Diagnostics and treatment of urinary system infections
Infection of urinary system is second most common disease in children (only respiratory infections are more common).
Diagnosing of urinary system infection in children can be very difficult due to numerous uncharacteristic symptoms. The dominating symptoms in babies are of general nature: high fever, anxiousness, vomiting, acceptance of only small amount of food, diarrhoea, dehydration, sometimes jaundice. Older children can complain about pain in suprapubic area, pollakiuria or incontinence. Thus, in any child presenting with high fever for unexplained reasons, it is important to perform urinalysis and culture test.
Due to lack of characteristic symptoms and common flippancy towards urinary infections, undiagnosed or not fully treated infections occur.
We have to always remember that bladder function disorder or urinary system defect may hide behind a urinary system infection. Such conditions, if undiagnosed or untreated can lead to kidney failure and necessity for renal replacement therapy.
The actions of doctors in the Children’s Health Clinic along with access to modern diagnostic techniques at the Medicover Hospital will guarantee young patients the best healthcare simultaneously reducing parents’ stress caused by their child’s condition.
Defects and disorders of urinary system
Most common defects and disorders of urinary system treated at the Medicover Hospital:
Vesicoureteral reflux (VUR) happens when some urine goes back up into the ureters and possibly up to the kidneys, which causes gradual failure of renal parenhyma. Kidney damage form regurgitation of most commonly infected urine may result in renal scarring which may be a cause of renal failure and high blood pressure. Bladder defects and failure may foster the back feed of urine and recurring infections. Urinary system defects, eg. posterior urethral valves and bladder function disorders which foster urinal back feed after urination and therefore infections, are often accompanied by VUR. The treatment of VUR depends on its level and the age of the child. The treatment can be prophylactic, drug admission and appropriate hygiene, or surgical. The sugery may include the introduction of a thin tube into the urethra and injecting teflon or collagen into the area where ureter joins the bladder, or surgical reconstruction of correct ostium of the ureter into the bladder.
Hypospadias. It involves an abnormally placed urinary opening. Instead of opening at the tip of the glans of the penis, a hypospadic urethra opens anywhere along the urethral groove from the ventral side of glans penis, along the shaft or scrotum or perineum. This condition must be treated surgically. The surgery involves penis planishing and development of missing part of urethra in order to place the ostium at the end of glans. The surgery is performed in young males aged 2-3. In advanced hypospadias multiphased treatment is needed. The surgical methods should be aligned with the type and severity of the defect. A regular, follow up check-up is required, usually one month, three months and every six months and then once a year (until adulthood) after the surgery.
Cryptorchism is the absence of one or both testes from the scrotum. The absence is caused by failure in testes descending to scrotum. The surgery should be performed before the age of 2 and involves descending the testis/testes into the scrotum. If testis/testes are found in abdominal cavern, a laparoscopic surgery can be carried out. Sometimes, due to numerous complications, the surgeries need to be multiphased. The surgery is performed under general anesthesia and involves the opening of the inguinal canal, finding the testis, placing it into the scrotum in way, that would make its return to inguinal canal impossible.
Cryptorchic complications:
- Testicular cancer
- Testicular torsion
- Reduced fertility
Hydrocele (also in spermatic cord) – in case of congenital hydroceles, which occur in children, it is the fluid from petrinoteum. The testis, descending to scrotum at the end of fetal life drags along a spicule of petrinoteum - processus vaginalis peritonei. During the infancy, in most boys this apophysis remains open, which allows uninhibited flow of the fluid between tunica vaginalis and petrinoteum. In that case the disease is called communicating hydrocele. The hydrocele changes its volume depending on child’s motor activity. If the communication channel is wide enough, the intestines can enter and form inguinal hernia. If processus vaginalis peritonei obliterates unequally, a spermatic cord hydrocele can result. It is the fluid collection above the testis along the spermatic cord. The sugery is similar to the one treating the inguinal hernia with additional excision of processus vaginalis peritonei and can be carried out laparoscopically. This allows the patient to go home one day after the surgery.
Phimosis - is a condition where the male foreskin cannot be fully retracted from the glans of the penis, due to narrow, often scarred ostium. The surgical treatment involves excision of foreskin (circumcision) or plastic surgery of the foreskin which widens its ostium. In case of such surgery a short-term intravenous or local anesthesia is possible, which allows the child to leave the hospital on the same day.
Urological surgeries at the Medicover Hospital:
- Bladder augmentation
- Development of a tight vesical fistula to empty the bladder from the bladder lobe in patients with neurogenic bladder
- Supracystic urine diversion by the method of Bricker
- Development or closing of urocutaneous fistula
- Development or closing of vesicocutaneous fistula
Back