Pediatric Urology
Antenatal hydronephrosis
Grade severity using standardized urinary tract dilation criteria. Most mild cases resolve with observation and repeat ultrasound; voiding cystourethrography is reserved for suspected posterior urethral valves, high-grade dilation, duplex systems, or recurrent infection.
Posterior urethral valves
A male infant with bilateral hydronephrosis, a thick-walled bladder, and a keyhole urethra has valve obstruction. Initial management is bladder drainage with a catheter, correction of electrolytes and creatinine, then endoscopic ablation. Watch for urinary ascites, pneumothorax from pulmonary hypoplasia, and later renal insufficiency or bladder dysfunction.
Vesicoureteral reflux
Grade I to V; low grades often resolve. Continuous antibiotic prophylaxis is used for higher grades or recurrent infection; DMSA scanning assesses scarring.
Scrotum and genitalia
Undescended testes are corrected by orchidopexy, generally between six and eighteen months, to reduce malignancy and infertility risk. Torsion requires urgent exploration with bilateral fixation. Hypospadias repair is delayed and circumcision is avoided because the foreskin may be needed for reconstruction.
Traps
Circulating a hypospadias; diagnosing enuresis before age five; missing valves in a male infant with bilateral hydronephrosis; over-investigating every febrile urinary tract infection with cystography.
Worked example
A newborn boy with bilateral hydronephrosis, a thick bladder, and a keyhole urethra needs catheter drainage and correction of chemistry before valve ablation, not immediate ablation in an unstable neonate.