Answering Clinical Questions Improves Patient Safety

  • What is hydronephrosis?

    What is hydronephrosis?

    Hydronephrosis (hydo=water; nephron=kidney) is a descriptive term, not a diagnosis. It is the term doctors use to describe a kidney that appears “swollen” (“dilated”) because it holds more urine than normal. It is often picked up on antenatal scanning (1:500 pregnancies) and is transient and insignificant in up to 90% of cases, depending on the measurements used. This is because the fetus produces much more urine than a newborn baby and this increased flow may transiently stretch the kidney. The hydronephrosis then often resolves once the baby is born.

  • What do the hydronephrosis measurements mean?

    What do the hydronephrosis measurements mean?

    The fetal medicine specialist will often document the diameter of the kidney pelvis prenatally,as will the radiologist on the ultrasound scan performed once the baby is born. The measurements are very operator-dependent and will vary – so it is best to wait until the consultation with your Paediatric Urologist who will be able to interpret all the measurements and decide whether they are significant enough to warrant further investigation. The measurements help us establish whether the hydronephrosis is getting better or worse, and also whether we need to not all babies require.

  • I am pregnant and I was told that my baby’s kidney is not normal, should I consult a Paediatric Urologist?

    I am pregnant and I was told that my baby’s kidney is not normal, should I consult a Paediatric Urologist?

    A number of kidney conditions may be diagnosed prenatally, including hydronephrosis, duplex (“double”) kidneys, bladder cysts (“ureterocoele”), cystic kidneys (“multicystic dysplastic kidney”) and a thick-walled or distended bladder which may be suggestive of a blockage called “posterior urethral valves”. A paediatric urology consultation may reduce anxiety, and facilitate a postnatal plan. In the north west London area I carry out prenatal counselling clinics in Queen Charlotte’s and Chelsea Hospital (NHS) and Chelsea & Westminster Hospital (NHS and Private). In other areas it is best to ask your GP to refer you to your local Paediatric Urologist.

  • Why was my baby started on antibiotics and will they effect his/ her immune system?

    Why was my baby started on antibiotics and will they effect his/ her immune system?

    Babies born with prenatally-diagnosed hydronephrosis are usually started on an antibiotic called Trimethoprim once they are born. The antibiotic is given once every evening and is prescribed at a quarter of the normal dose for that antibiotic. It protects the baby from developing an infection in the hydronephrotic kidney, which can be very serious. It is therefore important that you give the baby the antibiotic until advised otherwise by the paediatric or paediatric urology team. It is a very small dose and does not harm the baby or effect its immune system. It will be stopped once the doctors are happy that the kidney is normal.

  • How do I know if my baby develops a urine infection?

    How do I know if my baby develops a urine infection?

    Look out for fever, poor handling and poor feeding – especially if there are no other signs such as a cough, cold or ear infection. Ensure your GP dipsticks the urine AND sends it to the lab for culture as the result will help us determine the correct antibiotic for the baby to be on.

  • Is smelly urine a sign of infection?

    Is “smelly” urine a sign of infection?

    Babies and children often have smelly urine but this is usually a result of concentrated urine rather than infection – just ensure that they are drinking enough! Avoid testing urine in the absence of associated symptoms such as fever or a burning pain on voiding, as boys with intact foreskins as well as little girls are often harbouring innocent bacteria which will show up as “infection” on the dipstick – this often results in anxiety and unnecessary antibiotic and investigations.

  • How much should my child be drinking? Are any drinks harmful to the urinary tract?

    How much should my child be drinking? Are any drinks harmful to the urinary tract?

    The National Institute for Clinical Excellence (NICE) guidelines on fluid intake is as follows:

    4-8 years Female 1000-1400ml

    Male 1000-1400ml

    9-13 years Female 1200-2100ml

    Male 1400-2300ml

    14-18 years Female 1400-2500ml

    Male 2100-3200ml

    A good fluid intake is imperative for normal bladder development and is the key to gaining continence. Parents tend to reduce the fluid intake of children who wet – but this is counter- productive and will make the situation worse. Natural fluids such as water, milk and fresh juices are the best. Blackcurrent drinks tend to stimulate the bladder and exacerbate wetting as do caffeinated (tea. Coffee, chocolate) and fizzy drinks.

