It has been found that young parents often bring their children to the clinic for consultation and often ask about these topics, such as “how can the balls be so big and small”, “why does the penis look different from other children”, “does the foreskin need to be cut? Therefore, as people pay more and more attention to health and quality of life, it is necessary for parents to know about common pediatric urological diseases in order to help early detection, early diagnosis and early treatment of diseases, avoid misdiagnosis and give children a healthy environment for growth.
1. Unequal scrotum size
Usually, the most common problem that young parents bring their children to the clinic ask about is “unequal scrotum size”, which is usually large on one side or small on the other. Only a small percentage of children do not have a disease factor for scrotal inequality, while the majority of children have a disease related condition.
2. Small scrotum
From clinical observation, the main reason for small scrotum on one side is incomplete testicular descent (cryptorchidism), or smaller testicles, and it is recommended to see a professional doctor at a specialist hospital when the child is about half a year old. Usually, surgery for cryptorchidism can be performed when the child is about 1 year old, and at the latest before the age of 2. The main reason for this is that if the child is still not operated after the age of 2, the testicles can be found to be obviously abnormal under the light microscope. Most cryptorchid surgery is not difficult and can be performed in one operation to pull the testicle down to the scrotum. After the testicle is fixed in the scrotum, it will help the child’s bilateral scrotum to approach symmetry, reduce the child’s psychological impact and reduce the chance of trauma.
3.Scrotal deviation
A large scrotum on one side is mostly caused by inguinal hernia (commonly known as hernia, small intestine gas, etc.), syringomyelia, and in rare children, testicular tumor may be present.
In some children, the inguinal hernia is unilateral, while in others it is bilateral. The chances of the hernia disappearing on its own are very small, and the herniated material is often the intestinal tube, which can cause necrosis of the herniated material (intestinal tube, etc.) and unnecessary injury if it becomes entrapped or strangulated. Here, we would like to remind parents that if a child has an inguinal hernia and the hernia does not return on its own in 2-3 hours, vomiting, hard lump, or lump with tenderness, the possibility of inguinal hernia entrapment should be considered and promptly go to the hospital for consultation. At the same time, inguinal hernia entrapment is also one of the common causes of abnormal crying in infants, and children with unknown abnormal crying can be examined for inguinal and scrotal masses to exclude the possibility of inguinal hernia entrapment. If the inguinal hernia is embedded and manual repositioning fails or is not possible, emergency surgery is required. For general inguinal hernias, surgical treatment is recommended when the child is 7-8 months old. In cases of recurrent inguinal hernias, earlier surgery may also be indicated. In addition, hiatal hernias can also occur in girls, although the incidence is lower than in boys. Inguinal hernia requires high ligation of the hernia sac. The success rate of high ligation of the hernia sac is high for both emergency and elective surgery, but the hernia sac is very thin in small infants and it is best to choose a specialist for surgery.
Syringomyelia includes testicular syringomyelia, spermatic cord syringomyelia (spermatic cyst), and traffic syringomyelia. The chances of a neonatal syringomyelia absorbing on its own within 6 months can reach about 80%. If it fails to resorb on its own, surgical treatment is required around 1 year of age. Testicular syringomyelia and spermatic cysts are also allowed to be observed for 3 months to 6 months, and if they do not disappear on their own, they need surgical treatment. Traffic syringomyelia manifests as little or no fluid (large scrotum) when the child wakes up in the morning, and significant fluid accumulation after activity, especially before bedtime. Traffic syringomyelia is very unlikely to recover on its own and requires surgery. The surgery for syringomyelia is a high ligation of the sphincter, which is not complicated and can be performed on an outpatient basis.
4.Penile deformity
Penile deformities are also common in outpatient clinics. According to experts, with the improvement of people’s life and medical examination level, as well as people’s attention to healthy life, the amount of outpatient consultation on penile deformity has increased greatly than before, and the detection rate is also much higher than in the past. In the case of the pediatric urology clinic at the 81st Children’s Hospital, almost 10 out of every 20 patients have penile deformity problems, and these children are basically under 12 years old. Several common conditions of penile deformity are prepuce, prepuce, prepuce adhesion, short penis appearance, etc.
