Bedwetting is a very common problem in children that affects about 9 million children every year. In my upcoming book “It’s Not Your Fault” I discuss bedwetting and other common urinary problems in children, especially toilet training problems. Bedwetting is part of normal growth and development in some children and it is not considered to be due to a medical problem. Bedwetting is considered to be due to a developmental delay, some children learn how to control their bladder later in life than others. This is not a medical problem, simply developmental delay.
We have been treating children for bedwetting and other toilet training problems for many years at our pediatric continent center. This is a specialized center for children with urinary control problems. We typically will treat bedwetting after doing a complete evaluation that includes a history of the bedwetting, physical examination, and some noninvasive urinary tests. Following this we begin treatment.
The most common way to treat bedwetting is using a bedwetting alarm system. Using these systems can be a little complicated so I highly recommend you use a bedwetting alarm system in consultation with your physician or a pediatric urologist. These bedwetting alarm systems are very effective in stopping bedwetting in up to 90% of cases provided they are used correctly. In many cases, the bedwetting alarm is not used properly and the bedwetting continues. This does not mean that the alarm did not work, it simply means that the alarm was not used correctly.
For those cases where the alarm does not work, we usually will discuss medications. There are different medications that can be used for bedwetting. Some medications decrease the amount of urine that is made at night. Other medications lighten the sleep stage and make the child more aware. The medications are generally not considered a cure for bedwetting but they can certainly help the problem.
Daytime Wetting Problems
Daytime wetting can be a very frustrating problem for children. It is usually not due to any type of a medical problem but it requires an evaluation by your physician or a pediatric urologist if it occurs in children beyond age 5. A typical evaluation would include a history, physical examination, some urinary tests and possibly an ultrasound of the kidneys. Following this, treatment is usually recommended.
Treatment for daytime urinary control problems include urinating on a regular basis, taking the proper amount of time to urinate, not holding the urine too long between urination, drinking lots of water and eating a healthy diet rich in fiber. We want to avoid constipation which can make the urinary control problem worse.
If these simple interventions are not helpful, medication is often discussed. The medication will help your child control the bladder better and should stop or at least reduce the number of accidents that your child is having during the day.
If your child is having problems with urinary leakage during the day, you should discuss this problem with your physician and see if a consultation to a pediatric urologist is indicated. Remember, we do have treatment for daytime and nighttime urinary control problems in children and we understand that these problems can be very frustrating for parents and children alike.
State of the art techniques are used to remove the foreskin safely. Care is taken to remove the proper amount of skin and advanced pain control is used. Minimal postoperative care is required with reduced need for dressing changes and application of ointments, which can be messy and painful.
Using plastic surgery technique, we remove all scarring and correct any issues to restore normal form and function. Minimal postoperative care is required with reduced need for dressing changes and application of ointments, which can be messy and painful.
Urinary Tract Infections
Urinary tract infections are one of the most common bacterial infections in children. Most children with urinary tract infections have no underlying medical problems but approximately 20 to 30% of children who have infections, especially recurrent urinary tract infections, might have an underlying urological problem that would be important to know about.
Your pediatrician would be the healthcare professional to determine if your child has a urinary tract infection and what the best course of treatment might be. If the infection is severe or if the infection happens repeatedly then sometimes referral to a pediatric urologist would be indicated. The pediatric urologist specializes in the treatment of urinary tract infections in children.
A urinary tract infection in a child is usually detected when a child has an unexplained fever, pain with urination or foul smelling urine. Urine analysis and culture can be done to determine if urinary tract infection is present. If it is, typical treatment is a 7 to 14 day course of antibiotics orally. If the infection is very severe with high fevers, sometimes hospitalization is necessary.
After the urinary tract infection is treated, it is not uncommon to order a kidney and bladder all percent to make sure the kidneys and bladder are growing and developing properly and there are no underlying problems like a kidney stone or urinary tract blockage. Sometimes a test called a VCUG, which is short for voiding cystouretherogram, is ordered to look for something called reflux. Reflux is a condition where when the child urinates not all of the urine comes out, but some goes backwards up into the kidney and this can carry infection and bacteria into the kidney and sometimes cause kidney damage.
Urinary Tract Obstructions
Most urinary tract obstructions are diagnosed now during prenatal ultrasound. Many of these obstructions will not cause any harm as your child grows, it will sometimes go away by itself, or sometimes just remained stable. The reason that we monitor children with obstruction is because there are some cases that will worsen over time. If that happens, we want to catch that early to prevent kidney damage.
Another word for obstruction is hydronephrosis. This basically means that the kidney or the tube called the ureter that drains urine from the kidney to the bladder is dilated. Ultrasound is a very useful tool to monitor hydronephrosis; it is noninvasive and does not cause any radiation exposure.
Narrowing in the ureter causes Hydronephrosis and the narrowing is simply an area of tightening in the tube. Most children with hydronephrosis lead a happy and normal life; in fact you would never even know they had hydronephrosis if the maternal ultrasound was never done. But once hydronephrosis is detected, it is important to monitor it on regular basis to make sure that it does not increase. Again that is very unlikely, but it’s better to be safe than to risk kidney damage.
