Pediatric Urology
Pediatric Urology is a surgical subspecialty of medicine dealing with the disorders of children’s genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are those involving disorders of urination, reproductive organs and testes.

How common are the problems?
Most people are unaware of the common urological problems of children. This is because they are not often discussed outside the family. Most people have heard of urinary tract infections, but do not know that these infections are associated with anatomical abnormalities in approximately 30% of all children who have them, and even a higher percentage in boys. Among the genital defects, abnormalities of the penis are the most common followed by undescended testicles.

Who cares for Pediatric Urological Problems?
Pediatricians often manage medical problems of the urinary tract and genitalia. Nephrologists are specialists in medical diseases of the kidney, and endocrinologists specialize in endocrine problems affecting the kidneys, like diabetes, and of some problems of the genitalia, like ambiguous genitalia. Patients may be referred to urology after seeing a pediatrician.

Some of the problems deal with are:

• Bladder control problems such as bedwetting and daytime urinary incontinence
• Undescended testes (cryptorchidism)
• Hypospadias
• Epispadias
• Urolithiasis (bladder and kidney stones)
• Chordee and other minor malformations of the penis
• Phimosis
• Urinary obstruction and vesicoureteral reflux
• Neurogenic bladder (e.g., associated with spina bifida)
• Antenatal hydronephrosis
• Tumors and cancers of the kidneys
• Repair of genitourinary trauma
• Genitourinary malformations and birth defects
• Prune belly syndrome
• Cloacal exstrophy, bladder exstrophy, and epispadias
• Ambiguous genitalia and intersex conditions

Male infertility
Reproduction is a simple and natural experience for most couples. However, for some couples, it is very difficult to conceive.

A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm is of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy.

Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male.

How common is male infertility?
Infertility is a widespread problem. For about one in five infertile couples, the problem lies solely in the male partner.

It is estimated that one in 20 men has some kind of fertility problem with low numbers of sperm in his ejaculate. However, only about one in every 100 men has no sperm in his ejaculate.

Symptoms of male infertility
Infertility symptoms in men can be vague. They may go unnoticed until a man tries to have a baby.
Symptoms depend on what is causing infertility. They can include:

• Changes in hair growth
• Changes in sexual desire
• Pain, lump, or swelling in the testicles
• Problems with erections and ejaculation
• Small, firm testicles

Causes male infertility
Male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem.

About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that is made do not work properly.

Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.

Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilization to take place (one in 100 infertile couples); low levels of hormones made by the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men). In most men, sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.

Known causes of male infertility

• Sperm production problems
• Chromosomal or genetic causes
• Undescended testes (failure of the testes to descend at birth)
• Infections
• Torsion (twisting of the testis in scrotum)
• Varicocele (varicose veins of the testes)
• Medicines and chemicals
• Radiation damage
• Unknown cause
• Blockage of sperm transport
• Infections
• Prostate-related problems
• Absence of Vas deferens
• Vasectomy
• Sexual problems (erection and ejaculation problems)
• Retrograde and premature ejaculation
• Failure of ejaculation
• Erectile dysfunction
• Infrequent intercourse
• Spinal cord injury
• Prostate surgery
• Damage to nerves
• Some medicines
• Hormonal problems
• Pituitary tumors
• Congenital lack of LH/FSH (pituitary problem from birth)
• Anabolic (androgenic) steroid abuse
• Sperm antibodies
• Vasectomy
• Injury or infection in the epididymis

Risk factors
Risk factors linked to male infertility include:

• Smoking tobacco
• Using alcohol
• Using certain illicit drugs
• Being overweight
• Having certain past or present infections
• Being exposed to toxins
• Overheating the testicles
• Having experienced trauma to the testicles
• Having a prior vasectomy or major abdominal or pelvic surgery
• Having a history of undescended testicles
• Being born with a fertility disorder or having a blood relative with a fertility disorder
• Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease
• Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer

As the temperatures begin to rise in accordance with the summer season, warm days can be a challenge particularly if you are a Chronic Kidney Disease patient who under go Dialysis has common fluid restrictions, which can cause to feel extra thirsty and dehydrated. Hence, Chronic Kidney Disease patients who must undergo Dialysis to maintain their lives should be very selective about the types and amounts of fluid they consume especially during these warm months of summer.

