Urologic Problems in Childhood*

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The problems presented by diseases of the urinary tract in children have a right, I think, to be segregated from the other problems with which the urologist is confronted, not only because these diseases in childhood differ in many respects from those in adults, but also because attention is thus directed to lesions in the urinary tract in children which are all too often overlooked. Many phases of urinary diseases in children might be discussed, but I have chosen to emphasize certain problems relating to the upper urinary tract.

Urologic diagnosis in infants and young children is rendered more difficult because of the impossibility of eliciting subjective symptoms accurately and because physical examination is so often unsatisfactory. The diagnostic methods, however, differ in no way from those employed in adults, and roentgenologic examinations play a major role in all cases. Every child who is suspected of having some disease of the urinary tract should have a preliminary stereoroentgenogram of the kidneys, ureters, and bladder, followed by additional studies according to the individual indications.

When intravenous urography was introduced it was hoped that this would solve the problem of urologic diagnosis in children, but it has not completely met these expectations. Although it is employed more or less routinely as a preliminary investigation, it has been, on the whole, rather disappointing as regards final diagnosis and in many instances it has been necessary to resort to cystoscopy and retrograde pyelography before any final decision could be reached. This experience is supported. . .



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