Specialized Pediatric Urological Care
Dr. Deval Parikh provides expert care for unborn babies diagnosed with urological anomalies via prenatal ultrasound, as well as children with genitourinary disorders. He also offers specialized care for prepubescent girls facing genital concerns. While pediatric urology typically involves patients under 18, Dr. Parikh also treats adults with congenital urological conditions or those requiring reconstructive procedures.
Dedicated to comprehensive pediatric urology, Dr. Parikh delivers advanced surgical solutions for a range of conditions, including penile abnormalities, hypospadias, hydroceles, hernias, undescended testicles, vesicoureteral reflux (VUR), pediatric kidney stones, ureteropelvic junction obstruction, hydronephrosis, and hydroureteronephrosis.
His practice is equipped with state-of-the-art technology, offering minimally invasive procedures such as endoscopic and laparoscopic surgeries. Dr. Parikh is also involved in research aimed at understanding kidney damage caused by urinary tract obstructions and developing therapies to halt or slow its progression.
Common Pediatric Urological Conditions
- Obstructive Uropathies: Conditions like ureteropelvic junction obstruction and posterior urethral valves can block urine flow and may require surgery or endoscopic procedures.
- Vesicoureteral Reflux (VUR): The backward flow of urine from the bladder to the kidneys increases the risk of infections and kidney damage. It can be managed with medication or surgery.
- Hydronephrosis: Swelling of the kidneys due to urine buildup, often from obstruction or reflux.
- Urinary Tract Infections (UTIs): Bacterial infections affecting the bladder, urethra, or kidneys, requiring prompt treatment.
- Undescended Testicles (Cryptorchidism): When one or both testicles fail to descend into the scrotum, surgical correction is usually needed.
- Phimosis: Tight foreskin that cannot retract fully, potentially causing infection or urination issues.
- Hypospadias: The urethra opens on the underside of the penis, requiring surgical correction.
- Epispadias: The urethra opens on the upper side of the penis, needing surgical management.
- Neurogenic Bladder: Nerve-related bladder dysfunction, often linked to spina bifida, requires careful management.
- Posterior Urethral Valves (PUV): A congenital obstruction in the urethra of male infants that can cause urinary retention and kidney damage.
- Duplex Kidney: A kidney with two drainage systems, requiring monitoring or treatment if complications arise.
Risks of Ignoring Urological Symptoms
Untreated or delayed care can lead to:
- Delayed toilet training
- Abnormal penile curvature
- Increased risk of kidney infections during pregnancy (in females)
- Hypertension
- Kidney scarring or failure
Diagnostic Techniques
- MR Urography: MRI imaging of the kidneys, ureters, and bladder using contrast dye.
- Nuclear Renal Scan: Assesses kidney function via radioactive tracers.
- Ultrasound: A non-invasive tool to visualize the urinary tract.
- Urodynamic Testing: Measures urine flow and bladder pressure.
- Voiding Cystourethrogram (VCUG): Uses contrast dye and X-ray to assess bladder function and check for reflux.
Conditions and Their Treatments
1. Hypospadias
What is Hypospadias?
Hypospadias is a congenital condition in which the urinary opening (meatus) is located on the underside of the penis rather than at the tip. Most affected children urinate from this abnormal position. It can also be associated with other conditions, such as undescended testes (where one or both testicles are absent from the scrotum).
Causes
The exact cause is multifactorial, involving a combination of genetic, environmental, and maternal factors during pregnancy.
Symptoms
- Urinary hole located on the underside of the penis
- Urination from the underside of the penis
- Abnormally shaped penis and/or scrotum
- Sometimes associated with undescended testes
Treatment
Hypospadias requires corrective surgery to reposition the urinary opening to the tip of the penis. Surgery is ideally performed between 6 to 18 months of age. If associated with undescended testes, correction for that should also be done as early as possible.
2. Antenatal Hydronephrosis
What is Antenatal Hydronephrosis?