• As most know, each Dialysis patient has a different allowance for daily fluid depending on physical activity level, body size and urine output. However, as a rule of thumb, the average Chronic Kidney Disease patient who conducts Dialysis is limited to approximately 32 to 50 fluid ounces per day.
• Going over the recommended fluid allowance may lead to weight gain, increase in Blood Pressure, Edema (swelling) in the feet, ankles, wrists, face and around the eyes, abdominal bloating, shortness of breath due to fluid in the lungs, and heart problems – which can include a fast pulse, weakened heart muscles and an enlarged heart.
• When it comes to hydrating, all beverages are not equal. For Chronic Kidney Disease patients who conduct Dialysis, water is probably the best bet to stay hydrated. It is suggested that drinks such as coffee, black tea and cocoa are very high in Purines which are toxins that must be diluted in large quantities of water to be flushed from the body. Hence, caffeinated, sweetened and alcoholic drinks carry chemicals or trigger chemical reactions that demand significant amounts of fluid to properly process and filter out of the body.
• Therefore, while consumption of beverages such as coffee and tea is fine for most Dialysis patients, they should be extremely careful to limit the intake of such fluids since certain options may not appropriately hydrate them. When a Chronic Kidney Disease patient is thirsty and needs hydration relief they should stick primarily with water. Pick up the fruits like raspberries or vegetables like cucumbers to your water.
• Of course Dialysis patients can improve hydration while limiting fluid intake by chewing ice or enjoying frozen fruits such as grapes. Still, patients should try to limit salt and if a Dialysis patient does exceed his or her fluid allowance, he or she may require an extra Dialysis Treatment Session to remove fluid buildup.

Chronic kidney disease (CKD) is a major public health concern. CKD often goes undetected until it is very advanced. But when it is diagnosed early through very simple tests, progression of CKD can be slowed or even stopped. Regular testing for everyone is important but it is especially important for people at risk. Follow these 5 steps to learn more about kidney disease, your risk, and how to prevent kidney disease.

Step 1: Know these facts
6 Things Healthy Kidneys Do:

• Regulate the body’s fluid levels
• Filter wastes and toxins from the blood
• Release a hormone that regulates blood pressure
• Activate Vitamin D to maintain healthy bones
• Release the hormone that directs production of red blood cells
• Keep blood minerals in balance (sodium, phosphorus, potassium)

8 Problems CKD can cause:

• Cardiovascular disease
• Heart attack and stroke
• High blood pressure
• Death
• Weak bones
• Nerve damage (neuropathy)
• Kidney failure (end-stage renal disease, or ESRD)
• Anemia or low red blood cell count

Step 2: Assess Your Risk
4 Main Risk Factors:

• Diabetes (self or family)
• High blood pressure (self or family)
• Cardiovascular disease (self or family)
• Family history of kidney disease or diabetes or high blood pressure

10 Additional Risk Factors:

• African-American heritage
• Native American heritage
• Hispanic, Asian, Pacific Islander heritage
• Age 60 or older
• Obesity
• Low birth weight
• Prolonged use of NSAIDs, a type of painkillers, such as ibuprofen and naproxen
• Lupus, other autoimmune disorders
• Chronic urinary tract infections
• Kidney stones

Step 3: Recognize Symptoms
Most people with early CKD have no symptoms, which is why early testing is critical. By the time symptoms appear, CKD may be advanced, and symptoms can be misleading.
8 Possible Trouble Signs:

• Fatigue, weakness
• Difficult, painful urination
• Foamy urine
• Pink, dark urine (blood in urine)
• Increased thirst
• Increased need to urinate(especially at night)
• Puffy eyes
• Swollen face, hands, abdomen, ankles, feet

Step 4: Get Tested
4 Simple, Life-Saving Tests:

• Blood Pressure
• Protein in Urine
• Creatinine in Blood (Serum Creatinine)
• Glomerular Filtration Rate (GFR)

Step 5: Stay Healthy
6 Things people with CKD should do:

• Lower high blood pressure
• Keep blood-sugar levels under control if diabetic
• Reduce salt intake
• Avoid NSAIDs, a type of painkillers
• Moderate protein consumption
• Get an annual flu shot

9 Things everyone should do:

• Exercise regularly
• Control weight
• Follow a balanced diet
• Quit smoking
• Drink only in moderation
• Stay hydrated
• Monitor cholesterol levels
• Get an annual physical
• Know your family medical history

Kidney Cancer
Kidney cancer is cancer that originates in the kidneys. Your kidneys are two bean-shaped organs, each about the size of your fist. They’re located behind your abdominal organs, with one kidney on each side of your spine.

Kidney cancer also called renal cancer is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most of the kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected.