This condition consists of having urinary opening that is not at the normal position at the tip of the head (glans) of the penis. Our goal in treatment is to create a functional penis that appears normal. We have performed hundreds of hypospadias repairs, ranging from mild to severe. In most cases, we do not use a catheter after the surgery and this reduces problems with after care.
Pediatric Hernia and Hydrocele Program
We perform pediatric hernia and hydrocele repairs using techniques that ensure the safety of your child’s reproductive system. We use a “no touch” technique that does not touch the vas deferens. This is the small delicate tube that carries sperm. If the vas deferens is touch too firmly with an instrument, it could be crushed and damaged.
Pediatric Orchiopexy, Undescended Testis
This surgery aims to move an undescended testis into its normal position in the scrotum. One of the main reasons to bring the testis into its normal position is that it may help prevent infertility. Depending on the location of the testicle, one or two small incisions are made in the scrotum, groin, or abdomen that allow the surgeon to reach the testicle and move it to the scrotum. If undescended testicles are located high in the inguinal canal or the abdomen, a minimally invasive laparascopic approach may need to be used.
A varicocele is a condition where the veins in the scrotum (sac that holds the testicles) are dilated. When they persist to adulthood, it can cause infertility. We perform varicocele repairs using techniques that ensure the safety of your child’s reproductive system. This can be done using laparascopic, microscopic or robotic techniques.
Meatal stenosis is a condition where the opening of the urethra is abnormally narrow. The urethra is the tube which transports urine from the bladder out of the body. The most common complication is difficulties with urination. We can correct meatal stenosis of the urethra in 20 minutes in most cases. Using plastic surgery technique, we correct any issues to restore normal function.
Testicular torsion is a condition in which the cord that holds the testicle gets twisted, which can stop blood flow to the testicle. If this occurs, emergent surgical correction could be necessary. We perform testicular torsion corrections that ensure the safety of your child’s reproductive system.
Labial adhesion can cause problems for young girls, such as urine build up as well as rashes. We can repair labial adhesions in 20 minutes in most cases. Using plastic surgery technique, we correct any issues to restore normal function.
Kidney stones are rock-like pieces that can be formed anywhere in the urinary system, including kidneys, bladder, ureter (the connection between kidney and bladder), and urethra (the connection between bladder to outside the body). We perform a variety of procedures to remove or reduce the size of your child’s stones depending on your child’s unique situation.
A ureteropelvic junction (UPJ) obstruction occurs when the connection between your child’s kidney and ureter, the tube that connects the kidney and bladder, is too narrow to allow the normal flow of urine. We use the latest state-of-the-art Robotic techniques to repair UPJ obstruction, often called “pyeloplasty”, to relieve this obstruction and allow your child’s urinary system to perform normally.
Reflux is the abnormal flow of urine from the bladder to the ureter, the tube that connects the kidney and bladder. We correct reflux to allow your child’s urinary system to perform normally using minimally invasive approaches such as ureteral reimplantation or Deflux injection to prevent reflux.
Reflux is usually detected after diagnosing a urinary tract infection. A test called a VCUG is ordered and the test is basically a picture while your child urinates. If some of the urine goes backwards into the kidney during urination, then your child has reflux.
There are five different types of reflux, grade one is very mild and great five is very severe. The reflux can be on one side or both sides. In almost all cases, children are born with reflux. The reason we want to know if your child has reflux is because if your child has reflux and has a problem with urinary tract infections sometimes kidney damage can occur.
Once reflux is diagnosed, there are different treatment options depending upon the severity of the reflux. Sometimes, no treatment at all is necessary. For example, an older child with grade 1 reflects on one side usually does not require any treatment. In contrast, a baby with grade 5 reflux on both sides would definitely require treatment to make sure kidney damage just not occur.
Reflux can be treated with antibiotics, deflux or surgery. Antibiotics are given on a daily basis for at least a year, to allow the urine to remain infection free. This is a good choice for children with low-grade reflux on one side, because there is a good probability that these children will eventually outgrow the reflux. Deflux is an outpatient procedure for many children with reflux, especially those who have problems with three current urinary tract infections. It is a noninvasive procedure that is performed using a cystoscope that is inserted through the urethra; no cutting or surgery is required. It is a 20 minute outpatient procedure and it provides a potential cure for most moderate types of reflux.
For severe reflux, surgery remains the gold standard, especially if there is already damage that has occurred to the kidney from the reflux. The surgery is called a ureteral reimplantation procedure. It is a very safe and time-tested procedure that will cure the reflux with a 99% success rate. Hospitalization for a few days is required but the success rate for stopping the reflux permanently is unsurpassed.
Spina Bifida and Neurogenic Bladder
Spina bifida is a condition a child is born with that affects the spinal cord. Children affected by spina bifida often have neurologic complications, one of which can be neurogenic bladder. Neurogenic bladder refers to a bladder that cannot be controlled normally by the nervous system, and often leads to difficulties with urination. We offer a variety of treatments aimed at alleviating the complications that spina bifida can cause and improving your child’s quality of life.
The Malone anterograde continence enema (MACE) is a surgical procedure used to help children who cannot control their bowel movements.
We perform the Mitroffanoff procedure when your child cannot empty their bladder normally and requires frequent catherizations.
We perform bladder augmentations to increase the size of your child’s bladder, allowing it to hold more urine. This is done when the bladder is too small or stiff to fully expand, which may lead to damage to the kidneys.