Pediatric Surgery

The three major urological conditions that affect children are hypospadias, vesicoureteral reflux (VUR), and undescended testicles.

Hypospadias Repair
Infants with hypospadias should not be circumcised. The foreskin should be preserved for use in later surgical repair. Surgery is usually done before the child starts school. Today, most urologists recommend repair before the child is 18 months old. During the surgery, the penis is straightened and the hypospadias is corrected using tissue grafts from the foreskin. The repair may require multiple surgeries.
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Vesicoureteral Reflux
Correction of reflux (called ureteral reimplantation or ureteroneocystostomy) is recommended for high grades of reflux (because they are unlikely to resolve by themselves), for reflux that fails to resolve on its own despite monitoring over several years, and for patients with breakthrough infections.

The traditional surgical approaches have high degrees of success and usually involve opening the bladder and creating a new, longer tunnel for the ureter to pass through the bladder wall. If the ureter is very wide due to high grade reflux, it may need to be narrowed to make a successful flap valve with at least a 4:1 ratio of tunnel length to ureter width.
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Undescended Testicals
Treatment for undescended testicle may include manipulation into the scrotum (in cases of retractile testes), hormone therapy, and surgery. Treatment is not recommended until after the age of 1 year, because in most cases, the testis descends without intervention during this time.
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