FOReskin problems 

A tight foreskin called phimosis is either normal with no sign of scarring or diseased due to scarring, such as balanitis xerotica obliterans. Treatment options such as medication, circumcision, preputioplasty, and frenuloplasty will be proposed after patient history and physical examination. The retraction of a too-narrow foreskin (paraphimosis) behind the glans penis must be considered an emergency. Paraphimosis may constrict the shaft and lead to swelling. Infection of the foreskin (balanitis) may require medication to treat. Circumcision might be recommended in these conditions. A buried penis or hidden penis may require repair in future. Circumcision is not recommended in the severe form of a buried penis.

hypospadias

Hypospadias is when the hole (meatal opening) through which a child passes urine is not at the tip of the penis as it should be. Hypospadias occurs during development before birth and affects approximately 1 in 300 live births. Circumcision should not be done before the repair. Hypospadias can be corrected by surgery. After a physical examination and review of the child’s medical history, many different operations for hypospadias can be discussed. An operation is performed to give the penis a normal appearance and usually allow the boy to pass urine.

Bed wetting (nocturnal enuresis)

Bedwetting (nocturnal enuresis) is a common childhood problem in the UK that can create stress and embarrassment for children and their families. It has been estimated that 5-10% of boys at the age of 7 might suffer from this. It might be the result of many factors. The child’s history is the primary source of diagnosis. Simple treatment measures should be considered before using a bed-betting alarm, nappy or medication.

Urinary Tract Infection 

A urinary tract infection is the most common bacterial infection for boys under two years old in the urinary tract (waterworks). Infants might show irritability, poor feeding, fever, tiredness, vomiting, tummy aches and smelly nappies. Older children might show symptoms of fever, vomiting, abdominal pain, increased frequency of passing urine, back pain, pain when weeing, vomiting and smelly or bloody urine. Your child’s urine sample will need to be collected to look for signs of infection and dehydration. The disease should be treated with antibiotics after a discussion with your medical practitioner (GP). Children who have had a urinary tract infection should have an ultrasound scan. Other tests and investigations might be needed. Circumcision may be required in boys to minimise the disease.

Undescended (absent) Testis

During pregnancy, the testes start developing inside the abdomen. Usually, about two months before birth, the testes move down (descend) into the scrotum. However, in some boys, this does not happen. This leads to undescended testis being detected in the baby. An operation called an orchidopexy might be required to place and fix the testes in the scrotum if they are still undescended by the time the baby is approximately one year of age. Occasionally, testes that have descended at birth ascend as the boy grows, and undescended testes are diagnosed at an older age. Boys can have one testis that is undescended or sometimes both. Some cases might require keyhole surgery (laparoscopy).

Painful Scrotum

The painful scrotum is an emergency, most commonly caused by torsion of the testis, cyst of the testis, or infections. Other causes of scrotal pain are trauma, varicocele, scrotal haematoma, obstructed hernia, appendicitis or systemic disease (e.g. Henoch-Schönlein purpura). Diagnosis is usually clinical, but some tests might be required for confirmation. Testicular torsion is an urgent condition which requires prompt surgical treatment.

Kidney and bladder problems

Urine is formed in the kidneys and collects in the pelvis of the kidney. The urine then drains from the kidney to the bladder through a tube called the ureter. From the bladder, urine is passed through another tube called the urethra. Hydronephrosis is a swelling in the pelvis of the kidneys. The two leading causes of swelling are an obstruction (blockage) to the flow of urine or vesicoureteric reflux, where urine leaks (flows back) into the ureters from the bladder as urine is passed through the urethra. If both kidneys are affected, an operation is likely needed, typically on the urethra. This condition is called posterior urethral valves. If the bladder does not work correctly, a child may develop a neurogenic bladder condition, which can be managed with medication, catheterisation and/or operation. Urinary infection is common in children with neurogenic bladder. Circumcision prevents urinary tract infection in these cases.

HYDROCELE

A hydrocele appears as a swollen scrotum. It is a fluid-filled pouch that lies alongside the testes within the scrotum. A hydrocele can occur on only one side or both sides. The hydrocele is not painful. The amount of swelling observed can change over

days or on different days. During the first year of life, the hydrocele resolves itself without requiring treatment. If the hydrocele does not resolve independently, an operation is needed. The procedure to correct the hydrocele is called ‘ligation of the Patent Processus Vaginalis’ and is carried out under general anaesthesia. 

Inguinal hernial 

An inguinal hernia appears as a lump or bulge in the groin, especially when part of the intestine gets into the sac. Children need to have an operation as there is a risk that a piece of the bowel can become trapped in the inguinal hernia (strangulated hernia). Correcting the inguinal hernia is called an inguinal herniotomy and performed under general anaesthesia. Complications from this operation are rare but might include infection and recurrence. 

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