A condition detected via prenatal ultrasound shows kidney swelling due to urine accumulation. In 60–80% of cases, it resolves spontaneously. The rest may require medical or surgical intervention, depending on the cause.
Causes
- Transient hydronephrosis
- PUJO (Pelviureteric Junction Obstruction)
- VUR (Vesicoureteral Reflux)
- PUV (Posterior Urethral Valves), etc.
Symptoms
- Detected on antenatal scan as kidney swelling
- Requires postnatal monitoring
Treatment
Most cases resolve by birth or within the first year of life. Some require antibiotics or surgery, depending on the severity and cause.
3. Kidney Tumors (e.g., Wilms Tumor)
What are Kidney Tumors in Children?
These are rare but serious conditions, with Wilms’ Tumor (Nephroblastoma) being the most common. Often first noticed by parents due to a bloated tummy or abdominal mass.
Causes
Primarily due to genetic mutations and other multifactorial reasons.
Symptoms
- Enlarged abdomen
- Mass noticed during bathing
- Blood in urine
- Occasionally, high blood pressure
Treatment
Management includes surgical removal of the tumor (with or without the kidney) followed by chemotherapy. Early detection ensures excellent survival and quality of life.
4. Phimosis
What is Phimosis?
A condition where the foreskin cannot be pulled back over the glans penis. It’s normal in infants and usually resolves by 6–7 years of age.
Causes
Often physiological. Pathological phimosis may arise due to trauma, infections, or BXO (Balanitis Xerotica Obliterans).
Symptoms
- Ballooning of the foreskin during urination
- Spraying of urine
- Discoloration at the tip (in BXO cases)
Treatment
Surgical intervention (circumcision) may be required if symptoms persist or complications like BXO are present.
5. Undescended Testes (Cryptorchidism)
What is it?
A condition where one or both testicles fail to descend into the scrotum.
Causes
Similar to hypospadias, caused by genetic and environmental factors during fetal development.
Symptoms
- One or both testicles are not felt in the scrotum
- Sometimes associated with:
- Hypospadias
- Abnormal penile appearance
- Ambiguous genitalia
Treatment
Some cases may not need surgery. Most require orchiopexy (surgical correction) between 6–12 months of age, depending on the location of the testes and associated abnormalities.
6. Vesicoureteral Reflux (VUR)
What is VUR?
A condition where urine flows backward from the bladder to the kidneys. It’s a common cause of urinary tract infections (UTIs) in children.
Causes
- Primary VUR: Congenital, cause unknown
- Secondary VUR: Due to bladder dysfunction, constipation, or posterior urethral valves
Symptoms
- Recurrent UTIs
- Growth delays
- Sometimes found during imaging for abdominal pain
Treatment
- Low-grade VUR: Observation or low-dose antibiotics
- High-grade VUR: May require endoscopic or open surgical correction
7. Urolithiasis (Kidney/Bladder Stones)
What is it?
Stone formation in the kidneys, ureters, or bladder, often discovered during evaluations for abdominal pain.
Causes
- Metabolic disorders
- Infections
- Diet-related issues
Symptoms
- Abdominal pain
- Whitish sediment in urine
- Recurrent UTIs
Treatment
- Small stones often pass naturally
- Larger stones may need removal via:
- Endoscopic procedures (no cuts)
- ESWL (shock wave therapy) for stone fragmentation
- Long-term follow-up is essential
8. Posterior Urethral Valves (PUV)
What is PUV?
A congenital condition affecting only male children, caused by abnormal valve-like flaps in the urethra, obstructing urine flow.
Causes
A failure in the regression of embryological tissue during fetal development. The exact reason remains unclear.
Symptoms
- Enlarged bladder or abnormal kidneys on prenatal scans
- Poor urinary stream after birth
- Recurrent UTIs
- Potential kidney damage
Treatment
- Endoscopic removal of the obstructing valves
- Long-term follow-up and medication may be required
