Does your baby have any congenital urinary problems? (Congenital Urinary Abnormalities) Let's talk about this!

Oh, does your little one feel like there's something strange when he urinates ? Sometimes doctors tell us through scans before the baby is born that there are small changes in the baby's urinary system. It's normal to feel scared when you hear this. But don't worry, let's talk about this simply. Today we'll look at what these conditions are, why they happen, how to detect them, and how to treat them.

What are these 'congenital urinary system abnormalities'?

Simply put, congenital urinary abnormalities are changes or defects in your baby's urinary system and sometimes the genitourinary systems that are present at birth, meaning they occur while the baby is still developing in the womb. These are also called congenital urinary anomalies.

The organs that can be mainly affected by these conditions are:

• Kidneys: As you know, the two kidneys in our body filter the salt, water, toxins, and waste products from the blood and produce urine . Most people have two kidneys.
• Urinary bladder: This is the elastic sac-like organ that stores urine .
• Ureters: These are the two muscular tubes that carry urine from the kidneys to the bladder.

What are the most common abnormalities?

There are several types of such abnormalities. Let's look at a few of them:

• Hydronephrosis: This is when one or both kidneys become swollen. Imagine that something is blocking the path of urine from the kidneys to the bladder, causing the urine inside the kidneys to fill up and swell. It's like a water pipe getting clogged and filling up with water.
• Undescended testicles (cryptorchidism): Normally, a baby boy's testicles develop inside the abdomen while he is still in the womb. They then gradually descend into the scrotum, the sac where the testicles are located. However, some babies have one or both of these testicles that have not descended into the scrotum for some time after birth.
• Hypospadias: This is also a condition that affects male babies. The opening in the urethra, the tube through which urine and sperm exit, should be at the tip of the penis. However, in this case, the opening is located somewhere else on the underside of the penis.
• Spina bifida: This is a slightly more complicated condition. It occurs when the brain, spinal cord, and/or the protective membranes around the spinal cord (meninges) do not fully develop while the baby is developing in the womb. In severe cases, this can cause partial or complete paralysis. It can also cause neurogenic bladder and other problems.
• Vesicoureteral reflux (VUR):Normally, urine travels from the kidneys through the ureters to the bladder, and then out through the urethra. However, in this condition (VUR), the urine in the bladder flows back up through the ureters, sometimes back into the kidneys.
• Bladder exstrophy: This is a very rare condition. In this condition, the baby's bladder develops in a way that the inside is exposed, meaning that the inside is exposed. The baby then urinates through an opening in the lower abdomen, rather than through the urethra.
• Prune belly syndrome (Eagle-Barrett syndrome): This is also a very rare condition. The main symptom of this is the weakening or loss of the abdominal muscles, which makes the stomach look like a dried plum. Along with this, the testicles may descend and disappear, and there may be other abnormalities in the urinary system.
• Posterior urethral valve (PUV): This condition affects male babies. An extra flap (valve) at the back of the urethra blocks the flow of urine. This can cause urine to back up into the bladder, causing it to swell. This can damage the urethra and kidneys.

What are the most common situations?

Undescended testicles are the most common urinary tract abnormality in boys.

Vesicoureteral reflux (VUR) is a common condition among girls.

What are the symptoms of these abnormalities?

This varies depending on the type of abnormality. In some cases, there may be no pain or visible signs. In these cases, a doctor can only detect these through tests such as scans. However, here are some of the most common symptoms:

• Pain in the side, abdomen, or back.
• Burning or pain when urinating (dysuria).
• Urinary diversion , or a weak urine stream.
• Passing more or less urine than normal.
• Blood in the urine (hematuria).
• Nausea and vomiting .
• Hernia .
• Frequent occurrence of urinary tract infections (UTIs).
• The baby is not growing up as healthy as expected.

Why is this happening? What are the reasons for this?

It's really hard to pinpoint a single cause for this. It's a bit complicated. Most of the time, these urinary system abnormalities are caused by a combination of both environmental factors and genetic mutations .

Environmental factors that can affect are:

• My mother has diabetes .
• Deficiency of certain vitamins and minerals, such as folate and iron, during pregnancy.
• Some medications that the mother takes (for example, some medications for epilepsy) can adversely affect the kidneys.

The main genetic mutations associated with these abnormalities are the genes PAX2 and HNF1B. These genes help the kidneys, urinary system, and other tissues form during fetal development.

Who is most affected by these conditions?

Generally, if someone in the family (biologically related) has had kidney or urinary system problems before , the baby is slightly more likely to have this type of congenital urinary system abnormality.

How do you find these? How to diagnose the disease?

Most of the time, doctors find these congenital urinary abnormalities during prenatal ultrasounds . You know, these scans check the health and development of the baby. They can also detect things like oligohydramnios, which is the lack of amniotic fluid around the baby. Usually, after about 20 weeks of pregnancy, most of this amniotic fluid is urine . So, if there is not enough amniotic fluid, doctors suspect that there is something wrong with the baby's urinary system.

