The reproductive and urinary systems have some features in different periods a man's life, so the boys are treated by a separate doctor.

When to contact

The child has violations genitourinary system In terms of distribution, they are on the same level as acute respiratory infections. The problem of diagnosing diseases of the genital organs and urinary tract is that children often long time hide the problem.

Parents of boys, and especially teenagers, should be extremely careful, noting any changes in the behavior and condition of their child.

You should contact a pediatric andrologist if your child has the following symptoms:

You should also undergo examination by an andrologist children with genetic diseases , since most often they are found hormonal imbalances and backlogs in physical development. Planned appointments are held for boys whose illnesses can resolve on their own. For example, such pathologies include hydrocele. In this case, the andrologist adheres to a wait-and-see approach, examining the disease over time.

Features of the reception

All pathologies that can be treated pediatric andrologist, require specific examinations. However, seeing a doctor starts with a standard conversation and survey. Next, the child will have to undergo several examinations, which the andrologist considers necessary.

The most common diagnostic measures:

Once the final diagnosis is made, a treatment plan is developed. It may include taking medications, surgical intervention, physiotherapeutic procedures. Sometimes you have to wait some time to determine the prognosis of the disease in order to decide exactly how best to treat the child.

Parents of boys need to know who this is - a pediatric andrologist. Ignoring genitourinary problems in childhood can develop into serious disorders reproductive function in the future, and lead to some psychological disorders.

After the birth of the baby, parents have to learn many new skills to care for the baby. The skills of feeding, cleaning ears and nose, and skin care, as a rule, do not cause embarrassment for parents and are learned quickly, without any problems. However, caring for a child’s genitals is sometimes limited to washing the diaper area. Parts of one of critical systems body - reproductive system- sometimes cause embarrassment for parents. What does absence lead to? necessary care what developmental features do boys have? infancy and what deviations should you definitely pay attention to? Information on this matter in global network quite a lot, but sometimes it’s not easy to figure it out. IllnessNews advises.

Alexander Georgievich today talks about the features of development in accordance with the age of the child and possible complications associated with pathologies or non-compliance with the rules of care and hygiene, such as phimosis, paraphimosis and balanoposthitis.

Parents of boys often experience a disease called phimosis, or narrowing of the foreskin of the penis, and inflammatory processes, and some mothers and fathers may have yet to discover complications in the natural development of the child’s sexual organ.

This is one of the main reasons why parents of little boys consult a urologist. At this state It is not possible to expose or open the head of the genital organ: foreskin narrowed and does not “let” the head out.

The anatomical structure of the foreskin is as follows: this area skin consists of two leaves attached to the base of the head. The outer part is covered with thin skin epithelium, inner part- mucous tissue that protects the covering of the head from drying out.

A few numbers from statistics to give you a better idea this problem. Congenital, physiological ( anatomical structure the foreskin of the first year of a child’s life), phimosis occurs in more than 95% of boys. By two years, full opening of the head of the genital organ is observed in 20% of boys, by the beginning of the third year - about 50%.

What is the most important thing to pay attention to: physiological phimosis most often goes away on its own between the ages of 3 and 6 years. These figures very clearly demonstrate that the problem is solving itself. For those parents who have reason to believe that developmental features will not allow the state of physiological phimosis to end without outside help, or have already encountered complications, we offer the following information.

The main manifestation of the disease is difficulty opening the head. In this case, complaints may be completely absent or manifested only by impaired urination already at late stages diseases.

The child is excited, he has to strain. Urine, lingering between the leaves of the foreskin, fills it in the form of a “ball” and through a narrow, and in some cases almost pinpoint opening, comes out in a thin stream and even drops, as in the last, most severe stage of phimosis.

This is a far-reaching complication; at this stage, serious disturbances in the outflow of urine are possible, which can cause complications. infectious nature in the urethra. But most often a disease such as balanoposthitis occurs. This is an inflammation of the foreskin, the head of the penis. Sometimes there is an increase in regional (inguinal) lymph nodes and body temperature rises.

Neglect of hygiene rules contributes to the accumulation of secretions and the development of bacterial infections in the preputial sac of smegma (secretion of the glands of the foreskin). There are a number of other, less common complications, but we will talk about this, perhaps next time.

