Pediatric urological conditions: Clinical

Some of the most common urologic issues in children include congenital defects of the urethra - so hypospadias and epispadias; hematuria; pathologies associated with hydronephrosis - so congenital ureteropelvic junction obstruction, ectopic ureter, vesicoureteral reflux, and posterior urethral valves; and lastly, urinary tract infections.

Let’s begin with congenital defects of the urethra. First, hypospadias is a congenital disorder that’s common in males but extremely rare in females.

In hypospadias, the urethral opening or meatus is not at the tip of the penis but on the bottom of the urethra, which is located on the ventral side of the penis. This occurs because the urethral folds along the penile urethra don’t meet up and close properly, leaving an opening along the bottom of the penile shaft. Diagnosis is mostly clinical.

On examination, there are three possible types of hypospadias in males: glanular, which is near the head of the penis, midshaft, which is the middle of the penis, and penoscrotal—where the penis and scrotum come together. Additional findings include foreskin that fails to become circumferential and appears as a dorsal hood; chordee, which is when the penis has a hook shape and curves inwardly; inguinal hernia, which is a protrusion of bowel through the inguinal canal, and cryptorchidism, which is the absence of testes from the scrotum. The clinical picture might also present with painful urination, recurrent urinary tract infections, sexual dysfunction, infertility, and psychosocial problems, especially as the individual grows and matures sexually.