The genitourinary system in children, encompassing the kidneys, ureters, bladder, urethra, and reproductive organs, is critical for waste filtration, fluid regulation, and reproductive function. Due to ongoing development, this system is particularly vulnerable to congenital anomalies, infections, and other disorders.

Paediatric nurses play a vital role in early detection, management, and family education to prevent complications such as renal damage or developmental issues. This lesson covers common genitourinary conditions, their clinical presentations, diagnoses, treatments, and nursing considerations.

Common Congenital Anomalies

Congenital anomalies of the genitourinary tract are prevalent and often detected prenatally via ultrasound. They may lead to complications like urinary tract infections (UTIs), obstructions, or impaired renal function, requiring surgical or medical intervention.

• Hypospadias:

  • Definition: A congenital condition where the urethral opening is located on the underside of the penis rather than the tip.

  • Incidence: Approximately 1 in 250 male births.

  • Clinical Presentation: Varies from mild (distal) to severe (proximal); may include chordee (penile curvature).

  • Diagnosis: Physical examination at birth.

  • Management: Surgical correction (hypospadias repair) between 6–18 months to ensure functional urethra and cosmetic appearance. Complications include fistula formation or strictures.

• Cryptorchidism (Undescended Testes):

  • Definition: Failure of one or both testicles to descend into the scrotum.

  • Incidence: 3% in full-term infants, 20–30% in premature infants.

  • Clinical Presentation: Palpable or non-palpable testicle, often associated with inguinal hernia.

  • Diagnosis: Physical examination; ultrasound for non-palpable testes.

  • Management: Orchiopexy by 18 months to reduce risks of infertility and testicular cancer.

• Vesicoureteral Reflux (VUR):

  • Definition: Backflow of urine from the bladder to the kidneys due to an incompetent vesicoureteral junction.

  • Incidence: 1–2% of children, more common in girls.

  • Clinical Presentation: Often asymptomatic; may present with recurrent UTIs or pyelonephritis.

  • Diagnosis: Voiding cystourethrogram (VCUG).

  • Management: Antibiotic prophylaxis for low-grade VUR; surgical reimplantation for high-grade VUR.

• Posterior Urethral Valves (PUV):

  • Definition: Congenital obstructing membranes in the posterior urethra of males.

  • Incidence: 1 in 5,000–8,000 male births.

  • Clinical Presentation: Prenatal hydronephrosis, poor urinary stream, UTIs, renal insufficiency.

  • Diagnosis: Prenatal ultrasound; postnatal VCUG.

  • Management: Endoscopic valve ablation; long-term renal and bladder function monitoring.

• Bladder Exstrophy:

  • Definition: Bladder exposed outside the body due to an abdominal wall defect.

  • Incidence: 1 in 50,000 births.

  • Clinical Presentation: Visible bladder tissue, epispadias, widened pubic symphysis.

  • Diagnosis: Clinical examination; imaging for associated anomalies.

  • Management: Surgical closure within 48 hours, followed by staged reconstructions.

Infections

Infections are a leading cause of genitourinary morbidity in children, with UTIs being the most common.

• Urinary Tract Infections (UTIs):

  • Definition: Bacterial infection of the urinary tract, affecting the bladder (cystitis), kidneys (pyelonephritis), or urethra.

  • Incidence: Higher in girls (10:1 ratio post-infancy); boys more susceptible in first year due to anomalies.

  • Pathogenesis: Ascending bacteria, commonly Escherichia coli, Klebsiella, Proteus, or Enterococcus.

  • Risk Factors: VUR, constipation, incomplete bladder emptying, urinary tract anomalies.

  • Clinical Presentation: Infants: fever, poor feeding, vomiting, jaundice. Older children: dysuria, frequency, urgency, suprapubic pain, costovertebral tenderness (pyelonephritis).

  • Diagnosis: Urinalysis (leukocyte esterase, nitrites, pyuria, bacteriuria); urine culture (>50,000 CFU/mL of a single pathogen); renal ultrasound, VCUG for recurrent cases.

  • Management: Antibiotics (e.g., amoxicillin-clavulanate, cephalosporins); hydration, antipyretics; prophylaxis for recurrent UTIs; surgical correction for underlying anomalies.

• Sexually Transmitted Infections (STIs):

  • Relevance: Relevant in adolescents; includes chlamydia, gonorrhea, syphilis, human papillomavirus (HPV).

  • Clinical Presentation: Urethral discharge, dysuria, genital lesions.

  • Diagnosis: Nucleic acid amplification tests, cultures.

  • Management: Antibiotics (e.g., azithromycin for chlamydia, ceftriaxone for gonorrhea); education on safe sex practices.

Glomerular Diseases

Glomerular diseases affect the kidney’s filtering units and can lead to significant renal impairment.

• Glomerulonephritis:

  • Definition: Inflammation of the glomeruli, acute or chronic.

  • Causes: Post-streptococcal, IgA nephropathy, Henoch-Schönlein purpura (HSP).

  • Clinical Presentation: Haematuria, proteinuria, hypertension, oedema.

  • Diagnosis: Urinalysis (haematuria, red cell casts, proteinuria); renal function tests; renal biopsy if needed.

  • Management: Supportive care (fluid restriction, antihypertensives); immunosuppressants for specific types (e.g., steroids for HSP nephritis).

• Nephrotic Syndrome:

  • Definition: Heavy proteinuria, hypoalbuminemia, oedema, hyperlipidemia.