In adults, the most common type of kidney cancer is renal cell carcinoma. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms’ tumor.

The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) scan are being used more often. These tests may lead to the accidental discovery of more kidney cancers.

Kidney cancer staging
Once your doctor identifies a kidney lesion that might be kidney cancer, the next step is to determine the extent (stage) of cancer. Staging tests for kidney cancer may include additional CT scans or other imaging tests your doctor feels are appropriate.
Then your doctor assigns a number, called a stage, to your cancer. Kidney cancer stages include:

• Stage I. At this stage, the tumor can be up to 2 3/4 inches (7 centimeters) in diameter. The tumor is confined to the kidney.
• Stage II. A stage II kidney cancer is larger than a stage I tumor, but it’s still confined to the kidney.
• Stage III. At this stage, the tumor extends beyond the kidney to the surrounding tissue and may also have spread to a nearby lymph node.
• Stage IV. Cancer spreads outside the kidney, to multiple lymph nodes or to distant parts of the body, such as the bones, liver or lungs

Causes:
It’s not clear what causes renal cell carcinoma. Doctors don’t know the causes of kidney cancer but know that kidney cancer begins when some kidney cells acquire mutations in their DNA. The mutations tell the cells to grow and divide rapidly. The accumulating abnormal cells form a tumor that can extend beyond the kidney. Some cells can break off and spread (metastasize) to distant parts of the body.

Symptoms of Kidney Cancer
Kidney cancer rarely causes signs or symptoms in its early stages. As the tumor grows larger, symptoms may appear. You may have one or more of these kidney cancer symptoms:

• Blood in your urine
• A lump in your side or abdomen
• A loss of appetite
• A pain in your side that doesn’t go away
• Weight loss that occurs for no known reason
• Fever that lasts for weeks and isn’t caused by a cold or other infection
• Extreme fatigue
• Anemia
• Swelling in your ankles or legs
• Back pain just below the ribs that doesn’t go away

Kidney cancer that spreads to other parts of your body may cause other symptoms, such as:

• Shortness of breath
• Coughing up blood
• Bone pain

How do I know if I have kidney cancer?
Maybe you’ve had kidney cancer symptoms such as pain in your side, weight loss, or extreme fatigue. Or maybe your doctor has found a lump in your side during a routine exam or a sign of kidney cancer during a test for another disease. Regardless, to confirm a diagnosis of kidney cancer, you will need a thorough physical exam, health history, and tests. Your doctor will feel your abdomen and side for lumps and check for fever and high blood pressure, among other things. You will also answer questions about your health habits, any past illnesses, and types of treatment.

Risk Factors:
Factors that can increase the risk of kidney cancer include:

• Smoking. If you smoke cigarettes, your risk for kidney cancer is twice that of nonsmokers. Smoking cigars may also increase your risk.
• Being male. Men are about twice as likely as women to get kidney cancer.
• Being obese. Extra weight may cause changes to hormones that increase your risk.
• Using certain pain medications for a long time. This includes over-the-counter drugs in addition to prescription drugs.
• Having advanced kidney disease or being on long-term dialysis, a treatment for people with kidneys that have stopped working
• Having certain genetic conditions, such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma
• Having a family history of kidney cancer. The risk is especially high in siblings.
• Being exposed to certain chemicals, such as asbestos, cadmium, benzene, organic solvents, or certain herbicides
• Having high blood pressure. Doctors don’t know whether high blood pressure or medication used to treat it is the source of the increased risk.
• Being black. The risk in blacks is slightly higher than in whites. No one knows why.
• Having lymphoma. For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.
• Older age. Your risk of kidney cancer increases as you age.
• Treatment for kidney failure. People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.
• Certain inherited syndromes. People who are born with certain inherited syndromes may have an increased risk of kidney cancer, including those who have von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis and familial papillary renal cell carcinoma.

Diagnosing kidney cancer:
Tests and procedures used to diagnose kidney cancer include:

• Urine tests: check for blood in your urine or other signs of problems.
• Blood tests:show how well your kidneys are working.
• Intravenous pyelogram (IVP):involves X-raying your kidneys after the doctor injects a dye that travels to your urinary tract, highlighting any tumors.
• Ultrasound:uses sound waves to create a picture of your kidneys. It can help tell if a tumor is solid or fluid-filled.
• A CT scan:uses X-rays and a computer to create a series of detailed pictures of your kidneys. This may also require an injection of dye. CT scans have virtually replaced pyelogram and ultrasound as a tool for diagnosing kidney cancer.
• Magnetic resonance imaging (MRI):uses strong magnets and radio waves to create detailed images of soft tissues in your body. You may need an injection of a contrast agent to create better pictures.
• Removing a sample of kidney tissue (biopsy).In rare cases, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer.
• Renal arteriogram:This test is used to evaluate the blood supply to the tumor. It is not given often, but may help diagnose small tumors. It has other uses, as well.

