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Pediatric Urology Referral Guidelines

 

A pediatric urologist has completed a residency and is certified by the American Board of Urologic Surgery or a national equivalent and has completed additional training in pediatric urology. For purposes of developing these guidelines, the following group definitions are used: infants (0-1 year), child (2-12 years), and adolescent (13-18 years).

      • Undescended testicles and elective congenital hydrocele/hernia are optimally corrected in infancy (6-12 months of age); the operation should be performed by a pediatric urologist or surgical specialist.
      • Hypospadias is usually repaired at 6 months of age; the operation should be perfromed 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 of the kidney, bladder, and testicle should be treated from the outset by a pediatric urologist or surgical specialist in conjunction with a pediatric medical cancer specialist.
      • Intersex (ambiguous genitalia) conditions should be co-managed from the outset by the primary care pediatrician and a pediatric urologist or surgical specialist. The management team should include a pediatric endocrinologist and a psychologist in consultation with the primary care pediatrician and pediatric urologist or surgical specialist.
      • 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.
      • 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 at the nearest medical center and operated on promptly.

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