  • Causes: Minimal change disease, focal segmental glomerulosclerosis.

  • Clinical Presentation: Periorbital oedema, ascites, frothy urine.

  • Diagnosis: 24-hour urine protein, serum albumin, lipid profile; renal biopsy if steroid-resistant.

  • Management: Corticosteroids, diuretics, ACE inhibitors, albumin infusions.

Obstructive Uropathy

Obstructive uropathy involves blockages in the urinary tract, leading to complications like hydronephrosis or renal damage.

• Ureteropelvic Junction (UPJ) Obstruction:

  • Definition: Blockage at the ureter-renal pelvis junction.

  • Incidence: 1 in 1,500 births.

  • Clinical Presentation: Prenatal hydronephrosis, abdominal mass, flank pain, UTIs.

  • Diagnosis: Renal ultrasound, diuretic renogram (MAG3 scan).

  • Management: Observation if asymptomatic; pyeloplasty for significant obstruction.

• Neurogenic Bladder:

  • Definition: Bladder dysfunction due to neurological impairment.

  • Causes: Spina bifida, spinal cord injury.

  • Clinical Presentation: Urinary incontinence, frequent UTIs, hydronephrosis.

  • Diagnosis: Urodynamic studies, renal ultrasound.

  • Management: Clean intermittent catheterization, anticholinergics, botox injections, surgery if needed.

Renal Failure

Renal failure can be acute or chronic, requiring careful management to prevent complications.

• Acute Kidney Injury (AKI):

  • Definition: Sudden decrease in kidney function.

  • Causes: Pre-renal (hypovolemia), renal (nephrotoxic drugs, glomerulonephritis), post-renal (obstruction).

  • Clinical Presentation: Oliguria, oedema, hypertension, electrolyte imbalances.

  • Diagnosis: Serum creatinine, BUN, electrolytes, renal ultrasound.

  • Management: Treat underlying cause; supportive care (fluids, electrolytes); dialysis if necessary.

• Chronic Kidney Disease (CKD):

  • Definition: Progressive loss of kidney function over months to years.

  • Causes: Congenital anomalies, glomerular diseases, obstructive uropathy.

  • Clinical Presentation: Growth failure, anaemia, hypertension, renal osteodystrophy.

  • Diagnosis: GFR calculation, renal biopsy, imaging.

  • Management: Conservative management (diet, medications); renal replacement therapy (dialysis, transplantation).

Genitourinary Trauma

Trauma to the genitourinary tract can result from accidents or medical procedures.

• Renal Trauma:

  • Causes: Blunt or penetrating trauma (e.g., road traffic injuries).

  • Clinical Presentation: Haematuria, flank pain, shock.

  • Diagnosis: CT scan, ultrasound.

  • Management: Observation for minor injuries; surgical intervention for severe cases.

• Urethral Injury:

  • Causes: Pelvic fractures, straddle injuries.

  • Clinical Presentation: Blood at urethral meatus, inability to void.

  • Diagnosis: Retrograde urethrogram.

  • Management: Catheterization, surgical repair.

Tumours

Genitourinary tumours are rare in children but require prompt diagnosis and treatment.

• Wilms’ Tumour (Nephroblastoma):

  • Definition: A malignant kidney tumour, most common in young children.

  • Incidence: 1 in 10,000 children, typically ages 2–5 years.

  • Clinical Presentation: Abdominal mass, haematuria, hypertension.

  • Diagnosis: Ultrasound, CT/MRI, biopsy.

  • Management: Nephrectomy, chemotherapy, radiation therapy.

Functional Disorders

Functional disorders affect bladder control and can impact quality of life.

• Enuresis (Bedwetting):

  • Definition: Involuntary urination during sleep in children over 5 years.

  • Clinical Presentation: Nighttime wetting, often with psychological impact.

  • Diagnosis: History, physical exam, urinalysis to rule out organic causes.

  • Management: Behavioural therapy, bedwetting alarms, desmopressin in select cases.

Adolescent Issues

Adolescents may present with genitourinary issues related to puberty or sexual activity.

• Phimosis:

  • Definition: Inability to retract the foreskin over the glans in uncircumcised boys.

  • Clinical Presentation: Difficulty with urination, recurrent balanitis.

  • Diagnosis: Physical examination.

  • Management: Topical steroids, circumcision if severe.

• Varicocele:

  • Definition: Dilated veins in the scrotum.

  • Clinical Presentation: Scrotal swelling, discomfort, “bag of worms” appearance.

  • Diagnosis: Physical exam, scrotal ultrasound.

  • Management: Observation for asymptomatic cases; surgical ligation for pain or infertility risk.

Nursing Considerations

Paediatric nurses are integral to the care of children with genitourinary conditions, focusing on assessment, management, education, and support.

• Assessment: Monitor vital signs, urine output, fluid balance, growth parameters, and signs of infection or obstruction.

• Diagnostic Tests: Assist with urine collections, prepare for imaging (ultrasound, VCUG), and support during procedures like urodynamic studies.

• Management: Administer medications (antibiotics, diuretics, antihypertensives), manage fluid and electrolyte balance, provide nutritional support.

• Education: Teach families about disease management, medication administration, signs of complications, and preventive measures (e.g., hygiene, hydration).

• Psychosocial Support: Address emotional impacts, provide age-appropriate explanations, and facilitate communication with specialists (e.g., urologists, nephrologists).