Hypospadias is the condition where the urethral meatus is lower than it should be on the penis. The foreskin is not fully developed in patients.
There are many hormonal and genetic causes. It is known that the incidence increases in cases such as smoking during pregnancy, gestational hypertension, and low birth weight.
It occurs in approximately one in 300-500 births. Although it can be seen with more than 200 syndromes, it is mostly seen as an isolated disease. The most common concomitant pathology is unilateral or bilateral undescended testis.
The treatment for hypospadias is surgery. Although the surgery can be performed at any age, the most appropriate time frame is between 6-24 months. If not treated;
During the development of the testicles in the mother's womb, they are first in the posterior abdominal wall and descend into the scrotum during the last 3 months of pregnancy and immediately after birth.
Undescended testis is classified as palpable (can be felt on physical exemination) or nonpalpable (cannot be felt on physical exemination). 80% of undescended testicles can be felt on palpation.
If the testicle is not in the scrotum in a baby, the main causes of this condition are:
Retractile Testicle: In some children, the testicles sometimes descend into the scrotum and sometimes go up. This is due to the overactive cramester reflex. The approach for these patients is different from the undescended testis. The distinction should be made by a specialist with physical exemination. Annual follow-up is recommended for retractile testicles due to they can transform into real undescended testicles.
Cryptorchidism or undescended testis is one of the most common birth defects of male newborns. Its incidence varies with age.
Undescended testis may predispose to testicular cancer and infertility. The earlier the treatment for an undescended testicle, the lower the risks.
Physical examination by a specialist is the first and most important step for the diagnosis of undescended testis. Conditions such as family history, previous surgery history should be questioned. If necessary, radiological imaging is used.
The main treatment for undescended testicle is surgery. The recommended time for surgery is between 6 months and 12 months. Treatment is recommended for at least 18 months. Hormone therapy; It is not preferred because of the low chance of success (20%) compared to surgical methods and its side effects.
Urine flowing from the kidneys to the bladder in a healthy person; In this disease, the ureter escapes upwards due to the insufficiency of the muscle structure at the end of the opening to the bladder.
The frequency of VUR in the normal population is 1%. This rate is 30% in children with recurrent urinary tract infections. In newborns with kidney enlargement (hydronephrosis) detected in ultrasonography in the womb; While the frequency of VUR is 15% in those with no abnormality in postnatal ultrasonography, this rate is around 35% in those with any abnormality.
While the probability of having VUR in siblings of children with VUR is 35%; 100% VUR is detected in identical twins.
The most common sign of vesicoureteral reflux is a previous febrile urinary tract infection. Imaging methods are mandatory for the diagnosis of VUR.
The methods that can be used in standard imaging are Ultrasonography (USG),Voiding Cystourethrography (VCUG) and Renal Scintigraphy. Voiding Cystourethrography (VCUG): It is the most important test to be performed in the diagnosis of VUR. Contrast material is injected into the bladder through a catheter. With the images taken at intervals, it is evaluated whether there is an upward escape or not. If there is VUR, it is graded between 1-5 according to its severity.
VUR; It is a disorder that can have serious consequences such as kidney damage, hypertension, kidney failure and growth retardation.
Non-Surgical (Conservative) Treatment: The main goal is to prevent febrile urinary tract infections. Because most patients with low-grade VUR recover spontaneously.
Antibiotic Prophylaxis: It is the long-term administration of low doses of antibiotics to prevent urinary tract infection.
Urination Training: The child should be encouraged to go to the toilet and urinate regularly at home and at school. The child must sit on the toilet in the appropriate position so that the child completely empties the bladder and bowels. Fluid intake is evenly spread throughout the day. Children with constipation problems must be treated.
Vesicoureteral Reflux Surgery Turkey: Reconstructive operation should be considered for VUR with persistent urinary tract infection despite antibiotic prophylaxis, increased areas of renal loss in high-grade reflux, or girls who have reached puberty.
Endoscopic Technique: It is the process of injecting a filling material near the ureter orifice (the hole entering bladder) with a cystoscope. It is a daily procedure, it can be applied in a short time. The success rate is up to 85% in repetitive applications.
