Pediatric Urology Referral Guidelines

The Urology practice at Valley Children’s provides specialized care for infants, children and adolescents with genital and urological problems. In addition to pediatric urologists, the practice is staffed with dietitians, social workers and nurses. A urologist is on-call 24 hours a day for emergencies. 

A pediatric urologist has completed a residency in urology, is certified by the American Board of Urologic Surgery and boarded in the sub-specialty of Pediatric Urology, and has completed additional
training in a pediatric urology fellowship. In select situations, a urologist may have gained a lifetime of pediatric experience but started practice before such fellowships were available. For purposes of developing these guidelines, the following group definitions are used: infant (0–1 year), child (2–12 years), and adolescent (13–18 years).

• Undescended testicles and elective congenital hydrocele/hernia are optimally corrected in infancy or early childhood.
• Hypospadias: chordee, buried penis, COMPLEX congenital urologic conditions: epispadias, prune belly syndrome, urachal remnants are usually repaired in infancy or early childhood; the operation should be performed by a pediatric urologist.
• Complex congenital urologic problems (eg, duplex systems, ureterocele, bladder exstrophy, moderate or severe vesicoureteral reflux, posterior urethral valves) should preferably be managed by a pediatric urologist.
• Solid malignancies: childhood solid/cystic benign or malignant tumors of the bladder / prostate, kidney, testicles should be treated from the outset by a pediatric urologist in conjunction with a pediatric medical cancer specialist.
• Disorders of sexual development (ambiguous genitalia) conditions should be co-managed from the outset by the primary care pediatrician and a pediatric urologist. The management team should include a pediatric endocrinologist and a psychologist in consultation with the primary care pediatrician and pediatric urologist.
• Cystoscopic procedures in infants and children preferably should be performed by a pediatric urologist.
• A pediatric urology consultation should be considered when a child has prolonged, severe daytime voiding difficulty.
• A pediatric urologist should be involved in the care of children with spinal cord disorders (eg, spinal cord injuries, myelomeningocele).
• Infants or children with major urologic injuries should be stabilized at the nearest medical center and then transported to a pediatric trauma center.
• Infants or children with testicular torsion should be evaluated and operated on promptly at the nearest medical center. 

When a urinary tract abnormality has been identified prenatally, a pediatric urologist should be consulted as a member of the fetal treatment team.