Paediatric Urology
Urinary and genital conditions in children are not a smaller version of adult urology. Most findings relate to development and some resolve on their own, so the first question is not "when do we operate" but "is an operation actually needed".
Last medically reviewed: October 6, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- Varies with the procedure
- Anesthesia
- General anaesthesia, planned for the child
- Hospital stay
- Day case – 2 nights
- Stay in Türkiye
- 7–14 days
- Return to work
- Back to nursery or school in 1–3 weeks
- Flight clearance
- After the review appointment
About the condition
Paediatric urology deals with congenital conditions, and conditions arising in childhood, that affect the kidneys, urinary tract, bladder and external genitalia. What separates it from adult urology is not only size: a child is still growing, and a finding that looks like a problem today may resolve on its own within a few years.
The first decision is therefore usually not "which operation" but "is an operation really needed". An unnecessary procedure turns a self-limiting condition into a permanent scar and an avoidable anaesthetic. Equally, delaying a necessary one can affect the kidney permanently. The right path is to establish, using objective criteria, which of those two situations you are in.
The commonest reasons for referral are: a urinary opening not at the tip of the penis (hypospadias), urine flowing backwards from the bladder to the kidney (vesicoureteral reflux), recurrent urinary infection, an undescended testis, a foreskin that will not retract, daytime or night-time wetting, a groin swelling (hernia or hydrocele), and kidney dilatation seen on an antenatal scan.
KIDNEY DILATATION SEEN BEFORE BIRTH IS USUALLY NOT A DISEASE. In most babies described as having "dilated kidneys" on a pregnancy scan, the picture settles by itself after birth. Follow-up is still needed, because a small group do have genuine obstruction or reflux underneath. The aim is not to alarm families but to identify in good time which group the child belongs to.
A FEBRILE URINARY INFECTION IS A WARNING. In a young child in particular, a urinary infection with fever can be the first sign of something that may affect the kidney. "Antibiotics were given and it settled" is therefore not the end of the matter; with recurrent episodes, imaging is used to look for reflux or obstruction. Scarring of the kidney is irreversible, and preventing it is the real objective.
AN IMPORTANT POINT ABOUT CIRCUMCISION: a boy whose urinary opening looks unusual should not be circumcised before a urologist has seen him. The foreskin is the most valuable tissue available for hypospadias repair, and once removed the repair becomes harder.
When a surgical decision is made in a child, age, organ development, anaesthetic safety and whether the child will remember the event are weighed together. For some operations infancy is the best window, for others the pre-school years, for others after puberty. "Let us get it done as soon as possible" is not always the right approach.
LESS IS ALSO BETTER IN IMAGING. A child is more sensitive to radiation than an adult and has more years ahead. The first step is therefore almost always ultrasound; a CT scan is requested only where it will genuinely change the outcome. The same reasoning applies to studies needing a catheter: voiding cystourethrography is a valuable test but is not repeated routinely. If you are told "let us take a film at every visit", you are entitled to ask how it will change the decision.
Who is it suitable for?
May be suitable
- Boys found to have the urinary opening away from the tip (hypospadias)
- Children with recurrent febrile urinary infections
- Children in whom imaging shows vesicoureteral reflux
- Babies with kidney dilatation on antenatal or postnatal ultrasound
- Boys with an undescended testis
- Children with daytime wetting, urgency or difficulty voiding
- Children operated elsewhere whose problem persists
May not be suitable
- Children with mild findings expected to settle on observation — surgery is not advised
- Children with an active urinary infection: the infection is treated first
- Children whose diagnosis is not yet clear — imaging and assessment are completed first
- Children with other conditions who need paediatric assessment beforehand
Technology used
- Child-calibre cystoscopy and endoscopic instrument sets
- Magnified surgery with an operating microscope or loupes
- Ultrasound and voiding cystourethrography (VCUG) for diagnosis
- Scintigraphy showing each kidney’s function separately (DMSA / MAG-3)
- Paediatric anaesthetic team and child-specific pain management
- Bulking material for endoscopic injection
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Review of documents
Birth details, previous ultrasound and scintigraphy reports, urinalysis and culture results and any operation notes are reviewed. In most cases a first opinion on whether surgery is needed can be given at this stage.
- Day 1
Examination and tests
Examination, ultrasound and any further tests are carried out. If the urine culture grows an organism, the planned procedure is postponed.
- Day 2
Procedure
Endoscopic or open surgery according to the plan. Most children are discharged the same or the following day.
- Days 3–10
Follow-up and catheter removal where relevant
Where a catheter has been placed it is removed here and the first void is observed. For that reason the return flight is not planned for the day after removal.
- Months 1–3
Review
Urinalysis, ultrasound and, where needed, further imaging assess the result. Documents may be requested for remote follow-up.