What is lupus nephritis?
There are two types of lupus. Systemic lupus erythematosus (SLE) is the form of lupus that can harm your skin, joints, kidneys and brain and may be fatal. The other form of lupus is called “discoid” lupus erythematosus, which affects only your skin. Systemic lupus erythematosus (SLE) that affects the kidneys is called lupus nephritis. Lupus is an “autoimmune” disease. With lupus, the body’s immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys.

Up to 60% of lupus patients will develop lupus nephritis. When the kidneys are inflamed, they can’t function normally and can leak protein. If not controlled, lupus nephritis can lead to kidney failure.

What causes lupus nephritis?
No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Men and women of all ages and races get lupus. However, about 90 percent of people diagnosed with lupus are women.

What are the symptoms of lupus nephritis?
Lupus nephritis can cause many signs and symptoms and may be different for everyone. It is a serious problem. Its symptoms, though, are not always dramatic Signs of lupus nephritis include:

• Blood in the urine (hematuria)
• Edema
• Weight gain
• High blood pressure
• Dark urine
• Foamy, frothy urine
• The need to urinate during the night

Not all urinary or kidney problems in people with lupus are due to lupus nephritis. People with lupus may also be prone to urinary tract infections. These cause burning on urination and require treatment with antibiotics.

What tests are done to find out if I have lupus nephritis?
Your doctor will do a physical examination, get your medical history, and do special tests. These tests include:

• Urine test to check for protein and blood
• Blood tests
• Check your levels of protein and cholesterol
• Check your GFR (glomerular filtration rate) to show how well your kidneys are filtering wastes
• Check for antiphospholipid antibodies and antinuclear antibodies (ANA) at least once during your disease.
• Kidney biopsy to look at a tiny piece of the kidney under a microscope

How is lupus treated?
Lupus is treated with drugs that block your body’s immune system. These include drugs like steroids (corticosteroid) and antimalarial drugs. Everyone is different and your doctor will make a treatment plan that is right for you. Usually, treatment for lupus nephritis include:

• Corticosteroids (often called “steroids”)
• Immunosuppressive drugs
• ACE inhibitors and ARBs
• Diuretics
• Diet change

Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis. Dialysis involves filtering the blood through a machine to remove waste products from the body.

Ultimately, it may be necessary to have a kidney transplant. In those cases, people will need additional drugs to keep their immune system from rejecting the transplanted kidney.

Do these treatments have side effects?
You should always speak with your doctor about the risks and benefits of any of the treatments you receive. Each of the drugs during any of these treatments can have their own side effects. Fortunately, these side effects usually are manageable for most patients. Discuss your treatment with your healthcare provider. Your overall health and the health of your kidneys should always be considered. There are times when the side effects of certain treatments are not worth the risk to your health.

If you are a woman with lupus nephritis and want to have children, you should discuss with your healthcare provider the effect your treatment may have on that process. There are ways to make sure that treatment is less harmful to this process.

The kidneys play several vital roles in maintaining good health. One of their most important jobs is to filter waste materials from the blood and expel them from the body as urine. The kidneys also help control the levels of water and various essential minerals in the body.

There is also need kidney function testing done if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure.

Healthy kidneys remove wastes and excess fluid from the blood. Blood and urine tests show how well the kidneys are doing their job. Urine tests can show how quickly body wastes are being removed and whether the kidneys are leaking abnormal amounts of protein.

• Blood Tests
• Serum Creatinine

Creatinine is a waste product that comes from the normal wear and tear on muscles of the body. This blood test examines whether creatinine is building up in your blood. The kidneys usually completely filter creatinine from the blood. A high level of creatinine suggests a kidney problem. Creatinine levels in the blood can vary depending on age, race and body size. In many labs the normal range is 0.6 to 1.2 mg/dl. Higher levels may be a sign that the kidneys are not working properly. As kidney disease progresses, the level of creatinine in the blood increases.