There are four degrees of narrowing of the preputial ring with phimosis:

• the first, the easiest, is characterized by the ability to freely remove the head into calm state, but during erection it is difficult or painful;
• in the second degree, there is difficulty exposing the head at rest. During an erection, the head is not visible at all under the foreskin, or a small part of it is noticeable;
• third degree of severity: the narrowing does not allow the head to be seen under any conditions, but the child can still write without difficulty, there are no obstacles to the exit of urine;
• with the most severe degree of phimosis, the foreskin is so narrowed that the boy experiences problems with urination.

Now let’s try to correct the condition, take therapeutic and preventive measures that will help the child get rid of phimosis without surgical treatment.

Expert commentary

Ekaterina Valova, psychologist

Some parents are embarrassed by the topic of genitals, fear a reaction from the child, or feel shame when manipulation arises. Adults try to avoid touching or generally paying attention to this issue, which can lead to developmental complications, illnesses and the need for surgical intervention.

It's much easier to avoid this by using simple methods and hygiene rules in early age, when the child is still small, the tissues are pliable, and the possibility of in any way incorrectly influencing the child’s sexual education is vanishingly small.

If the mother does not feel very confident, the father can take upon himself the need for special care for the boy after the doctor’s explanation. Due to experience, men know better how to and how not to handle the penis, feel more confident and can show and explain hygiene rules to their sons without feeling awkward. And, according to experts, boys, as they get older, find it easier to turn to their father with such questions.

In any case, instill hygienic rules for caring for the genitals with early childhood Just as important as teaching a child to brush his teeth is to wash his hands. Therefore, trying to put off teaching a child about hygiene is similar to trying not to brush or treat baby teeth. Complications can significantly affect the boy’s health and his future life.

Moms and dads, when bathing your baby, pay a little more attention to the boy’s genitals (we also don’t forget about the hygiene of girls). Stretch the foreskin, gently pull it onto the head of the penis, without significant effort (otherwise you may experience next complication, paraphimosis) until the child feels pain. This exercise is carried out daily, in the bath or under a warm shower, when the skin becomes more elastic and pliable, for 5-10 minutes.

The essence of the exercise is to prevent the disease and its complications. After a certain period of time (4 or more weeks), you can notice the result. The foreskin retracts freely and does not interfere with the opening of the head. Over time, the boy gets used to this procedure, does not feel discomfort, does not resist and accepts this exercise without tears. Older children can do the exercise on their own after training.

Why is it important to be patient, not to be overzealous, and not to trust your child to immediately do everything on his own without supervision? Improper execution can lead to the development of paraphimosis. Paraphimosis is one of the complications of phimosis. It is diagnosed by the following symptoms: the head of the genital organ is completely exposed, narrow part The foreskin is located behind the coronal part, and its reverse reduction is significantly difficult. This complication can occur when parents or a child are too persistent in exposing the head and, as a result, leads to pinching, swelling, and poor circulation.

Paraphimosis - acute condition requiring urgent intervention. What to do if parents are faced with a similar phenomenon?

First of all, you need to try to straighten the head, “cover” it with the foreskin, sometimes this is enough and simple to do. If such manipulation fails, there is no need to continue trying, you need to urgently consult a doctor. In a situation where time is lost and visible changes in the form of edema appear, independent reduction, in most cases, is impossible and surgical assistance is necessary. In this situation, the intervention of a specialist (urologist-surgeon) is necessary.

A pediatric urologist-andrologist is a medical professional whose main specialization is the diagnosis and treatment of diseases of the male reproductive system in children and adolescents. If you notice that your baby is developing any problems with the pelvic organs, be sure to consult with a specialist. In this article we will try to figure out the answer to actual question young parents “Pediatric urologist-andrologist – who is he and what does he treat?”

To understand who a pediatric urologist-andrologist is, you first need to find out exactly what diseases this doctor can cure. The most common pathologies included in the specialization of a urologist surgeon include:

• Neoplasms in the prostate area (benign tumors).
• Inflammation and suppuration prostate gland.
• Varicose veins in the male genital area (varicocele).
• Sexually transmitted diseases.
• Male infertility.
• Oncology.
• Sexual disorders.
• Pathologies endocrine system associated with hormonal imbalance.

The specialist must first conduct a thorough examination of the patient, collect anamnesis, and, if necessary, prescribe additional examination for staging accurate diagnosis and definitions suitable method treatment.

