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Wetting - Nocturnal Enuresis
Undescended Testicle
Urinary Tract Infections (UTI) in Children

Wetting - Nocturnal Enuresis

1. What is Bed Wetting/Nocturnal Enuresis?

Bed Wetting/Nocturnal Enuresis is persistent, involuntary bed wetting during sleep, without the evidence of an abnormal urinary system. The widely accepted view of the cause of nighttime bed-wetting is that the child has failed to learn to awaken to the bladder pressure and volume before the bladder automatically empties. By age 6-7 years, if the problem still persists then treatment should be started.

2. How is Bed Wetting/Nocturnal Enuresis diagnosed?

The urologist will take a complete history, do a complete physical and exam the urine. As long as there is no other problems such as urinary infection, painful urination, stream abnormality, daytime incontinence, bowel problems or anatomic disorders, most bed wetters become dry without treatment. Patience and understanding are the best things of offer.

3. How is Bed Wetting/Nocturnal Enuresis treated?

There are different treatment options available. The urologist may use a combination of treatments depending on the individual situation.

Behavior Programs

  • Timed Urinating Program- The waking hours are used to set a schedule to empty the bladder during specific times. In timed urination, the child assumes the responsibility for identifying when the bladder is full and initiates voiding at his/her convenience.
  • Fluid Restriction- Parent(s) are told to restrict the child's fluid intake in the evening and take the child to the bathroom prior to going to bed.
  • Self-Awakening Program- Teaches the child to wake-up during the night to urinate. A self-awakening approach can be tried at any age if the child is willing. Awakening the parents is discouraged because it takes away from the child's need to feel responsible for getting up.
  • Alarm Conditioning- The quickest way for a child be become dry is to awaken during the night to urinate. The goal of conditioning treatment is to teach the child to respond to their bladder pressure by awakening.


  • The urologist may prescribe medication as part of your child's plan of treatment.

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1. What is Hypospadias?

Hypospadias is a birth defect found in boys in which the urinary tract opening is not located properly at the tip of the penis. There are varying degrees of severity of hypospadias and several different surgical procedures to correct it.

2. Why should Hypospadias be treated?

The ability to stand and urinate is important for boys. When the urethra opens before it reaches the tip of the penis, a boy may be unable to stand and urinate with a direct stream. Additionally, as an adult male, a straight penis is necessary for satisfactory sexual function and reproduction.

3. How is Hypospadias treated?

Hypospadias is treated surgically. The surgical procedure for a mild case of hypospadias may be corrected by a simple outpatient procedure. Moderate to severe cases of hypospadias may require more extensive surgery with a stay in the hospital.

4. What are the possible complications of Hypospadias repair?

  • Bleeding
  • Bladder spasms
  • Infections
  • Fistula - urine leak
  • Stenosis - a narrowing of the urethra
  • Recurrent Chordee

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Undescended Testicle

1. What is an Undescended Testicle?

An undescended testicle is a birth defect found in boys in which one or both of the testicles are not properly positioned in the scrotum. Sometimes the testicle will come down on its own by the age of one year.

2. How is an Undescended Testicle diagnosed?

The initial evaluation will include a thorough history, physical examination, and inspection of the child's testicles. Sometimes, ultrasound or other imaging tests may be performed. There is a need for concern with an undescended testicle. Permanent damage can occur, resulting in scarring and poor sperm development.

3. How are Undescended Testicles treated?

There are two options, non-surgical and surgical. The non-surgical option is a series of hormone injection treatments. This is effective in about 30% of the cases. The other option is surgical. The urologist will perform an outpatient procedure, where he will bring the undescended testicle down into the scrotum.

4. What are the possible complications?

There are a number of possible risks associated with any surgical procedure. Some of the more common are:

  • Bleeding
  • Infection
  • Atrophy - the shrinking of the testicle
  • Infertility
  • Re-ascent - the testicle may move back up into the body.

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Urinary Tract Infections (UTI) in Children

1. What causes a UTI?

An infection occurs when bacteria enter the urethra and start multiplying. If the infection stays within the urethra, it is called urethritis. If the infection enters the bladder, the infection is called cystitis. The infection will sometimes involve the prostate, this is called prostatitis. Last, the infection can go into the kidneys, this is called pyelonephritis. UTI's can occur in infants and children who are born with urinary tract abnormalities, some of which need to be corrected with surgery.

Normally, the act of urination will wash the bacteria out of the urethra to help prevent infections.

2. What are the symptoms of a UTI?

  • Frequent urination
  • Urgency of urination
  • Burning during urination
  • Pain in lower abdomen
  • Pain in back or side
  • Frequent urination at night
  • Pelvic discomfort

The urine may appear:

  • Discolored
  • Cloudy
  • Brownish or reddish

If the Kidneys are involved:

  • High fever
  • Overall bad feeling
  • Nausea
  • Vomiting

Children’s symptoms also can consist of:

  • Irritability
  • Abnormal eating pattern
  • Unexplained fever
  • Loss of bladder control
  • A change in the child's urinary pattern

3. How is a UTI diagnosed?

A "Clean Catch" or catheterized urine sample.

4. How is a UTI treated?

Urinary tract infections usually require treatment with antibiotics that are often selected according to the sensitivity test done in the office. Most UTI's are treated with short courses of antibiotics usually only one to three days. However, some infections require treatment for one to two weeks. 

Treatment of urinary tract infections involve not only an antibiotic but also measures to alleviate the discomfort that may be caused by a UTI. Warm tub baths or sitz baths can often be beneficial as can heating pads. Avoidance of urinary tract irritants such as caffeine, alcohol and spicy foods can also help alleviate some of the symptoms.

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