Some of the most common pediatric urological problems occur during fetal development. The conditions often require surgery at Batson Children's Hospital, a part of Children's of Mississippi, to correct the abnormality and restore full kidney, bladder and urinary functions.
A malformed bladder is one of the many congenital abnormalities that can affect a child’s urologic health. Rather than being its normal round shape, the bladder may be flattened and exposed on the abdominal wall and pelvic bones may be widely separated. The lower urinary tract also may be affected, causing abnormal formation of the prostate, penis or female genitalia.
There are many types of exstrophy, depending on its severity and organ involvement. Several surgeries may be required to reconstruct the bladder, penis or female genitalia. A rare congenital condition called epispadias can produce an abnormal-shaped penis or vagina that performs inefficiently. It is usually accompanied by a bladder exstrophy.
The anomaly, usually detected in a prenatal ultrasound, causes urine to back up in the ureter, the tube that takes urine from the kidney to the bladder. The reflux into the renal pelvis can cause distention and kidney damage. There are two types of VUR: primary, a congenital problem; and second, caused by an infection or obstruction. The reflux is graded according to its severity. Surgery may be required to prevent kidney damage.
Testicles form in the abdomen and during the last few weeks of pregnancy, they pass through the abdominal wall muscles and groin to their normal local. The condition occurs in 3 to 5 percent of full-term boys. Many times the testicles will descend to a normal position within the first six months of life. A testicle missing at birth may be the result of abnormalities in testicular blood vessels or testicular torsion in utero, a twisting and subsequent loss of blood supply to the area.
An obstruction can prevent the flow of urine from the kidney, causing the organ to be filled with fluid. The condition, usually detected with a prenatal ultrasound, can range from mild to severe. Associated disorders may include, but are not limited to, idiopathic hydronephrosis, ureteropelvic junction obstruction, posterior urethral valve (PUV) disorder and multicystic dysplastic kidney.
Hypospadias is the congenital abnormality caused by the incomplete development of the urethra in utero. It occurs in one of about 150 to 300 boys, according to the American Urological Association Foundation. The tube that carries urine and semen is located on the underside of the penis. There may be associated bending of the penis, known as chordee. Degrees of hypospadias are classified according to location, including anterior, middle and posterior. Without surgical correction, severe hypospadias may cause urination problems and infertility.
Spina bifida is a condition in which the lower part of the spinal cord does not form normally. Remnants of the abnormal cord are enclosed in a sac on the child’s back. Even as newborns, some patients may have difficulties emptying their bladder. Oftentimes, nerves and muscles that tighten or release the bladder do not function properly. UMMC pediatric urologists often help empty the bladder by inserting a tube to drain the urine, prevent bladder or kidney damage and prevent urinary tract infections.
The abnormal congenital membrane forms an obstruction in the male urethra, creating a valve that prevents normal bladder emptying. The degree of obstruction varies, but in severe cases, it can lead to renal failure if left untreated. Associated disorders include, but are not limited to, hydronephrosis and vesicoureteral reflux.
Newborn babies often are born with this condition, in which the baby has no abdominal muscles. The stomach looks like a shriveled prune. Known as a triad syndrome, it has a set of anomalies including: absence of abdominal muscles; undescended testicles; and an abnormal, expanded bladder and problems in the upper urinary tract.