Competence

Patients of a pediatric urologist can be boys from birth to 18 years of age. Most often, parents with children who have been diagnosed with a congenital or acquired disease of the reproductive or urinary organs turn to such a specialist. Full list The pathologies that a pediatric urologist-andrologist has to deal with are quite extensive and include more than 40 items. A newborn may develop a hernia or dropsy, and a teenager is often diagnosed with infections transmitted through unprotected sex.

Urological diseases in boys can be congenital or acquired, namely:

• Congenital pathologies of the genital organ and foreskin (diagnosed by doctors immediately after the birth of the child).
• Dropsy, hernia, absence of one testicle (most often such pathologies are detected in children aged 5-6 years).
• Epididymal cyst, varicocele, pathologies of the foreskin (affect boys in adolescence).

A pediatric urologist-andrologist can also find out the cause of delayed sexual development and prescribe effective therapy.

Indications

Many teenagers and parents of little boys avoid going to a pediatric urologist-andrologist. This is a big mistake, because visiting such a specialist for preventive examination need to be done regularly, at least once a year.

Be sure to contact male doctor if you find the following alarming symptoms:

• A small lump or subcutaneous growth has appeared in the scrotum area;
• The child's testicles do not descend;
• There are problems with urination due to pathological disorders;
• The child has reached the age of three, and the head of the penis has not yet opened;
• The teenager has reached the age of 13 but shows no signs of sexual activity;
• The boy suffers from obesity and excess weight due to imbalance male hormones in organism.
• Enuresis in a child over four years of age, problems with urination;
• Unpleasant sensations in the groin area.

Modern treatment methods make it possible to quickly get rid of any pathology of the male reproductive system. The main thing is to detect the problem in time and seek help from a qualified specialist.

Treatment

After preliminary inspection little patient the doctor can prescribe a test additional tests for examination. This can be a scraping, blood test, urine test, etc. In addition, in modern clinics today they are widely used innovative methods diagnosis of diseases of the male reproductive system.

Electrical stimulation – modern method research. Biological structures the prostates are treated with electrical impulses. This procedure allows not only to identify pathology, but also to successfully get rid of it. ES is often combined with medication, laser treatment or electromagnetic fields.

It is used to treat certain pathologies of the reproductive system in boys. laser therapy. The patient's body is directly affected using special equipment electromagnetic radiation a certain range. This technique turns out to be quite effective in the treatment of dermatological, venereal and urological diseases.

Do you want a visit to a pediatric urologist-andrologist to be carried out exclusively in for preventive purposes? Then be sure to listen to the advice of experienced specialists in this field of medicine.

• While the child is small, hygiene procedures should be done after each bowel movement. Water procedures will allow you to quickly wash away the secretions accumulated on the genitals.
• Bathing with baby soap or special hygiene products should be carried out at least once a week.
• Bactericidal agents destroy the natural microflora on the child’s skin. That is why experts do not recommend using such drugs too often.

Head of the Urology Department Dyakov Stepan Nikolaevich

Parents quite often have questions about why they need routine examinations urologists, if nothing outwardly worries you. Let's try to understand this issue.

Plan medical examinations children by doctors of various specialties is prescribed in the law of the Ministry of Health of the Russian Federation No. 1346n “ On the procedure for minors to undergo medical examinations, including upon admission to educational institutions and during the period of study in them" Came into effect in 2013 new edition, in which changes have been made. In particular, when designing medical records now needed for kindergarten and school examination by a urologist-andrologist for boys and a gynecologist for girls.

Not all parents are happy with these changes, since they incur additional costs of time and money if the card is issued in private clinic. But doctors are definitely in favor, since these examinations really help to identify problems that can be solved in a more late age can lead to serious consequences for reproductive function. Statistics were collected that showed enough a large number of missed developmental anomalies of the genital organs in children who were not examined by a urologist or gynecologist in the first years of life.

Let's look at each stage in more detail.

In the first year of life
1 month - pediatric surgeon
12 months - pediatric surgeon
3 years - pediatric urologist-andrologist
7 years old - pediatric urologist-andrologist
12 years old - pediatric urologist-andrologist
14 years old - pediatric urologist-andrologist
15 years old - pediatric urologist-andrologist
16 years old - pediatric urologist-andrologist
17 years old - pediatric urologist-andrologist

I believe that at 1 year An examination by a urologist is also necessary, although it is not on the list. At this age, the doctor must exclude pathologies of the development of the scrotum (dropsy, undescended testicles, testicular hypoplasia), discrepancy in the size of the penis and testicles, and evaluate hormonal levels.

