In this interview, pediatric urologist and professor at the Bahiana School of Medicine and Public Health, Dr. Ubrajara Barroso, talks about the main urological problems that affect boys and girls in childhood and adolescence. Get to know this medical specialty.
iSaúde Bahia - What are the main uropediatric problems?
Dr. Ubirajara Barroso - Pediatric urology deals with genital and urinary problems in children. Common problems such as phimosis, the absence of a testicle in the scrotum (cryptorchidism) or more prominent congenital alterations such as a urethral canal that is born out of its usual position (type or epispadias), genital ambiguities and a bladder that is born outwards (bladder extrophy) are some examples of genital alterations. In the area of urinary alterations, the most common are urinary incontinence during the day or during sleep (nocturnal enuresis), neurogenic bladder, renal dilations (hydronephrosis) and reflux of urine from the bladder to the kidney (vesicoureteral reflux). Another frequent problem that pediatric urology deals with is urinary infection.
The pediatric urologist is also involved in prevention, guidance on genital care, diaper changing and, in adolescence, sexual guidance and genital and urinary examination.
iSB - Does a pediatric urologist only take care of boys?
Dr. Ubirajara Barroso - No. After the age of six months, girls have more urinary infections than boys. Also, girls have more urinary symptoms after they get out of diapers than boys. In addition, it is the pediatric urologist who performs major vaginal reconstructions on children born with congenital anomalies of the vagina, such as genital ambiguity.
iSB - Up to what age can a patient be seen by a pediatric urologist?
Dr. Ubirajara Barroso - At first until the age of 18. However, there are adults who have chronic urinary diseases that start in childhood and persist beyond adulthood. These cases can continue to be monitored by the pediatric urologist, as there are rare situations in which the adult urologist is unable to gain experience, such as hypospadias, bladder extrophy and myelomeningocele.
iSB - Up to what age is urinary incontinence healthy (or within the normal range)?
Dr. Ubirajara Barroso - Children can be expected to have incontinence while they sleep (nocturnal enuresis) until they are five years old. During the day, children over the age of three who are still incontinent should see a urologist.
iSB - What is the difference between phimosis and circumcision?
Dr. Ubirajara Barroso - Phimosis is the inability to retract the skin of the penis (foreskin) and be able to see the glans (head of the penis) as a whole. Circumcision is a surgical procedure to remove the excess foreskin. Not all phimosis requires circumcision. The pediatric urologist will determine this.
iSB - Who has more urological problems: girls or boys? Is there a cause?
Dr. Ubirajara Barroso - Girls are more prone to incontinence and urinary infection and this is due to a shorter urethra. Boys have more congenital anomalies, such as hydronephrosis. There is no clear explanation for this.
iSB - Why are some children born with their testicle(s) misplaced (outside the scrotum)?
Dr. Ubirajara Barroso - This is a problem called cryptorchidism. The testicles are located inside the abdomen during the fetal period. However, from the seventh month of pregnancy onwards, they move towards the scrotum under the effect of a hormone called chorionic gonadotrophin, produced by the placenta. Other substances such as procalcitonin and insulin-like growth factor also have an effect on this process. If these substances are lacking during pregnancy, or if the testicles are insensitive to them, they can remain in the abdomen or stop descending and remain in the inguinal region (groin). The problem with cryptorchidism is that increased testicular heating reduces the function of the organ and can lead to cancer.
iSB - What is an inguinal hernia?
Dr. Ubirajara Barroso - A hernia is the passage of an organic structure through an orifice. In the case of children, an inguinal hernia is due to the persistence of the peritoneal-vaginal duct. This is a duct that connects the abdomen to the scrotum or inguinal region, which must be closed before birth. Persistence can lead to the entry of contents such as intestinal loops or fat into the inguinal orifice. The hernia must be treated with surgery to avoid damaging these structures.
iSB - Is urinary infection in childhood common?
Dr. Ubirajara Barroso - Around 3% of all boys and 8% of all girls will have a urinary tract infection. In children, urinary infection should be treated quickly because of the risk of kidney damage. In addition, it should be investigated from the first episode, because in younger children it is usually caused by congenital anomalies and in older children by changes in urination. Phimosis is also an important cause and constipation increases the chance of this occurring.
Source: http://www.isaudebahia.com.br/noticias/detalhe/noticia/quando-levar-seu-filho-ao-urologista/