Pediatric Urology is a sub-speciality of surgery which deals with disorders of the Genitourinary System in children, that includes the kidneys, ureters, bladder, sexual and reproductive organs. Pediatric urological disorders are present in children from birth and are very different from that of adult urological problems. We focus on a wide range of urologic problems affecting children, including obstructions in the urinary tract, incontinence, vesicoureteral reflux, hypospadias, undescended testis, genital abnormalities and tumors of the kidney, bladder, vagina, and testes in children.
In many cases nowadays, urological problems can be managed successfully without surgery by waiting with careful observation, thus delaying or even avoiding the surgery completely. Advances in technology and instrumentation have made more and more Laparoscopic and Endoscopic urological surgeries possible in children, eliminating many other problems associated with open surgeries.
In cases where there is a need for a surgery, it is performed with great expertise, precision and care, considering the fact that the patient being operated on is a small child. The management of urological problems, if any, in a child can be planned even before the delivery of a child. We work in collaboration with our obstetrician and pediatric nephrologist to ensure that.
Phimosis is defined as inability to retract prepuce. It is important to understand that most of these phimosis are physiological and does not require any surgical intervention.
Non retractile foreskins are common among young boys and is a part of normal preputial development. Prepuce of new born is non retractile and at the age of 3 years up to 10% remain non-retractile. It has been seen that 8% of boys at the age of 6 years and 1% at the age of 16 years still had non-retractile foreskin. The foreskin gradually becomes retractile secondary to intermittent erections and keratinization of the inner epithelium. That is most of the prepuce becomes retractile by adulthood.
It is important to differentiate true pathologic phimosis from physiological phimosis. While physiologic phimosis consists of pliant, unscarred preputial orifice, true pathological phimosis is characterized by contracted white fibrous ring around the preputial orifice.
Most of the patients with phimosis require only reassurance and preputial hygiene. A short course of topical corticosteroids (0.15 triamcinilone / betamethasone/0.1% mometasone)twice daily for 6-8 wks has success rate of 80-90% in separating preputial adhesions and can be given if child has symptoms of straining and ballooning of prepuce. The only indication of circumcision is pathologic phimosis with scarred prepuce which is a result of recurrent balanitis.
To conclude, most of the phimosis are physiological and self correcting by adulthood and does not require any treatment. Also to discourage unnecessary circumcision which carries multiple complications it is necessary to differentiate physiological phimosis from pathological phimosis. (AMERICAN ACADEMY OF PEDIATRICIANS STRONGLY CONDEMNS THIS OPERATION IN THE STRONGEST OF WORDS).
The Pediatric Surgeon is regularly consulted to participate in counseling when prenatal evaluation reveals a fetus having a condition requiring surgery after its birth. The anticipated surgical care issues are discussed with the parents, and decisions regarding timing, location, and method of delivery are made in conjunction with the neonatologist, obstetric services and the parents.