Pediatric Urology treats the main urological diseases of childhood, being urogenital alterations very frequent. Entities such as phimosis, varicocele, and cryptorchidism require evaluation by a urologist specialized in pediatric urological surgery.
Phimosis is a condition characterized by the inability to retract the foreskin and uncover the glans. It is physiological until 3 years of age. The incidence of phimosis at 6-7 years of age is 8% and at 16 of 1%. The initial treatment is usually a local corticoid treatment. If there is no response to the topical treatment, if there is an absolute indication or a family preference, circumcision is performed. This surgery consists in the resection of the foreskin. There are other options such as partial circumcision, in which the foreskin is preserved, making a minimal incision in the phymotic ring, and thus preserving the foreskin.
The buried penis is a normal-sized penis that, due to an anormal layer fixation, is camouflaged by a suprapubic fat pad. This non-aesthetic situation might result in infections such as balanitis and hinder the urinary projection. The surgery consists in the attachment of the layers of the penis to deep layers, and sometimes it is necessary to perform a liposuction of the suprapubic fat pad.
The webbed penis appears when the scrotal skin extends towards the lower side of the penis, even up to the balano-prepucial furrow. It can be congenital or appear after a penis surgery. Restorative surgery consists in performing incisions in the scrotum with posterior suture that improve the cosmetic and functional appearance of the penis.
Congenital penile curvature
The congenital penile curvature is due to a disproportion of the cavernous bodies and can be ventral, dorsal or lateral. When it appears isolated it is usually lateral and its incidence is 0.6%. Frequently it is not recognized until the end of childhood because the appearance of the penis is anatomically normal, only the curvature is observed during the erections. It does not always require restorative surgery; it is decided according to the degree of affectation. The surgery mainly consists of realizing plication stitches to compensate the penile deviation.
During the testicular descent after the third month, the testicles drag a peritoneal tab that is obliterated when it reaches the scrotum. An alteration in this obliteration will lead to persistence of the peritoneum-vaginal duct, which can cause a fluid of the abdomen in the scrotum (communicating hydrocele). This persistence occurs in 5% of newborns. There may be a delay in obliteration, but if the liquid at the scrotal level persists, it is what causes what is known as a simple hydrocele. The importance of its correction is due to the higher risk of hernia in intestinal handles. This surgery is performed by means of an inguinal approach so that the peritoneal tab is released and the peritoneal orifice is closed.
From the third month of gestation the testicle begins its descent from the retroperitoneum going through the inguinal canal until it finally reaches the scrotum. The testicle that has not performed a complete migration and is outside the scrotal bag, at any point in its physiological path, is what is called a cryptorchid testicle. Between 2-5% of newborns and up to 30% of preterm infants have cryptorchidism. Their main risks are the appearance of testicular cancer and the affectation of fertility, which is why early treatment is justified. In the case of a palpable testicle, its approach will be via groin, releasing the testicle and fixing it in the scrotal bag. In the case of a non-palpable testicle and if the testicle cannot be located at the inguinal level, a laparoscopic exploratory surgery will be performed to locate and lower the testicle or discard its presence.