Most congenital problems require early intervention, such as hypospadias when urethra does not open on the head, but is displaced from the normal position. The earlier the operation is performed in these cases, the less it injures the child and the lower the risk of complications. The year is a turning point in resolving issues regarding planning surgical treatment, especially in matters of scrotal pathologies.

Later, irreversible changes in reproductive function may begin.

The urologist should also discuss with parents issues related to the opening of the glans penis, hygiene and prevention of overheating of the scrotal organs, and the regime of wearing diapers.

Undoubtedly, an examination by a pediatrician and an examination by a surgeon should include an examination of the genital organs. But, since it is urologists-andrologists who deal with these problems, doctors of this specialty have more focus and experience in working with such pathologies, therefore the detection of disorders that may not be obvious at first glance is higher. Fortunately, these pathologies do not occur often; mostly fathers and mothers hear the phrase: “Your child has everything required sizes and in in the right place

”, which calms and pleases any parent. The first two examinations, required by standards, at 3 and 7 years, most often coincide with the timing of the preparation of medical records for kindergarten

and schools.

What issues are discussed during these periods? At 3 years old parents are primarily concerned physiological phimosis

. For some boys, the head is already opening, for others it is not yet. It's time to teach parents and children how to properly perform hygiene and prepare the head for opening. Questions arise about urination, it is still a little early to talk about the diagnosis enuresis , but for most children at three years old this is already a completely controlled process. If there are still “wet nights” or the child is still in a diaper, this is a reason to talk to the parents about urotherapy

– formation of correct urination stereotypes.

Parents are often concerned about their children's attention to their genitals; boys begin to show interest and touch them. Prohibitions and rigidity in this matter can affect psycho-sexual development; parents need to be explained how to react to such behavior. At three years old, they already talk to the doctor not only about assessing the development of organs, but also about the child’s behavior and the attitude of the parents. the examination is carried out in order to identify diseases that may not have manifested themselves in the first three years of life. We need to make sure that the boy is doing well and that he is developing according to his age. At the age of 7, children can already wash themselves; the urologist must explain how to do this correctly, assess whether there are any signs insufficient hygiene, inflammation.

At 12 years old we evaluate sexual development whether or not the child entered puberty. Body hair, genital development, Adam's apple size, etc. are assessed. external signs. If there are signs of the onset of puberty, the doctor should discuss issues related to libido and the sexual sphere, the presence of an erection, and wet dreams. It is important for the child to accept these changes and body reactions as part of a normal, positive process.

At 14 years old there is a re-evaluation, we look at how the child progresses puberty, whether there is a delay in sexual development. 12-14 years old the most common age for debut (varicose veins spermatic cord), it is necessary to exclude this disease.

At 15, 16, 17 years old Dynamic monitoring of the transition period is carried out. This time possible start sexual contacts, therefore the urologist is obliged to talk about issues of contraception, infectious diseases. The changes that occur with teenagers cannot always be discussed with parents. Many young men are concerned about whether everything is in order with their genitals; they mistake completely normal elements that may be present on them, for example, Fordyce granules (small seborrheic cysts or sebaceous glands) or pearly papules. In a conversation with a doctor, fears and incorrect awareness of one’s own body are removed.

Up to the age of 15, children often come to an appointment with their mother or father; examinations are carried out behind a screen, but if there is any pathology, they have to be shown to the parent in order to achieve an understanding of what is happening and how it needs to be treated. It is not always comfortable to discuss these issues with the mother of older boys. That's why I'm in Once again I’m writing about the fact that it is advisable for dads to come with their boys to see the urologist.

Dealing with defects and anomalies of the development of the genitourinary system in boys and girls, treatment of its dysfunction (for example, incontinence problems).

What is the competence of a pediatric urologist?

The competence of a pediatric urologist includes examining the child, collecting anamnesis, prescribing the necessary examination and determining the method of treatment.

A pediatric urologist works with children from 0 to 18 years old who have birth defects, acquired diseases and damage to the urinary and reproductive organs.

What diseases does the Pediatric Urologist treat?