  • Why is my child getting recurrent urine infections? She has had a normal urinary tract ultrasound scan.

    Why is my child getting recurrent urine infections? She has had a normal urinary tract

    ultrasound scan.

    This is a very common problem in children, particularly in school-age girls. It is usually due to a combination of functional and behavioural factors and the majority of children do not have an underlying abnormality. It is best to consult a Paediatric Urologist for a detailed assessment.

  • My child goes to the toilet several times an hour and sometimes has nothing to void, is that normal?

    My child goes to the toilet several times an hour and sometimes has nothing to void, is that normal?

    This is often a sign of early bladder dysfunction so a urine dipstick at your GP and a paediatric urology consultation is warranted. Very often there is no infection and the child’s bladder function needs to be assessed.

  • My child holds on to his wee till the last minute, then has to rush to the toilet and sometimes cannot hold it – how should I handle the situation?

    My child holds on to his wee till the last minute, then has to rush to the toilet and sometimes cannot hold it – how should I handle the situation?

    Again this may be a sign of early bladder dysfunction and warrants a paediatric urology consultation.

  • My son’s foreskin looks closed and it balloons when he pees, does he need a circumcision?

    My son’s foreskin looks closed and it balloons when he pees, does he need a circumcision?

    All baby boys are born with a “tight” foreskin which is initially adherent to the underlying glans of the penis. The foreskin starts to naturally retract with age and about 50% of boys have a retractile foreskin by the age of 2. In the other 50% the process takes a while longer, but as long as the boy has no symptoms and is voiding well, there is no need for a circumcision. “Ballooning” is the result of wee getting beneath the foreskin during the nomal process of retracting – it is not a sign of blockage. However, it is worth getting the foreskin checked as there is a rare condition called Balanitis Xerotica Obliterans (BXO) which could in fact cause a blockage, and is a medical reason for a circumcision. Other indications for circumcision are recurrent foreskin infections (“balanitis”) or a condition called “paraphimosis”.

  • I would like my newborn baby to be circumcised for cultural/ religious reasons, is there an age-limit for the procedure?

    I would like my newborn baby to be circumcised for cultural/ religious reasons, is there an age-limit for the procedure?

    A circumcision may be performed at any age. The age is relevant when it comes to choice of anaesthetic. Newborn babies may be fed and wrapped and held still enough for the procedure to be performed under local anaesthetic (usually a penile block, which just numbs the penis). This form of anaesthetic works best from 0-6 weeks of age. Thereafter, in my practice, I feel it is kinder for the child to have a general anaesthetic, but different paediatric centres may have different age criteria. In either case the child may go home after the procedure and the recovery time is the same.

  • What is a hypospadias?

    What is a hypospadias?

    A hypospadias is a very common male genital anomaly found in 1:300 male births. During a boy’s development, the urethra (wee tube inside the penis) starts off as a plate and “zips up” to form a tube. If the tube fails to develop all the way to the end of the penis, the boy will wee from a hole (the “meatus”) somewhere along the ventral aspect of the penis. In the commonest type, the hole is about 3mm below the normal position – in others it may be down in the scrotum. The penis often also has a ventral curvature (a “chordee”) and an abnormal foreskin which is open on the front (“hooded foreskin”). Your paediatric urologist will consult you on the type and significance of your baby’s hypospadias and whether it needs intervention. The minor types may not require surgery, whereas others may require a single (day-case) or two-stage procedure depending on the severity.

  • What age range does “Paediatric” Urology cover?

    What age range does “Paediatric” Urology cover?

    0-16 years – if your child needs urology follow-up after the age of 16, they will be transitioned to an adolescent urologist or adolescent gynaecologist.

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