Ask the experts

How are UTIs in Children Diagnosed and Treated? 

Urinary tract infections, or UTIs, don’t just affect adults. As many as 8 in 100 girls and 2 in 100 boys get UTIs. Young children have a greater risk of developing kidney damage from a UTI than do older children or adults, even when treated with the right antibiotic therapy. 

For younger children, symptoms may involve a fever, loss of appetite, fatigue or vomiting. Signs of an infection may include a strong-smelling or abnormally dark urine. Older children may complain of pain in the low stomach area or back. They may have pain when they urinate, or feel the need to urinate often. 

Your child’s health care provider will diagnose a UTI through a urine sample and a urine culture. As with adults, UTIs in children are treated with antibiotics. For most UTIs, antibiotics are given by mouth, as a liquid or a pill. If your child is very ill, the antibiotic may be given as shots in your practitioner’s office or acute care setting. Your child’s health care provider will choose a drug that treats the bacteria most likely to be causing the problem. 

In some cases, after the provider has received the results of the urine culture, often 24-48 hours later, he or she may change the antibiotic to one that works better against the type of bacteria found in your child’s urine. 

To help fight the infection, encourage your child to drink plenty of fluids and not hold their urine. Your child may appear better after only a few doses of the antibiotic, but it’s important to take the medication for the full length of the prescription. If UTIs are not fully treated, they may return, or your child may get another infection.

Robert Mevorach, MD, is a pediatric urologist with Nemours Children’s Specialty Care in Pensacola, Florida.

How are Robotics Used in Pediatric Surgery?

If your child or a child that you care about needs surgery, you may have concerns. How will the child recover? How much pain will they have after surgery? The good news is robotic surgery may be an option.

Robotic surgery, sometimes called robot-assisted surgery, is performed using small tools attached to a robot’s arm. This type of surgery can enhance a surgeon’s natural abilities and skills. For example, robotic surgery allows for more range of motion than the human hand because the tools are smaller. Robotic surgery also allows the pediatric surgeon to be more precise. 

The surgeon controls the robotic arm with a computer. But don’t worry, the surgeon is nearby. The surgeon sits at a computer station and directs the movements of the robot. During the procedure, the robot makes small cuts to insert tiny instruments for the procedure into the body. The robot matches the doctor’s hand movements to perform the procedure using the small surgical tools.

To help the surgeon see clearly, a thin tube with a camera attached to the end of it (endoscope) allows the surgeon to view high definition images of the child’s body as the surgery is taking place. These images are magnified and in 3-D. 

One benefit of robotic surgery is that it’s minimally invasive. As a result, the cuts are smaller and there is less bleeding. Robotic surgery is appealing for many families because the hospital stays are shorter and children have less scars. 

If your child needs surgery, ask if robotic surgery is an option.

Stacy Tanaka, MD, is a pediatric urologist at Vanderbilt University Medical Center in Nashville, Tennessee.

When Should a Patient Consider Fertility Preservation Options?

Fertility preservation is the process of saving or protecting eggs, sperm or reproductive tissue. This is done so you can use them to have biological children in the future. Health conditions like cancer can affect a man or woman’s fertility. 

If you will be treated for cancer or another health condition that can affect fertility, here are 3 things you should do: 

  1. Talk to your doctors about your desire to have children biologically. Ask what can be done to preserve fertility before your treatments start. 

  2. Know your options. For men, sperm banking, sperm extraction and protecting the testicles from radiation may be options. Sperm banking is when men freeze their sperm until they need them. For men who have trouble ejaculating or have limited sperm in their semen, sperm extraction may help. That’s when a health professional removes sperm from a part of the testicle to fertilize a woman’s egg in the short-term or to freeze them for a later time. Shielding the testicles during radiation treatments lower the likelihood that sperm will be damaged. 

    For women, options may include freezing eggs or embryos (eggs fertilized with sperm). Another option is gonadal shielding or covering the pelvic area with a shield to protect ovaries from radiation. Ovarian transposition may also be an option. This is when a doctor performs a minor surgery to move the ovaries and sometimes the fallopian tubes from the area that will receive radiation to an area that will not receive radiation.

  3. Understand your insurance coverage for fertility preservation. If you do not have health insurance, ask about the costs associated with each fertility preservation option. 

Mark Fallick, MD, is a urologist with New Jersey Urology in Vorhees, New Jersey.  |  SUMMER 2020  |  UROLOGYHEALTH extra