretic hormone (ADH) causes an individual's body to produce less urine at night. In instances where not enough ADH is produced, the body can produce more urine than it should.
  • Bladder Problems
    In some people with enuresis, too many muscle spasms can prevent the bladder from holding a normal amount of urine. Some teens and adults also have relatively small bladders that can't hold a large volume of urine.
  • Genetics
    Enuresis in a child can often be linked to a parent who had the same problem at about the same age.
  • Sleep Problems
    Some children can sleep so deeply that they do not wake up when they need to urinate.
  • Medical Conditions
    Medical conditions that can trigger secondary enuresis include diabetes, constipation, and urinary tract infections. Spinal cord trauma, such as severe stretching of the spinal cord resulting from a fall, sports injury, auto accident, or other event may also play a role in enuresis, although this is rare. Abnormal development of the spinal cord can also lead to enuresis.
  • Psychological Problems.
    A disruption of sleep patterns may also cause enuresis. This disruption can be caused by events such as divorce, the death of a friend or family member, a move to a new town, adapting to a new school or social environment, or family tension.

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Urinary Incontinence (Leakage of urine)

Urinary incontinence occurs when urine leaks from the bladder, or an individual cannot control the urge to urinate. It occurs more frequently in women than in men, often in older women and after pregnancy. Although incontinence is often caused by weakened, aging muscles, there are other causes that are treatable such as onset caused by an illness or infection, a blockage in the urinary passage, or because the bladder can't fully empty itself.

Once diagnosed, incontinence can be treated successfully through:

  • Exercise, which can help strengthen the pelvic muscles
  • Collagen injections, which narrow the area near the urinary sphincter muscle
  • Surgery, to reposition the muscles and connective tissues that support the bladder and the bladder neck.

At the North Texas Center for Urinary Control, our physicians can offer patients the solutions and options that will enable them to return to enjoying a more carefree lifestyle.

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Undescended Testicle (Cryptorchidisn)

About 5 out of every 100 baby boys are born with an undescended testicle, which occurs when a testicle does not move into the scrotum as it should. It is most common in babies who were born before their due date or who were very small at birth. In more than half of cases, the testicle descends on its own by the time a baby is 3 months old. If the testicles have not descended by the time a child is 6 months of age, your doctor may suggest treatment.

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Hernia

A hernia occurs when the inside layers of the abdominal wall weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing pain and other potentially serious health problems.

Men and women of all ages can have hernias. Hernias usually occur either because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall, such as the strain from heavy lifting, substantial weight gain, persistent coughing, or difficulty with bowel movements or urination. Eighty percent of all hernias are located near the groin. Hernias may also occur below the groin (femoral), through the navel (umbilical), and along a previous incision (incisional or ventral).

What are the symptoms of hernias?

  • A noticeable protrusion in the groin area or in the abdomen
  • Feeling pain while lifting
  • A dull aching sensation
  • A vague feeling of fullness

How can a hernia be repaired?

Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery takes about an hour and is usually performed on an outpatient basis. This surgery may be performed by an open repair (small incision over the herniated area) or by laparoscopic surgery (minimally invasive). Your surgeon will determine the best method of repair for your individual situation.

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Hydrocele

A hydrocele is a collection of fluid in the scrotal sac of male infants that drains downward from the abdominal cavity. The baby's scrotum will appear swollen or large, but he will not have other symptoms.

There are two types of hydroceles:

  • Communicating hydrocele -- This is a hydrocele that has contact (or communication) with the fluids of the abdominal cavity. A communicating hydrocele is caused by the failure of the processus vaginalis (the thin membrane that extends through the inguinal canal and descends into the scrotum) to close completely during prenatal development. If this membrane remains open, there is a potential for both a hernia and a hydrocele to develop.
  • Non-communicating hydrocele -- This condition might be present at birth or might develop years later for no obvious reason. A non-communicating hydrocele usually remains the same size or has a very slow growth.

Unlike an inguinal hernia, a hydrocele generally is not painful and does not have noticeable symptoms. (An inguinal hernia is tender and causes intestinal symptoms.)

How can a hydrocele be repaired?

A non-communicating hydrocele usually does not need to be surgically repaired, since it usually goes away spontaneously within six to 12 months. A communicating hydrocele needs to be surgically repaired to prevent further complications. The surgery takes about an hour and is usually performed on an outpatient basis.

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Urinary Tract Infections (Bladder/Kidney infections)

Your urinary tract is the system that makes urine and carries it out of the body. It includes the bladder, the kidneys and the tubes that connect them. When germs get into this system, they can cause an infection. Most urinary tract infections are bladder infections. A bladder infection usually is not serious if it is treated right away. If you do not take care of a bladder infection, it can spread to your kidneys. A kidney infection is serious and can cause permanent damage.