Risks
- As with any operation, bleeding, infection and problems with wound healing can occur
- Risks of general anaesthesia — reduced by child-specific dosing and monitoring, but never eliminated
- Depending on the procedure, a urine leak (fistula) or a stricture may develop
- The procedure may not deliver the full expected benefit and a second one may be needed
- In children managed by observation, the picture may settle more slowly than expected and surgery may later be required
- Permanent kidney scarring after recurrent febrile infections — this is precisely the outcome being guarded against
- As the child grows the picture may change, and reassessment at puberty may be needed
Alternatives
- Observation — in many children the first and most appropriate option, with regular ultrasound and urine checks
- Preventive (prophylactic) antibiotics — in selected cases of reflux, to prevent infection
- Managing bladder and bowel habits — treating constipation and voiding retraining; in most children this comes before medication
- Endoscopic injection — an option in reflux that avoids an incision
- Open or laparoscopic surgery — when observation and less invasive options are not enough
Recovery
First 48 hours
Pain is usually controlled with simple analgesics. Plenty of fluids are given. Fever, inability to pass urine, or discharge from the wound require immediate contact.
Week 1
The child rests at home. Activities that press on the area (bicycles, carrying the child astride the hip) are avoided.
Weeks 2–4
Return to nursery or school usually falls in this period. Active play and sport wait a little longer.
Months 1–3
A review ultrasound and urinalysis assess the result. Scars begin to fade in this period.
Long term
In children with reflux or affected kidneys, blood pressure and kidney function are checked intermittently over the years. That is a routine follow-up plan, not a sign of trouble.
Frequently asked questions
Does my child definitely need an operation?
In most situations observation is the first option. The decision rests on the chance of spontaneous resolution, whether the kidney is affected, and the child’s symptoms. Once your documents are reviewed this distinction is explained to you plainly.
The pregnancy scan showed kidney dilatation — should I worry?
This finding is common and settles by itself in most babies after birth. Follow-up is still needed, because a small group do have genuine obstruction or reflux. The aim is not to alarm you but to identify in good time which group your child is in.
My child keeps getting urinary infections — is that normal?
No. Recurrent infections with fever in particular should be investigated. "Antibiotics were given and it settled" is not enough; imaging is used to look for reflux or obstruction. The aim is to prevent permanent kidney scarring.
Can he be circumcised?
If the urinary opening looks unusual, not before a urologist has seen him. The foreskin is the most valuable tissue for hypospadias repair; once removed the repair becomes harder and a graft from inside the mouth may be needed.
His testis has not descended — will waiting help?
Spontaneous descent is possible in the early months, but that window is not open indefinitely. Beyond a certain age, waiting does not help testicular development. An undescended testis is therefore not simply left; it is checked at set intervals.
My child wets during the day — is surgery needed?
Usually not. The commonest causes of daytime wetting are constipation, the habit of postponing urination, and bladder–bowel dysfunction. A procedure carried out before these are addressed will not deliver the expected benefit.
Is anaesthesia harmful to my child?
Paediatric anaesthesia uses child-specific doses and monitoring, which is why the pre-operative assessment is a separate step. The risk is not zero; but the risk of delaying a necessary procedure is also weighed.
How long should we stay in Türkiye?
Usually 7–14 days depending on the procedure. Where a catheter is placed it is removed here and the first void observed, so do not plan the return flight for the day after removal.
What documents should we send?
Antenatal and postnatal ultrasound reports, scintigraphy and voiding cystourethrography results, urinalyses and cultures, records of previous infections, and notes of any previous surgery. With these, a first opinion can usually be given before you travel.
Will he need checking again when he is older?
In some conditions, yes. After hypospadias repair in particular, reassessment at puberty as the penis grows is routine. In children with reflux or affected kidneys, blood pressure and kidney function are followed intermittently for years.
Should my child have a CT scan?
In most situations, no. Ultrasound is the first step in a child; tests involving radiation are requested only where they will genuinely change the outcome. A child is more sensitive to radiation than an adult and has more years ahead. When a test is proposed, you are entitled to ask whether the result will change the plan.
Can I stay with my child during the operation?
You cannot remain inside the operating theatre; but it may be possible for you to be with your child until he or she is asleep, and to be the first person seen on waking. That arrangement varies with the hospital and the child’s age and is discussed at the anaesthetic assessment. One parent staying overnight in hospital is routine.
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Treatments in this category
Hypospadias Repair
Surgical repair of a congenital condition in which the urinary opening lies on the underside of the penis rather than at the tip. Function comes first — a straight stream and a straight penis — and appearance after that.
Learn moreVesicoureteral Reflux (VUR) Surgery in Children
In reflux — urine flowing backwards from the bladder to the kidney — the real aim is not to "close the reflux" but to protect the kidney. In a large proportion of children reflux resolves as they grow; surgery is for the situations in which we cannot wait for that.
Learn more