When a child is diagnosed with a urologic condition, parents understandably have many questions and concerns about how the child's life will be impacted. “However, urologic problems are common in children—both boys and girls," says Adam Hittelman MD, PhD, a Yale Medicine pediatric urologist.
Hydronephrosis, urine collecting in the kidney, is the most common pediatric urology problem identified on fetal ultrasounds performed during pregnancy. "When a problem is identified, we will often speak with the families during the pregnancy to reassure them as well as to establish relationship for after the delivery," Dr. Hittelman says. "Fortunately, many babies will outgrow hydronephrosis and can be followed with serial renal ultrasounds. There are some children who will not spontaneously resolve and may have to go on to surgery or other medical care, though the majority of these can be corrected and very few children will develop long term kidney problems."
Doctors within the Yale Medicine Pediatric Urology Program treat a wide range of urologic health conditions from routine circumcisions to complex reconstructive surgeries for sexual development disorders. Communication with parents is central to everything we do. "We also work closely with our colleagues in our multidisciplinary programs to co-manage children with more complicated urologic and medical problems,” says Dr. Hittelman.
What is pediatric urology?
Pediatric urology is focused on treating problems related to the genitals or urinary tract in children, which includes the kidneys, ureter and bladder.
What are the specialties of Yale Medicine's Pediatric Urology department?
- Minimally invasive and robotic surgery: Yale Medicine's Pediatric Urology Department offers minimally invasive approaches, including laparoscopic, endoscopic and robot-assisted surgery. These procedures have been shown to minimize incision size and shorten recovery time. Children are able to return home sooner with less scarring and faster healing.
- Complex urogenital reconstruction: We specialize in surgery for serious congenital and acquired genitourinary defects. Doctors work with parents to create a complete treatment plan tailored for their child. We apply cutting-edge diagnostic and treatment techniques and consult noted multi-disciplinary specialists, including endocrinologists, nephrologists, geneticists, neurologists, radiologists and neurosurgeons.
- Disorders of sexual development: These are complex congenital and developmental problems affecting the external genitalia and reproductive system. Caregivers adopt a multi-disciplinary approach to treating these children, utilizing different pediatric specialists to help diagnose and manage the care of each patient and working with families to explain the issues and incorporate them in the care plan.
- Stone disease: Kidney stones can be an extremely painful condition with a high rate of recurrence. Our pediatric stone team, which includes pediatric nephrologists, urologists, nutritionists, radiologists and interventional radiologists, provides comprehensive treatment to help children manage their kidney stones. We apply holistic approaches and develop preventative plans. Because young patients with stone disease may have to undergo repeated computed tomography scans (CT scans), our team utilizes ways to reduce their radiation exposure. We monitor this condition using an ultra low-dose CT scan which exposes children to 87 percent less radiation than standard CT scans.
- Common urologic issues: These include circumcisions, hernia and hydrocele repairs as well as correcting undescended testicles, a condition that occurs when one or both testicles fail to move into the scrotum before birth.
- Kidney conditions: Caregivers use a multi-disciplinary approach to diagnose and treat conditions including kidney infections, vesicoureteral reflux, hydronephrosis—when the kidney swells because of a back-up of urine—congenital kidney anomalies and kidney cancer.
- Spina bifida: Spina bifida is a birth defect of the spinal cord, which can lead to neurologic problems of the lower extremities, bowel and bladder. Our team of pediatric urologists collaborates in a multi-disciplinary clinic and incorporates minimally invasive treatments for the bladder and bowel dysfunction that can occur with spina bifida.
- Dysfunctional elimination syndrome: Urologists work with children to improve problems with bladder and bowel function. We also treat enuresis, urinary accidents which can occur during the day or at night.
- Hypospadias: This is an abnormality of the penis in which the urethra opens on the underside. Hypospadias typically treated with surgery.
- Neurogenic bladder: Typically a disease of the central nervous system or peripheral nerves, neurogenic bladder is a condition that causes the bladder to become overactive or underactive. This can lead to chronic infections, problems with urinary accidents and harm to the kidneys.
- Bladder exstrophy: A congenital condition in which the bladder and associated structures are malformed.
- Varicocele: An enlargement of the veins from the testicle, which can lead to the appearance of scrotal swelling and potentially impair fertility.
- Urologic cancers: These conditions include testicular, kidney and bladder masses.
What makes Yale Medicine's approach to pediatric urology unique?
Pediatric patients are seen in a warm, kid-friendly setting, designed to comfort children and put parents at ease. Parents are welcomed and encouraged to be with their children all through courses of treatment.
Because urologic problems are often discovered in utero, our relationship with families in our practice begins early and can extend for many years. At Yale Medicine, our physicians are committed to being there through your child's the whole treatment process.