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Vesicoreteral Reflux

Urine normally flows in one direction-down from the kidneys, through tubes called ureters, to the bladder. Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder back into the ureters. VUR is most commonly diagnosed in infancy and childhood after the patient has a urinary tract infection (UTI). About one-third of children with a UTI are found to have VUR. VUR can lead to infection because urine that remains in the child's urinary tract provides a place for bacteria to grow. Sometimes, however, the infection itself is the cause of VUR.

There are two types of VUR. Primary VUR occurs when a child is born with an impaired valve where the ureter joins the bladder. This happens if the ureter did not grow long enough during the child's development in the womb. The valve does not close properly, so urine backs up (refluxes) from the bladder to the ureters, and eventually to the kidneys. This type of VUR can get better or disappear as the child gets older. The ureter gets longer as the child grows, and the function of the valve improves.

Secondary VUR occurs when there is a blockage anywhere in the urinary system. The blockage may be caused by an infection in the bladder that leads to swelling of the ureter. This also causes a reflux of urine to the kidneys.

Infection is the most common symptom of VUR. As the child gets older, other symptoms, such as bedwetting, high blood pressure, protein in the urine, and kidney failure, may appear.

The goal for treatment of VUR is to prevent any kidney damage from occurring. Infections should be treated at once with antibiotics to prevent the infection from moving into the kidneys. Antibiotic therapy usually corrects reflux caused by infection. Sometimes surgery is needed to correct primary VUR.

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Circumcision

Males are born with a hood of skin, called the foreskin, covering the glans (head) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis. A circumcision is best performed within the first 2 to 3 weeks after birth, as it can become more complicated as a child gets older, but the procedure is usually performed during the first 10 days, often within 48 hours of birth.

Benefits of Circumcision

Studies indicate that circumcised infants are less likely to contract a urinary tract infection (UTI) in their first year of life. About one out of every 1,000 circumcised boys has a UTI in the first year, whereas the rate is one in 100 (at most) for uncircumcised infants.

Some studies also suggest that circumcision may offer an additional line of defense against sexually transmitted diseases, HIV in particular, but the results of these studies are inconclusive.

While circumcision appears to offer some medical benefits, it also carries the same potential risks as any surgical procedure. Complications resulting from newborn circumcision are uncommon, occurring in between 0.2% to 3% of cases. Of these, the most frequent are minor bleeding and local infection, both of which can be easily treated by your child's doctor.

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Hematuria (blood in urine)

When red blood cells are detected in the urine - but the urine doesn't appear red from blood - this is called "microscopic hematuria." Blood in urine can be caused by many conditions, including:

  • Urinary tract infection (cystitis)
  • Bladder or kidney stone
  • Noncancerous or cancerous enlargement of the prostate in men
  • Bladder or kidney cancer
  • Kidney disease, such as nephritis
  • Medications such as warfarin, aspirin, ibuprofen and naproxen

To try to determine the cause of blood in urine, your doctor may recommend additional tests, such as:

  • Urine tests (urinalysis)
  • Blood tests
  • Kidney- and bladder-imaging studies
  • Cystoscopy, a procedure in which a narrow tube is inserted through your urethra and into your bladder, which allows your doctor to visually inspect your urethra and bladder. Sometimes the cause can't be determined. In such cases, your doctor may simply monitor the condition to see if it persists. If blood is visible in your urine (gross hematuria), consult your doctor.

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Obstructed kidneys (UPJ Obstruction)

Ureteropelvic junction (UPJ) obstruction is defined as a blockage in the area that connects the renal pelvis (part of the kidney) to one of the tubes (ureters) that move urine to the bladder. Generally, the condition occurs in the womb and most of the time, the blockage is caused when the connection between the ureter and the renal pelvis narrows, causing urine to build up, damaging the kidney.

The condition can also be caused when a blood vessel is located in the wrong position over the ureter. In older children and adults, UPJ obstruction can be due to scar tissue, infection, previous treatments for a blockage, or kidney stones.

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Hydronephrosis

UPJ can lead to hydronephrosis, a swelling of the urine-collecting structures of one or both kidneys due to obstruction of urine flow from the kidney. This can impair kidney function. Hydronephrosis isn't a specific disease, but a sign of an underlying problem. Other causes include:

  • A kidney or ureteral stone (nephrolithiasis)
  • A blood clot
  • Scarring of the ureter, usually from injury, radiation therapy or previous surgery
  • A tumor in or around the ureter
  • Prostate gland enlargement (benign prostatic hyperplasia)

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Kidney Stone

A kidney or bladder stone is formed from minerals in urine that crystallize and harden. Kidney stones are usually painless while they remain in the kidney, but they can cause severe pain if and when they break loose and travel through narrow tubes to exit the body.

Our pediatric urologists are available for questions and consultation. If you have questions, please call us at 817 461-UANT (8268).

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