Practice ABC of urology

Common paediatric problems

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7566.486 (Published 31 August 2006) Cite this as: BMJ 2006;333:486
  1. A R Prem, acting chief
  1. Department of Urology, The Armed Forces Hospital, Al-Khod, Sultanate of Oman.

    Many paediatric problems can present to medical professionals. This article covers some of the common ones including phimosis, undescended testis, retractile testis, vesicoureteric junction reflex, hypospadias, neonatal hydronephrosis, obstruction of the pelviureteric junction, and some types of tumour.


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    Inguinal exploration of undecended testis

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    Indications for circumcision in patients with phimosis

    Phimosis

    Phimosis is the most common reason for circumcision, although recurrent balanitis is also an indication. Circumcision may also be performed for religious or social reasons.

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    Sites of undescended testis

    At birth, adhesions are present between the glans penis and foreskin, but separation begins to occur immediately and continues thereafter. The prepuce normally becomes retractile after the age of two years, but many adolescent boys retain some adhesions. Preputial adhesions are a common reason for referral to a urologist, but adhesions are normal and should be treated only if “physiological phimosis” persists into adolescence and causes problems with masturbation or sexual intercourse. A non-retractile foreskin is free of symptoms and self limiting, and circumcision is not needed. Parents often say that the prepuce “balloons” when the child urinates, but this is a sign of a non-retractile foreskin rather than phimosis. Careful examination will show that the urethral meatus is visible through the narrowed preputial opening, and, with time, this opening widens to allow the foreskin to retract normally. True or “pathological phimosis” is rare, but it may cause appreciable problems in childhood or adolescence. Treatment is usually circumcision, whereas alternative treatments are preputioplasty or application of steroid creams.

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    Main findings on laparascopy to locate an impalpable testis

    Undescended testis

    The incidence of undescended testis ranges from 3.4% to 5.8% in full term boys but decreases to 0.8% in boys aged about one year. Why testes fail to descend into the scrotum is unclear, but recent evidence suggests that descent occurs in two distinct …

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