5.Circumcision
The foreskin cannot be turned up to reveal the glans due to the presence of a narrow ring at the intersection of the inner and outer plates of the foreskin, which is called prepuce. The foreskin needs to be treated surgically.
6.Circumcised skin is too long
There is no absolute standard for the determination of prepuce, which leads to a great difference in the determination of prepuce and surgical indications by different doctors. Usually, a certain amount of foreskin buildup in front of the glans when the child is young and overcircumcision is a fairly common phenomenon, and as the child gets older, especially after puberty, the head of the penis will gradually be exposed. However, there are many reports showing that circumcised children can reduce the incidence of glansitis, prepuce, urinary tract infections, distant penile head cancer, female cervical cancer and other diseases after circumcision. Although it is difficult to unify different doctors in terms of the determination of circumcision and the grasp of surgical indications, for children who also have unexplained urinary tract infections, recurrent glansitis of the foreskin, and small lumps at the front of the foreskin, surgery is certainly It can be helpful. The surgery is circumcision, and the glans will feel uncomfortable for a while after the surgery, but usually after the sensitive period, they get used to it.
7.Circumcision
The main problem is that the inner plate of the foreskin is attached to the glans and cannot be separated, and there is often a buildup of urine scale between the foreskin and the glans. If repeatedly occurrence of foreskin glansitis and other cases, feasible foreskin adhesion separation, circumcision.
8.Short penis
In recent years, there are many patients who come to the clinic because of the short appearance of the penis. There are two main categories of penile shortening, namely, one is congenital micropenis with abnormal penile corpus cavernosum development, which is mainly due to the penis being affected by hormones, genetics and other factors, endocrine examination is feasible, and if there is no endocrine treatment or the treatment is ineffective, penile prosthesis can be implanted when the patient is older; the other category is concealed penis with normal penile corpus cavernosum development but poor penile exposure, which is also These include congenital true occult penis, buried penis associated with obesity, and bound penis formed by scar stenosis ring after circumcision. It is important to mention here that with the improvement of living standards and the popularity of foreign fast food, more and more children have improper diet and lack of exercise and other bad habits, leading to an increase in obese children, and the short appearance of the penis associated with obesity has become more and more common. For these children, most of them can have erect penis at the stage of puberty, so it is recommended to lose weight in time and keep the penis locally clean, without surgery if it is not combined with prepuce. Congenital true occult penis and bound penis formed by scar stenosis ring after circumcision need surgical treatment. In recent years, flap transfer technique has been applied to the correction of occult penis, and the appearance of the penis after surgery has been greatly improved compared with the previous surgery.
9.Urethral hypospadias
The incidence of hypospadias is also one of the common congenital malformations of the urinary system in children, with some reports showing that one in every 150-200 boys has hypospadias. The occurrence of this malformation is mainly related to the maternal endocrine environment during fetal life, heredity, genetic mutations, and environmental pollution.
Hypospadias requires surgical treatment, and there are 200-300 surgical procedures available, and each specialist generally needs to master more than 7-8 surgical procedures. The large number of surgical approaches also indicates that there is not one or several absolutely good surgical approaches, and hypospadias repair surgery is still considered a great challenge for pediatric urologists, but the postoperative complication rate of hypospadias repair surgery performed by specialists is significantly lower than that of general surgeons. Currently, many developed countries have adopted a strict admission system for hypospadias surgery, and only doctors with rigorous specialist training are allowed to perform hypospadias repair surgery, which helps to reduce the incidence of post-operative complications of hypospadias, and this may also be the direction of development to improve the overall standard of hypospadias in China. Parents of children who are in a position to do so are advised to try to seek medical attention from a specialist doctor at a specialist hospital.
As a rule, children with hypospadias should be operated as early as penile conditions allow, usually when the child is 6 months old, to reduce the psychological impact of the disease on the child. Parents must pay attention to the psychological impact of hypospadias on the affected child, which can be lifelong.