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Tiny Patients

A Very Special Surgical Specialty

Pediatric urologists treat children of all ages – newborns through adolescents – for problems with the urinary tract. This includes the kidneys, ureters (the tubes carrying urine from the kidneys), bladder and urethra (the tube which drains the urine from the bladder). Problems involving the external genitalia are treated as well.

“The anatomy and development of the urinary tract is fairly complex, and problems may range from simple bedwetting through complex structural defects,” says Boyd Winslow, MD, of Children’s Urology of Virginia. “While many problems can be treated with medication and behavior modification, others may require surgical intervention.”

Dr. Winslow knows well that with today’s families, the urinary system is a particularly sensitive topic. Children are able to pick up on this very early, and part of the medical expert’s job is to compassionately deal with emotions – regarding both the child and the rest of the family. “We serve as educators and counselors as well as providing medical care, and we consider this whole-family approach vital to a positive outcome,” says Dr. Winslow.

He notes that the more common surgical problems he sees include inguinal hernia, undescended testicles, hypospadias (urinary opening on the bottom of the penis instead of on the end) and vesicoureteral refl ux (when urine leaves the bladder to travel up the ureter toward the kidneys). The procedures used to treat these problems are time-tested, and while complications may occasionally occur – as with any surgery – they are generally easily treated.

The most common – and sometimes the most controversial – procedure performed by urological surgeons is male circumcision, or surgical removal of the foreskin from the penis. For parents, there are religious, emotional, technical, and long-term health implications to consider regarding the procedure.

The American Academy of Pediatrics (AAP) has published new guidelines recommending that baby boys be circumcised. The AAP’s 2012 task force report analyzed the data from more than a thousand studies over a period of seven years. The study shows that the benefits of being circumcised are recognized relatively quickly. Boys who are circumcised are 80 times more likely to have a urinary tract infection during the first year of life.

“Any infection in a baby can be serious,” Dr. Winslow reports. “But as important as avoiding infection during the first year may be, the long-term benefits are even more important.”

Circumcised males are far less likely to be diagnosed with sexuallytransmitted diseases. While it might be difficult for most new parents to imagine their new baby as a sexually active adult, the day will come.

“STDs can result in discomfort at best, and infertility or even death, at worst. Partners can be infected, and human papilloma virus infection (HPV) can cause cervical cancer in women. The presence of HPV has been implicated in penis, anal, and other cancers as well,” says Dr. Winslow.

While some parents may acknowledge the health benefits, they often express what they consider to be a freedom of choice issue – that the decision should be made by the child when he is old enough to understand the pros and cons. Data has shown, however, that pain and surgical risks are much greater in an older boy or a man than they are for an infant.

Parents also express fears of a poor result from the procedure, resulting in possible deformity, as well as pain during and after the surgery.

Boyd Winslow, MD, with Children’s Urology of Virginia
Boyd Winslow, MD, with Children’s Urology of Virginia

“I completely understand the fears that parents may have,” says Dr. Winslow, “but given the modern techniques and local anesthesia used today, the risks and discomfort are nearly eliminated. We’ve even had babies sleep through the entire procedure as their mothers caress them.”

In the Richmond market, circumcision is typically performed by the OB/ GYN while the baby is still in the hospital nursery on the first or second day of life. At this time, if the baby’s pediatrician notes any abnormality with the penis, a referral will be given to the family with a recommendation that a pediatric urologist perform the circumcision. According to Dr. Winslow, babies are comfortable and tolerate the surgery well at two to four weeks of age, or, in the case of a preterm baby, by around 44 weeks after conception.

While circumcision is a relatively simple and painless surgery, suppose your child has a more complex medical issue requiring surgery? The first step is to carefully diagnose the specific problem in your child. Besides the evaluation performed at the pediatric urology office, additional tests may be recommended to address the child’s needs. The tests will vary with each child, of course, but may include imaging (x-ray, CT, MRI), chemical tests on urine, ultrasounds, and other specialized procedures.

“Every test will be carefully explained to you – and your child, to the level he or she can understand – before it’s done,” Dr. Winslow says, “and the results will be discussed with you, along with the treatment choices.”

An effective surgical team keeps the lines of communication open with families to provide needed information. Dr. Winslow says when the family is informed, they are less anxious about what to expect concerning any surgery. “Although some anxiety is perfectly normal and expected, anxiety is easily transferred to children.”

Whether it’s a circumcision or another surgical procedure, Dr. Winslow’s commitment to the health and wellbeing of the patient and the family is paramount.

“Doing the physical repair and then leaving the family on their own is not how we provide care to our patients,” Dr. Winslow says. “As a surgeon, I am a partner with your child. We all have the same goals. And we know that the more available the medical team is, the better the experience for all concerned, so we will be there for you.”

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