The list of diseases that andrologists deal with most often includes about 45 items: from dropsy and hernia in newborns to sexually transmitted infections in adolescents.

In infants there is often a pathology of the foreskin and penis, in older children - up to 5-6 years - the same hernia and dropsy, sometimes at this age the absence of a testicle is discovered.

In the next 4–6 years, no new diseases appear, only those untreated at an early age remain. Varicoceles are quite common in adolescents ( varicose veins veins of the spermatic cord and testicle) and epididymal cyst. Today, 11.4% of children have one or another pathology of the foreskin.

For example, phimosis in its various manifestations, including a functionally narrow foreskin. There are also various shapes delayed sexual development.

The most common childhood urological diseases:

Hydronephrosis (kidney disease due to obstruction of urine flow), vesicoureteral reflux ( reverse cast urine into the ureter from the bladder), kidney cyst, polycystic kidney disease (replacement of normal kidney tissue with cysts), megaureter (enlargement of the ureter), neurogenic bladder dysfunction, pyelonephritis (inflammation of the kidney), bladder exstrophy (absence of the anterior wall of the bladder and anterior abdominal wall), cystitis (inflammation of the mucous membrane of the bladder).

What organs does a pediatric urologist deal with?

Kidneys, ureters, bladder, urethra, prostate, urethra, testicles, penis, epididymis.

When should you contact a pediatric urologist?

- pain, difficulty urinating, rare or frequent urination;
- identification on ultrasound examination malformations of the genitourinary system;
- detection of an undescended testicle (cryptorchidism);
- swelling of the testicle;
- narrowed urinary opening in boys.

When and what tests should be done

Diseases of the prostate gland (general prostate-specific antigen, free prostate-specific antigen, enderoembryonic antigen).
- Diagnosis of kidney diseases (creatinine in urine, urea in urine, calcium, potassium, sodium, chlorides, inorganic phosphorus, general analysis urine, creatinine, urea).
- Sexual health (hepatitis B, herpes, candidiasis, syphilis).
- Sexual health (scraping study) – Ureaplasma parvum/ Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Gardnerella vaginalis, Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Candida albicans, HPV HCR – genotyping, herpes virus type I-II.

What are the main types of diagnostics usually performed by a pediatric urologist?

Endourethral or transrectal electrical stimulation (ES), consisting of irritation of the biostructures of the prostate with electrical impulses.

Electrical stimulation can be successfully combined with drug therapy, with laser with treatment, with treatment magnetic fields, thermo- and vacuum therapy, ozone therapy.

Laser therapy (quantum therapy) is therapeutic effect on the human body by electromagnetic radiation in the optical range (light); it is successfully used to treat diseases in urology, venereology, and dermatology. Laser treatment is a promising and modern treatment method that improves general state and well-being, microcirculation and blood saturation with oxygen increases.

The IVF method is in vitro fertilization(that is, spent outside the body), representing the pinnacle in the development of reproductive technologies.

The meaning of this technology is to carry out fertilization (fusion of female and male reproductive cells) in a special laboratory incubator.

Diagnosis of the prostate gland.
- Bladder catheterization.
- Bougienage of the urethra
- Needle biopsy.
- Cystomanometry.
- Uroflowmetry.

During infancy, correct hygiene care limited to daily bathing of the child and washing after the baby has emptied. During bathing, water gets under the foreskin, which naturally flushes out accumulated secretions. You should wash your penis and scrotum with soap at least once a week. For this it is better to use baby soap or special children's bathing products.

To avoid urinary tract infections, children should be washed from front to back. For boys, the penis is washed without moving the foreskin. If you still try (on the advice of some doctors) to gradually move the skin of the penis and expose the head, then this procedure should be performed very carefully, without causing the slightest pain to the child. It should be remembered that the area of ​​the glans penis contains a large number of pain nerve endings, and rough manipulation of the penis can lead to mental trauma and fear. Immediately after going to the toilet, the head, as well as the foreskin, should be returned to its place, in order to avoid the development of paraphimosis - pinching of the head in the foreskin.

It is advisable, after birth (in the first week of life), to consult a boy with an andrologist who deals with issues of the male reproductive system, who will examine the child and determine whether he has any pathology or not.

If it is not possible to see an andrologist, the baby should be examined by a urologist or pediatric surgeon. In the future, it is necessary to undergo regular medical examinations, especially during the onset of puberty.

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