If for some reason this cannot be detected before the baby is born, a doctor may suspect this after the baby is born or based on the symptoms the baby shows during childhood. Then, various tests are performed to confirm this condition. These tests are:

• Ultrasound scan: This is a painless test that uses sound waves to take pictures or videos of organs and tissues inside the body.
• Urinalysis / urine test: This can confirm things like whether there is a urinary tract infection.
• Blood tests: These can check things like how well the kidneys are filtering blood (estimated glomerular filtration rate - eGFR).
• CT scan (CT / computed tomography scan): This is also a painless test. It takes many X-rays in a row to create detailed pictures of the bones and tissues inside the body.
• MRI Scan (MRI / Magnetic resonance imaging): This is also a painless test. It uses a magnet, radio waves, and a computer to take detailed pictures of organs and things inside the body.
• Voiding cystourethrogram (VCUG): This is a special test that takes detailed pictures of the bladder while it is filling and emptying after urination .
• Renal scan: This is a nuclear medicine imaging procedure that uses a small amount of radioactive material to take detailed pictures of the kidneys.
• Urodynamic testing: This involves inserting a device, such as a catheter, to see how well the bladder is working.

How is this treated?

The type of treatment depends on the type of abnormality the baby has. Some conditions may not require any treatment. Other conditions may require different treatments. For example:

• Antibiotics (if there is an infection)
• Dialysis (when the kidneys are not working properly)
• Kidney transplant ( if kidney failure occurs)

Your baby's medical team will review your baby's complete medical history, thoroughly assess their current condition, and develop the best and most appropriate health plan for your baby.

Are there ways to prevent these situations?

To be honest, it's impossible to prevent all of these urinary tract abnormalities. However, having a healthy pregnancy can help reduce your risk to some extent. That means:

• See a doctor on time, get advice, and attend scheduled clinics.
• Talk to your doctor about the medications and vitamins you are currently taking.
• Take a prenatal vitamin that contains at least 400 micrograms of folic acid every day.
• Do not use alcohol, tobacco, or any drugs not prescribed by a doctor.

What happens if my baby has a congenital urinary tract problem like this? What will the future hold?

This really depends on the type of urinary abnormality your baby has and how severe the symptoms are. Some children may need regular medical care for the rest of their lives. But don't worry , your baby's medical team will work with you to create a personalized plan to help your baby stay safe, healthy, and as independent as possible.

As a baby grows, reaches puberty, and enters adolescence, some health and quality of life issues may arise. For example:

• Difficulty controlling urine and stool (urinary and bowel incontinence).
• Frequent urinary tract infections (UTIs).
• Damage to the bladder, kidneys, and/or urinary tract.
• Severe kidney damage can lead to kidney failure. In that case, dialysis or a kidney transplant may be necessary.
• This condition can affect the function and appearance of their genitals, which can affect their ability to have children in the future.

These congenital urinary system abnormalities can affect your baby emotionally and socially (how others see him, how he thinks about himself, etc.), but your medical team can provide support for all of this, helping your baby transition into adulthood as stress-free as possible.

When should I take my baby to the doctor? What to do in an emergency?

It's important to schedule regular appointments with your baby's doctor. They will monitor your baby throughout infancy, childhood, adolescence, and adulthood.

If your baby has a urinary tract abnormality and shows any of the following symptoms, go to the nearest hospital emergency department immediately :

• If you suddenly experience unbearable pain in your stomach, back, or side.
• If you have a fever higher than 100.5 degrees Fahrenheit (38 degrees Celsius).
• If you notice a change in the way you urinate (e.g., passing more or less urine than usual, not being able to urinate at all, feeling pain when urinating , passing blood in the urine ).

What are the important questions to ask the doctor?

Don't forget to ask these questions when you visit your baby's doctor:

• "What exactly is the congenital urinary system abnormality my baby has?"
• "How will this situation affect his life in the future?"
• "Is my baby at increased risk of other health problems because of this condition?"
• "Does my baby need treatment?"
• "So, what is the best treatment?"
• "What complications should I be especially aware of?"
• "What are the long-term effects of this condition on my baby?"

The most important things we need to remember

One of the biggest fears of many parents is that their unborn child or newborn baby will develop a disease or condition that could affect their life. These congenital urinary tract abnormalities are similar, and they can occur while the baby is developing in the womb or right after birth. Many of these conditions cannot be completely prevented. However, by having a healthy pregnancy,(That is, eating a nutritious diet, taking vitamins recommended by doctors, staying away from harmful things, and attending medical consultations and clinics on time) can reduce the risk of such conditions to some extent.

If you find out that your baby has a urinary tract abnormality, don't panic . The medical team will create a treatment plan that is specific to your baby and works best for him or her. They know how challenging and stressful this can be for you as a parent. That's why they are ready to explain to you the tests and treatments your baby will need, and answer any questions you may have. The most important thing you can do at this time is to follow your doctor's instructions carefully and trust your doctor.

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