• Blood Urea Nitrogen (BUN)

Urea nitrogen is produced from the breakdown of food protein. A normal BUN level is between 7 and 20 mg/dl. As kidney function decreases, the BUN level increases.

• Estimated Glomerular Filtration Rate (GFR)

This test estimates how well your kidneys are filtering waste. The test determines the rate by looking at factors, such as:

• test results, specifically creatinine levels
• age
• gender
• race
• height
• weight

Normal GFR can vary according to age (as you get older it can decrease). The normal value for GFR is 90 or above. A GFR below 60 is a sign that the kidneys are not working properly. A GFR below 15 indicates that a treatment for kidney failure, such as dialysis or a kidney transplant, will be needed.

• Urine Tests

Some urine tests require only a few ounces of urine. But some tests require collection of all urine produced for a full 24 hours. A 24-hour urine test shows how much urine your kidneys produce in 1 day. The test also can give an accurate measurement of how much protein leaks from the kidney into the urine in 1 day.

• Urinalysis

Includes microscopic examination of a urine sample as well as a dipstick test. The dipstick is a chemically treated strip, which is dipped into a urine sample. The strip changes color in the presence of abnormalities such as an excess amount of protein, blood, pus, bacteria and sugar. A urinalysis can help to detect a variety of kidney and urinary tract disorders, including chronic kidney disease, diabetes, bladder infections and kidney stones.
A urinalysis screens for the presence of protein and blood in the urine. There are many possible reasons for protein in your urine, not all of which are related to disease. Infection increases urine protein, but so does a heavy physical workout. Your doctor may want to repeat this test after a few weeks to see if the results are similar.

• Creatinine Clearance

A creatinine clearance test compares the creatinine in a 24-hour sample of urine to the creatinine level in the blood, to show how many milliliters of blood the kidneys are filtering out each minute (ml/min).

• Imaging Tests
• Ultrasound

This test uses sound waves to get a picture of the kidney. It may be used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.

• CT scan

This imaging technique uses contrast dye to picture the kidneys. It may also be used to look for structural abnormalities and the presence of obstructions.

• Kidney Biopsy

A biopsy may be done occasionally for one of the following reasons:

• to identify a specific disease process and determine whether it will respond to treatment
• to evaluate the amount of damage that has occurred in the kidney
• to find out why a kidney transplant may not be doing well

A kidney biopsy is performed by using a thin needle with a sharp cutting edge to slice small pieces of kidney tissue for examination under a microscope.

6 Foods to avoid

The following 6 foods (and food components) can actually harm your bones or your kidneys (especially when consumed in large quantities) and some of them may surprise you.

• Animal Protein (Meat and Dairy)

For one thing, milk contains animal protein. This protein is highly acidifying, whether it comes from a goat, sheep, or cow. This is why the consumption of milk and other dairy products increases calcium secretion in the urine – the body must take calcium from the bones to neutralise the acid in your system before your kidneys get bombarded with the excess protein.
Meat is, of course, straight animal protein, meat-rich diets increase the risk of uric acid kidney stones. This is direct evidence that animal protein harms your kidneys.
A balanced vegetarian diet with a moderate animal protein results in the lowest risk of uric acid crystallisation compared to the omnivorous diets

• Caffeine

It is to become caffeine dependent. But while this stimulant may make you feel more energy temporarily, it ultimately makes you feel older and more tired.
Long-term caffeine use can increase your risk of renal failure. Even brief caffeine consumption increases your risk of developing kidney stones, especially on an empty stomach. So have caffeine in moderation.

• Synthetic Sweeteners

While it’s true that sugar is bad for your bones, the “fake stuff” will rapidly decrease your kidney function. The fact is, these artificial sweeteners are synthetic chemicals that are toxic and acidifying.

• Sodas

Beverages rob your bones of their youthful vitality in other ways besides crippling your kidneys. They literally melt your bones because of the enormous amount of caustic phosphoric acid they contain. This acid dissolves calcium, making it just about impossible to prevent bone loss.

• Salt

Table salt contains sodium chloride (NaCl), anti-caking agents, and often dextrose. It’s also bleached and processed for uniform color and crystal size.The kidneys must try to keep up with the resulting salt levels in the blood, increasing the need for water to keep intercellular fluids balanced. The body then holds the water as it tries to correct for the excess salt, creating excessive blood volume. The cardiovascular and renal systems must work very hard under this pressure.

• GMOs (Genetically Modified Organisms)

Some very common foods like corn, canola, and soy are almost always genetically modified these days, while evidence mounts that these foods cause kidney damage.