Paediatric urology: children's kidney, bladder and genital conditions, tests and surgery

The specialty covers the kidneys, ureters, bladder, urethra and the genitals in children. It includes conditions present from birth, which are often spotted on antenatal scans or at the newborn examination, and problems that appear later such as infections, bladder control difficulties and stones.

The British Association of Paediatric Urologists says its aim is to promote excellence in the management of childhood urology, and describes a membership of surgeons involved in the care of children with urological conditions. Care is delivered by paediatric surgeons and urologists who focus on children, working with paediatric nephrologists, specialist nurses, continence nurses, radiologists, psychologists and play specialists.

Most childhood urinary problems, including common bedwetting and mild foreskin tightness, are managed in primary care. Specialist referral is for problems that persist, recur, are structurally complicated or need an operation.

• Bedwetting (nocturnal enuresis) and daytime wetting, which the NHS says may be related to producing too much urine at night, not waking to the need to pee, stress, constipation or an underlying condition such as diabetes.

• Urinary tract infections, which the NHS says in children may cause fever, irritability, poor feeding, wetting, vomiting or looking generally unwell.

• Undescended testicles, where one or both testicles are not in the scrotum, which the NHS says is common in young boys and often resolves in the first 12 weeks.

• Tight foreskin (phimosis), recurrent balanitis and other foreskin problems.

• Hypospadias, where the opening of the urethra is not at the tip of the penis, and other differences present from birth.

• Inguinal hernia and hydrocele, swellings in the groin or scrotum that are often treated surgically in children.

• Antenatally detected kidney swelling, vesicoureteric reflux, kidney stones and bladder problems related to nerve conditions.

Many problems are assessed through history and examination. The NHS describes how a child's UTI is typically investigated with a urine sample. Imaging is chosen with children in mind, balancing information gained against radiation and the need for sedation.

For bedwetting, the NHS says a GP can suggest a bedwetting alarm or medicine to reduce how much urine is made at night, after simple measures such as regular daytime drinks, regular toilet visits and avoiding caffeine. Children who do not respond may be referred to a specialist continence or bedwetting clinic. Treating constipation can improve bladder symptoms.

Urine infections are treated with antibiotics, and children with recurrent infections or abnormal scans are monitored in clinic. For tight foreskins the NHS lists steroid creams, antibiotics if infected, and surgery such as circumcision or a procedure where small cuts are made at the tip of the foreskin. Circumcision is only available on the NHS for medical reasons, usually when other treatments have not worked.

Operations commonly performed in children include orchidopexy (bringing a testicle down into the scrotum), repair of inguinal hernia and hydrocele, hypospadias repair and circumcision. They are generally done as day cases under general anaesthetic, with age-appropriate pain relief and written aftercare instructions. NHS information describes circumcision as taking about 30 minutes with dissolvable stitches that vanish in 2 to 6 weeks.

On the NHS, problems are usually picked up at the newborn examination, by health visitors, GPs or school nurses. The NHS says that if one testicle has not moved into the scrotum within 4 to 5 months a child is usually referred to a specialist, and sooner if both are affected. Waiting times for operations vary by hospital, and children are commonly operated on in children's theatres with paediatric anaesthetists.

Privately, a GP or paediatrician letter is usual. Ask whether the surgeon routinely operates on children of your child's age, whether paediatric anaesthesia and overnight facilities are available on site, and how an emergency would be handled. Costs vary by operation and hospital, and it helps to ask what is included for follow-up and complications.

• Bring a bladder and bowel diary, the red book if your child is young, and any previous scans or urine results.

• Ask what the underlying problem is, whether it is likely to improve with age and what the options are including watching and waiting.

• Ask how the child will be prepared for tests or surgery, and whether a play specialist is available.

• Ask what to expect on the day, how long recovery is, and when school or nursery can resume.

• See a GP if bedwetting persists despite home measures or starts again after the child has been dry for more than 6 months, as the NHS advises.

• Seek urgent help from NHS 111 or a GP for suspected UTI in a child, and go to A&E or call 999 if a child is confused, drowsy or has difficulty speaking. Severe sudden testicular pain, or a foreskin that cannot be returned and is painful and swollen, needs emergency assessment.