Open Surgery (Ureteroneocyctostomy Turkey): It is an important option in patients with a history of unsuccessful injections, in patients with high-grade VUR, and in cases where VUR is associated with other anatomical disorders. There are many surgical techniques reported and success rates are around 98%.
Ureteropelvic Junction Stenosis (UPJS) is a congenital anomaly of the ureter and is a functional impairment of the urinary passage from the kidney to the ureter. Urine transport is impaired due to UPJS and an enlargement of the kidney pool (hydronephrosis) occurs due to the urine accumulating in the kidney. This stenosis can lead to a decrease in kidney function over time and even to kidney failure.
Frequency of UPJS is approximately 1/750-1500. It is usually in boys (3 times more) and often on the left side. It is the most common cause of enlargement of the kidney pool (Antenatal Hydronephrosis) seen in the fetal age.It is usually a congenital pathology. Apart from this, vascular abnormalities, previous surgeries or infections may also be the cause.
The diagnosis is usually made by ultrasonography performed in the fetal age. Some cases are diagnosed by imaging techniques performed for pain, urinary tract infection or other reasons. Ultrasonography is the first preferred imaging method in the diagnosis of UPJS. In patients diagnosed with UPJS; Kidney Scintigraphy (DTPA or MAG-3) is the most important examination to determine the severity of this condition and to decide on surgery or follow-up.
The treatment of Ureteropelvic Junction Stenosis is surgery. The stenosis is treated with a surgery called "pyeloplasty". This method can be done by open or laparoscopic method. Laparoscopic surgery has advantages such as less bleeding, less post-operative pain, and less hospital stay.
In addition, the "Endopyelotomy" operation, which is performed endoscopically in some selected patients and therefore does not require any incision in the body, is another surgical technique in UPJS.
Circumcision; It is the process of surgically cutting and removing the piece of skin surrounding the tip of the penis (foreskin). Circumcision practiced by experienced people has many benefits. In the hands of inexperienced people, it brings many risks such as infection and bleeding.
In the neonatal period, circumcision can be performed with local anesthesia. In older children, circumcision is recommended to be performed under general anesthesia to avoid surgical stress.
Many surgical methods have been defined for circumcision and all these techniques have common stages. It should not be forgotten that no matter what technique is used, it is the most important condition for the circumcision procedure to be done by experienced people.
Involuntary leakage of urine during sleep is called enuresis. It is not considered abnormal for children under the age of 5 to wet the bed at night. Primary enuresis is defined as persistent nocturnal urinary incontinence of the child for no longer than 6 months without being dry. Enuresis that occurs after a dry period longer than 6 months is defined as secondary.
The frequency of enuresis decreases with age. About 15% of 5-year-old children have bedwetting problems at night. Its incidence decreases by about 15% each year, and its incidence in adolescence is approximately 1%.
First of all, the family and the child should be given detailed information about the situation and their participation in the treatment process should be ensured.
It is important for children to restrict their fluid intake about 2 hours before bedtime. Before going to sleep, it is necessary to make the child go to the toilet and urinate. Fluid intake should be spread throughout the day; If the patient has constipation problem, it should be resolved.
Urination habits should be regulated, the child should go to the toilet every 2-3 hours at school and at home and urinate regularly.
The nights that the child wets and does not wet the bed should be noted, and a voiding diary should be created.
Hydrocele is the name given to excess fluid accumulation between the two membranes surrounding the testis. It is divided into two types.
In Cominican Hydrocele, the relationship between the two membranes surrounding the testis and the membrane in the abdominal cavity continues. The fluid in the abdomen fills around the testis through this opening and causes this pathology, which is also called water hernia among the people.
Non-Communican Hydrocele occurs in advanced ages and the swelling is not related to the peritoneum. Usually the only symptom is painless swelling. If necessary, ultrasonography can be performed to understand whether there is a bowel in the swelling.
The treatment of hydrocele is surgical, but it is recommended to wait for 1 year as the possibility of spontaneous recovery is high in the first 12 months. However, in case of additional pathology, early surgery can be performed.
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Assoc. Prof. Dr. Arif Demirbaş
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