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Pediatric Urology is a sub-specialty that deals with children's urogenital systems like kidney infections, blockage, tumors in the kidney and allied organs, trauma, and congenital disabilities in the urinary tract. It is crucial for parents to be aware of pediatric-urology-related diseases and issues as the chances of renal disease diagnosing and occurring from birth up to 20 years of age are slightly higher than that in adults.
All the pediatric urological diseases could be traced back to six major causes:
Early diagnosis and timely detection of these diseases in children are crucial factors as delayed or inappropriate diagnosis and/or failure of proper treatment would lead to the kidneys packing up, leaving the parent and child with the only option of renal transplantation, which is critical to be carried out in children.
In my years of practice, I have seen less than five per cent of patients aware of the symptoms and diagnosis methods, and treatment approaches available to them. I would advise parents to look out for the following most common symptoms:
Other common symptoms include frequent fever and pain in the belly, lower back, and around the bladder.
The most common urologic condition amongst children is urinary tract infection (UTI), and simple Urine tests are recommended to diagnose the same. However, UTIs and especially recurring UTIs may be an indication for a bigger problem in Kidneys and allied organs. There are different kinds of scans of the bladder and kidneys, such as Kidney and/or Bladder Ultrasonography (Ultrasound), Voiding Cystourethrogram (VCUG), Nuclear Scan, CT Scan, or MRI.
It is advised to get an ultrasound for the child in the slightest case of urologic infection/ diseases and consult a pediatric urologist or an experienced urologist doctor for further management and treatment course.
Most of the common urological problems are managed with behavioral therapy and medication as prescribed by the concerned doctor. Depending on the child's specific urological condition and overall health profile, non-surgical treatment options are prescribed.
Other pediatric urology problems that have advanced may require surgical intervention. It has been observed that approximately 30 per cent to 35 per cent of tested children who face end-stage renal failure lead to the need for renal transplantation in India as compared to only 2 per cent to 3 per cent of children in Europe. That suggests that from the 30 children who developed renal failures out of 100 children in India, 28 children should not be in the difficult place. The primary reason for the poor statistics of the development of renal failure in our country is because of poorly managed urological conditions and diagnosis in the first ten years of childhood.
Surgical intervention for advanced urological conditions and renal transplantation for end-stage renal disease is the optimal therapy suggested for children. The parents are advised to consult specialist pediatric urologists in such cases as they are experienced in handling small kids and can operate on very soft and miniature tissues. It is critical that parents should consider visiting a pediatric urologist as in the case of children as the organ size is 1/4th of that of adults. Therefore, it requires a specialist to perform surgical procedures on children as the procedure has to be done right in the one attempt where there is a little to no margin for error.
The surgical approach includes open surgery; however, advanced and minimally-invasive (MIS) technology like laparoscopy and robotic-assisted surgery (commercially available as the da Vinci surgical system) is the optimal approach for pediatric surgeries. Laparoscopy surgery requires the expertise of the surgeon's team as the outcome is dependent on the combined efforts. In robotic-assisted surgery (RAS), only the surgeon's movements get translated into robotic arms, and the outcome depends on the surgeon's proficiency. In my experience of over 400 robotic procedures, have received comparable results to the other traditional and MIS alternatives. RAS provides the benefits of better precision and 3D vision, especially in case of reconstruction surgeries, to the surgeon and minimal blood loss and minimal recovery period for the children.
The recovery period of RAS is 2-3 days as compared to over a week for open surgery. Hence, with the help of RAS, a proficient surgeon is able to conduct the surgery safely and efficiently. A notable benefit of RAS in the case of children is the minimal scarring. The scars from urological surgery can adversely affect them physically and mentally, given that the children have their whole life ahead of them.
Although there are advanced management options like robotic-assisted surgeries and robotic renal transplants, and experienced surgeons to perform them in India today, there is a need to bring down the numbers by preventing the diseases from aggravating to that stage. It is advised that the parents must visit pediatricians for a regular health check-up and undergo the recommended tests and consult the pediatric urologists in case of further management of urological issues is required.
(This article is authored by Dr. Sujit Chowdhary, Clinical Director and Senior Consultant, Paediatric Urology & Paediatric Surgery, Indraprastha Apollo Hospitals, New Delhi)