Some Conditions We Treat
Undescended Testicle (Cryptorchidism)
Boys’ testicles develop in the abdomen prior to birth and typically descend to their normal position in the scrotum before birth. When a testicle cannot be found in the scrotum, it is considered undescended. This can occur because:
-The testicle retracts easily
-The testicle did not descend completely and is stuck higher in the groin or abdomen
-The testicle was lost while still in the womb or before birth
The condition occurs in up to 30% of premature boys and 4% of full term boys and can be present on one side or both. In many cases, the testicle will descend on its own in the first 3-6 months of life. In other cases, the position of the testicle can be corrected surgically. Close examination by a pediatric urologist can help determine the position of the testicle and the appropriate treatment course.
More about undescended testicles:
Hypospadias is a relatively common condition where the hole that urine comes from, or “meatus,” is located further down the shaft of the penis instead of the tip. In many cases, there is also an associated abnormal curvature of the shaft of the penis called “chordee.” Lastly, there can also be issues with the shape of the foreskin or other penile issues associated with hypospadias.
The severity of hypospadias is quite variable. In some cases, the hole/meatus is near the tip of the penis and there is minimal curvature/chordee. In other cases, the curvature is much more pronounced and the hole is located further down the shaft of the penis. The severity of your child’s hypospadias will dictate what, if any, surgical correction is indicated. Your pediatric urologist will discuss in detail with you the appropriate surgical plan specific to your son’s form of hypospadias.
For more about hypospadias, its causes, and treatment:
Concealed Penis/Buried Penis and Chordee
Approximately 1 in 200 boys will be born with penile chordee or buried/concealed penis. Penile chordee is curvature of the penis that can affect a boy’s ability to point his urine stream or in some cases can cause difficulty with sexual function later in life.
Concealed or buried penis can occur because of a prominent fat pad overlying the penis, but in some cases, it can occur due to poor fixation of the skin to the shaft of the penis, causing the penis to not fully protrude.
In most cases, chordee and buried penis are identified at birth or prior to circumcision. A pediatric urologist can discuss care for your son’s penis as well as options for circumcision for those considering it.
More information about chordee and buried penis:
A varicocele is a dilation of the veins leading to the testicle and they usually become noticeable during puberty. Varicoceles may be present in 15% of the male population. Most adolescent varicoceles are typically not bothersome. Any scrotal discomfort, soft mass in the scrotum, or a difference in size of the testicles should be evaluated for varicocele. Many varicoceles are managed with close observation and regular examinations looking for changes in the varicocele and testicle.
Your pediatric urologist will be able to evaluate the varicocele for severity and discuss treatment options with you.
For more information on varicoceles:
Vesicoureteral Reflux (VUR)
In the normal urinary tract, two kidneys filter the blood to produce urine, which drains through a funnel system within the kidney. Urine then travels from the kidney pelvis through the a tube called the ureter to the urinary bladder. A one-way flap valve at the bottom of the ureter allows urine to pass into the bladder freely, but prevents any urine from going backwards up the ureter to the kidney. This backward flow of urine is called vesicoureteral reflux (VUR).
VUR itself cannot be felt and rarely causes symptoms, but can promote kidney infection and renal scarring by rapidly transporting bacteria to the most susceptible parts of the kidney during urinary infection. Prevention of kidney infections and preserving good bladder function are critically important in caring for kids with reflux (VUR).
Vesicoureteral reflux is frequently managed with close observation and prevention of urine infections and in many cases, the reflux will resolve on its own. Good bladder emptying behaviors and constipation management are critical in any child trying to avoid urine infections. In some cases, surgery is required to reconstruct the one-way valve connecting the ureter and the bladder.
For more information on vesicoureteral reflux:
Hydronephrosis is a buildup of urine within the kidney. As urine is made by the kidney, it then travels out of the kidney through a tube called the ureter and finally into the bladder where it is stored until your child is ready to pee. Hydronephrosis can be caused by a blocked ureter or in some cases by urine reflux from the bladder.
Most of the time, hydronephrosis requires a comprehensive evaluation to identify its cause. In some cases, hydronephrosis can be watched closely for resultion, but in others, surgery or other interventions are indicated in order to prevent kidney infections and preserve kidney function over time.
For more information on hydronephrosis:
Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle. It can be caused by injury to the testicle, vigorous activity, and sleep. It is typically characterized by sudden, sharp pain in the testicle. It can occur in boys of any age. Testicular torsion is considered a medical emergency and boys with sudden onset sharp testicular pain should be taken to the ER for immediate evaluation.
For more information on testicular torsion:
Urinary incontinence (daytime and nighttime) is a common and often confusing problem among children. Most children are out of diapers and able to urinate in the toilet during the daytime by 3 ½ years of age. Nighttime urine control is usually achieved later, often after 4 or 5 years of age.
A variety of conditions can cause urinary incontinence. Therefore, it is important to determine the specific cause or combination of causes of incontinence so that the proper treatment can begin. Treatment is directed toward protection of normal urinary tract function and establishment of an effective voiding pattern with predictable dryness.
For more information on urinary incontinence:
UPJ (Ureteropelvic Junction) Obstruction
UPJ obstruction is when the ureter, a tube which carries urine from the kidney to
the bladder, is blocked at the point it connects to the kidney. This causes urine to back up in the kidney leading to hydronephrosis. A child can be born with a blockage, or the blockage can develop later in life. UPJ obstruction can cause pain and over time can cause deterioration of the kidney’s function.
UPJ obstruction in most cases requires a pyeloplasty, which is a surgical repair that can be done using a traditional open technique or using minimally invasive robotic assisted techniques.
For more information on UPJ obstruction and pyeloplasty:
Inuginal Hernia and Hydrocele
In boys, the testicles develop in the belly and in the weeks before birth, they will typically “drop” into their normal position in the scrotum. In some cases, the tunnel created by the testicle on its journey to the scrotum does not close completely allowing fluid and sometimes bowel to move freely between the scrotum and belly. The fluid around the testicle is called a hydrocele. The open connection is called an inguinal hernia.
Most inguinal hernias and hydroceles will resolve on their own over the first 6-12 months of life. In some cases, however, the connection becomes larger and does not correct itself, putting your son at risk of having bowel or other organs get trapped in the open tunnel. Your pediatric urologist will be able to closely examine your son and determine when and if the hernia/hydrocele requires surgical correction.
For more about hydroceles and inguinal hernias:
Penile adhesions occur when part of the penis skin is stuck to the head of the penis. They are present in all uncircumcised boys and usually separate naturally over time. Some circumcised boys can have adhesions develop after circumcision. Sometimes these may separate on their own, but other times, they have to be separated by a pediatric urologist.
For more on Penile Adhesions:
Phimosis is when the top of the foreskin of the penis becomes progressively tighter and cannot be retracted over the head of the penis. It occurs primarily in uncircumcised boys, but can occur in some boys that are circumcised as well. In some cases, it is related to repeated irritation of the penis and foreskin.
Many times, phimosis can be treated with a prescription strength steroid cream which allows the skin to soften over time. Phimosis can also be treated with circumcision or other similar procedures offered by your pediatric urologist.
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Circumcision is the removal of the foreskin from the penis and the procedure can be done in our office in most cases. The decision to circumcise your son is a personal and family decision. There are some cases where circumcision is medically recommended as well, such as when a boy is born with certain abnormalities of the urinary tract in order to reduce the risk of urinary tract infection.
We strive to make the circumcision process simple for your family and comfortable for your child.
For more about newborn circumcision: