Category Paediatric Urology

How to find a Paediatric Urologist

Mr Robb - Paediatric Urologist - Operating

How to Find a Paediatric Urologist.

 

Paediatric Urology is a small speciality in the UK.  Not all hospitals provide a Paediatric Urology Service.  This post aims to provide advice on how to find paediatric urologist within the UK.  It is not intended to give details on how to find a pediatric urologist in other countries.

 

Paediatric Urologists are surgeons who manage problems with children’s waterworks and genitalia.

 

To find out more about Paediatric Urology please read my article “What is Paediatric Urology”.

 

So, how do you find a Paediatric Urologist?  There are a number of questions that you should ask:

 

  1. Do I need a Paediatric Urologist?
  2. Does my child have a condition that requires special expertise?
  3. Where is the closest Paediatric Urology Service?
  4. How do I find information about Consultant Paediatric Urologists?

 

 

Do I need a Paediatric Urologist?

 

This may seem like a stupid question as this post is titled "How to find a paediatric urologist."

 

There are some conditions that are also managed by other specialists, such as Paediatric Surgeons or Paediatric Nephrologists.  This may mean that you can be treated closer to home.

 

What other surgeons can operate on children?

 

There are a number of other specialists who operate on Children.

 

Paediatric Surgeons.  Paediatric Surgeons specialise in the surgical management of problems in children.  The majority of Paediatric Urologists originally trained as Paediatric Surgeons before undertaking more training.  There is a lot of cross over in what Paediatric Surgeons and Paediatric Urologists manage.

 

Adult Urologists.  Some Adult urologists also look children.  They tend to look after what is referred to as General Surgery of Childhood. This includes inguinal hernias, hydroceles, undescended testes and foreskin problems.  They may also look some children with UTIs or incontinence.

 

General Surgeons.  There are some Adult General Surgeons who also look after children with General Surgery of Childhood.  In order to look after children Adult General Surgeons will have spent time being trained in looking after children.

 

What other Specialists may be able to look after some of the conditions?

 

For a number of the conditions there are a number of other specialists that may be able to treat the child.

 

Paediatrician (including Community Paediatricians).  These are doctors who look after a child’s medical problems.    They may look after some problems such as urinary tract infections.

 

Paediatric Nephrologists.  These are Paediatricians who have specialised in problems of the kidneys.  They also look after conditions that may effect the kidney, such as Urinary Tract Infections (UTIs) or Vesico-Ureteric Reflux (VUR).

 

 

What Conditions Can be Looked After by Other Specialities?

 

Conditions that are looked after by other specialists include:

 

  • Inguinal Hernias and Hydroceles – As well as Paediatric Urologists, these can be looked after by both Paediatric Surgeons, some Adult Urologists and some General Surgeons.

 

  • Foreskin Problems – Simple foreskin problems such as phimosis may also be managed by Paediatric Surgeons, some Adult Urologists and some General Surgeons. More complicated problems with the foreskin are managed only by Paediatric Urologists.

 

  • Urinary Tract Infections – As well as Paediatric Urologists, some Adult Urologists, Paediatric Nephrologists and some Paediatricians may initially manage children with UTIs. These children may still be referred to a Paediatric Urologist for specialist investigations.

 

  • Incontinence – Like with UTIs, some Adult Urologists, Paediatric Nephrologists and some Paediatricians may also initially manage children with UTIs. These children may still need to be referred to a Paediatric Urologist for specialist investigations.  There are also certain causes of incontinence that will be managed by Paediatric Urologists.

 

  • Haematuria (blood in urine) – The initial investigation of haematuria can be performed by Paediatric Urologists or Paediatric Nephrologists. There are some causes of haematuria that are medical and these are managed by Paediatric Nephrologists.  Others causes are surgical and are looked after by Paediatric Urologists.

 

 

In the NHS there are some regions where GPs will refer children locally to one of these specialists because there is no local Paediatric Urologist.  After the child is seen it may be necessary for the child to be referred to a Paediatric Urologist.  This is called a Tertiary Referral.

 

Even if there is another specialist who can manage the condition, it may not be appropriate for you to see that specialist.  You may still need to see a Paediatric Urologist because of other medical conditions that your child has or because their condition needs more expertise to manage.

 

If you are unsure whether you need a Paediatric Urologist you should talk with your family doctor.

 

Assuming that you do need a Paediatric Urologist then the next question to ask is does My Child Have a Condition that Needs Special Expertise?

 

 

What conditions need special expertise?

 

There are a number of conditions that need special expertise to manage.  This may mean that to get the right treatment you child may require to travel further to see a Paediatric Urologist with the right expertise to look after their condition.

 

Within the UK, some of the conditions that require a Paediatric Urologist with special expertise include:

 

Bladder Exstrophy / Epispadias.  This is a very rare condition where the bladder develops on the outside of the body.  It is managed in only 2 centres in England – Manchester Children’s Centre and Great Ormond Street Hospital for Children.

 

Kidney Stones  Kidney stones in children are rare.  The correct management of stones requires access to a lot of equipment.  This means that not all Paediatric Urology Centres are able to kidney stones in children.  I have patients that travel over 100 miles for me to treat their kidney stones.

 

Disorders of Sex Development (DSD)  To manage children with DSD you need to have a specialist team made up of a number of specialists including Endocrinologists, Psychologists and Paediatric Urologists.  This limits the number of centres that can offer this treatment.

 

Cloaca  A cloaca is a condition found in girls where the pee tube, the vagina and rectum join together and come out as a single perineal opening (opening between the legs.)  This condition is managed by a specialist Paediatric Urologist and Paediatric Surgeon who operate together.

 

Many of these problems will be diagnosed by a neonatologist (doctor specialising in the treatment of newborn babies) or another specialist.  They will often not be an expert in the management of the condition.  They will, however, know someone who can treat it.  They will be able to give you advice on which centre or who you need to see.

 

 

Where is my closest Paediatric Urology Unit?

 

The Specialist Paediatric Urology Centres in the UK and Ireland are shown below, along with links to their respective websites.  Just click on the marker to access the details.

 

A number of centres also have outreach services.  This means that the Children's Urologists go out to District General Hospitals (DGHs) in their catchment area and do clinics.  Sometimes they also operate in these hospitals.  Outreach clinics mean that patients do not need to travel as far to see a Paediatric Urologist.

Paediatric Urology departments often have Urodynamics Nurses.  Urodynamics Nurses are equally as important in managing patients, but have different expertise.  Their roles may include:

  • Performing investigations such as bladder assessments and flow rates.
  • Video urodynamics.
  • Providing Education for patients about conditions and surgery
  • Teaching patients Clean Intermittent Catheterisation and giving them support
  • Providing Post Operative Care for patients.
  • Running some clinics - such as Nurse Led Wetting Clinics.

Some consultants also have a Private Practice and see patients at other hospitals.

 

How do I find Information about the Consultant Paediatric Urologists?

There are a number of ways that you can find out information about which consultants work in your closest Paediatric Urology Centre.  The easiest way to find this information is to search on the Hospital Website.  This will normally list the consultants working in that centre.  As an example click here to see the list of Consultants in the Paediatric Surgery & Urology Department at Birmingham Children's Hospital.

There are other places that you can look for more information.  These include:

British Association of Paediatric Surgeons (BAPS) Website.

British Association of Paediatric Urologists (BAPU) Website.

British Association of Urological Surgeons (BAUS) Website.

 

If you are wanting to find a Paediatric Urologist to see privately then there are other places to search for information.

Some Insurance Companies, such as BUPA hold a list of recognised consultants.  click here to see the list of Paediatric Urologists registered with BUPA.

Private Hospitals will have a list of Consultants which will allow you to search for Paediatric Urologists.  As many hospitals are owned by larger companies such as BMI or Spire, you can search via the company website.  Unfortunately these hospitals do not tend to have Paediatric Urology as a speciality - as it is not common.  You often have to search under Paediatrics to find the Paediatric Urologists.  Click here to open the Spire and BMI consultant lists in a new tab.

TopDoctors - This site holds a list of doctors, along with useful information about conditions they manage.

 

Many of us have sub-sub-speciality interests.  This means that although we are sub specialists as Paediatric Urologists, we have areas of special expertise.  For example I have a special interest in kidney stones and with bladder problems.  Not all of my colleagues manage kidney stones for example.  It also means there are some conditions, such as DSD that I will ask my colleagues to take over.  This is because I am not an expert in managing patients with DSD.   When I or any of my colleagues receive a referral that we feel would be better looked after by someone with a special interest, we will refer the patient to our colleague.

Why is this important?  For most common conditions, Paediatric Urologists are able to see and manage children.  You may however want to find someone who has special expertise in your child's condition.  Information about special interests or expertise should be available on their web profile.

It is also important to remember that in large Paediatric Urology Centres, such as Birmingham or GOS, Paediatric Urologists may have more opportunity to specialise and have more experience with some complex procedures.  This does not necessarily mean they are better.

 

So, How Do I Find a Paediatric Urologist?

After working out that you need to see a Paediatric Urologist, there are a large number of ways to find out information about who practices locally.

There are very few conditions that need specialist expertise to be managed.  If your child has one of these issues then you should talk with your paediatrician or neonatologist.  They will be able to guide you.

Most often the best thing to do is to use the map above to find your closest Paediatric Urology Centre.  You can then find out who the Paediatric Urologists are in that centre.

I hope that this guide will help you find a suitable specialist.

 

What is Paediatric Urology?

Paediatric Urology Patient

What is Paediatric Urology?

Paediatric Urology is the Surgical Specialty that deals with problems with the genitourinary system in children.

The genitourinary system is made up of the Kidneys, Ureters (tubes that run between the kidney and the bladder), the Bladder and the Urethra (pee tube), as well as the genitalia in boys and girls.

 

What conditions are managed by a Paediatric Urologist?

Paediatric Urologists are experts at managing a wide range of problems, including:

Inguinal Hernias and Hydroceles - These are very common findings in young people.

Undescended Testicles - The testicle develops inside the tummy and then comes down to the scrotum.  If it does not come down properly then this needs to be assessed and treated.

Foreskin Problems (eg non retractile foreskin) - Consultations for foreskin problems are very common.  It may be that the child has a non retractile foreskin - this can be normal or it can be caused by a disease or trauma in which case it needs treatment.  It may be that there is a hooded foreskin and a Paediatric Urologist will discuss the possible treatments for this.

Problems with the penis (e.g. Hypospadias) - A major part of Paediatric Urology is managing congenital problems with the penis.  This includes hypospadias (where the pee tube doesn’t open in the right place) or a buried penis.  Paediatric Urologists are experts in how to manage these problems.

Hydronephrosis - this is a condition where there is fluid on the kidney and causes the kidney to be dilated.  There are a number of reasons why a kidney can be swollen with a hydronephrosis.  A Paediatric Urologist can investigate the cause and discuss what (if any) treatment options there are.

Duplex Kidneys - A duplex kidney is formed during development of the kidney before a baby is born.  Effectively there are 2 separate working parts to the kidney, instead of one.

Pelvic Kidney - This is a condition where the kidney is found in the pelvis.  It is caused during development of a baby.

Renal Cysts

Developmental Abnormalities of the Kidney

Multicystic Dysplastic Kidney (MCDK) - This is a condition where a kidney has not developed properly, and does not work.

Vesico-Ureteric Reflux (VUR) - In this condition urine goes from the bladder up to the kidney and can cause kidney damage.  Normally there is a valve that stops urine going back up the ureter.

Hydroureter - This describes where the ureter (tube between the kidney and the bladder) is swollen.  It can occur for a number of reasons (e.g. Vesico-ureteric reflux or narrowing where the ureter joins the bladder).  A Paediatric Urologist can investigate, diagnose and offer treatment.

Kidney stones - Just like with adults children can develop kidney stones.  There are a number of treatments that can be used to treat kidney stones.

Urinary Incontinence and Overactive bladder - The way the bladder works can have a major consequences for quality of life.  This can affects the child and the family.  A major part of paediatric urology is to assess the way the bladder is working and to support children to control the bladder.  There are some surgical options for managing functional bladder problems, but the majority of patients are managed without any surgery.   Paediatric urologists can perform Urodynamics Tests in order to accurately diagnose what is wrong with the bladder.

Bed Wetting 

Urinary Tract Infections (UTI) - Many UTIs are due to the way the bladder works in young people.  This is especially true for children with recurrent UTIs.

Neuropathic Bladder - In some young people with problems with the spinal cord (such as Spina Bifida or MS) the way the bladder works is affected.  This is called a Neuropathic Bladder.  As well as the bladder the bowel can also be affected.  A Paediatric Urologist should be involved with the care of all patients with a neuropathic bladder.  Initially they ensure that the kidneys are safe.  In the long term they will help the young person become clean, dry and independent.

Posterior Urethral Valves - This is the commonest cause of Bladder Outlet Obstruction (blockage to urine leaving the bladder).  It can cause life long issues with the kidneys and the bladder.  A Paediatric Urologist will look after young people with Posterior Urethral Valves throughout their childhood.

Narrowing of the pee tube (urethral Strictures)

Haematuria (Blood in the urine) - Haematuria is a symptom.  It is not a diagnosis.  A number of causes of Haematuria will be managed by a Paediatric Urologist.  They tend to be the cases where the blood can be seen in the urine.

As well as these common conditions there are some other things that Paediatric Urologists manage including:

  • Traumatic injury to the genitourinary tract
  • Cancers of the Genitourinary tract
  • Some rare congenital problems such as Cloaca or Bladder Exstrophy
  • Kidney Transplants
  • Antenatal Counseling

Further information can be found on my Clinical Conditions page.

 

How is Paediatric Urology Organised in the UK?

Some Adult Urologists will see children with urology problems, such as undescended testes and foreskin problems.  Any child with a more complex issue will often be referred to a specialist Paediatric Urologist.

Paediatric Urology is a very small specialty in the UK and Ireland.  There are about 40 Paediatric Urologists who are dedicated to looking after children.   All Paediatric Urology Consultants in the UK have trained as either a Paediatric Surgeon or an Adult Urologist.  They have then spent more time training to specialise and become Paediatric Urologists.  (see below for more information on training)

In the UK Paediatric Urology is provided in a limited number of centres.  All the centres also Provide Paediatric Surgery.  Specialist Paediatric Urology services are located in the following cities:

  • Aberdeen
  • Edinburgh
  • Glasgow
  • Newcastle
  • Leeds
  • Hull
  • Manchester
  • Liverpool
  • Sheffield
  • Nottingham
  • Birmingham
  • Bristol
  • Leicester
  • Oxford
  • Cardiff
  • Cambridge
  • Norwich
  • London
  • Brighton
  • Southampton
  • Belfast
  • Dublin

Whilst some centres have Paediatric Surgeons who have an interest in Paediatric Urology (such as in Addenbrooke’s Hospital, Cambridge), some of the centres have dedicated Paediatric Urology services where the team concentrates solely on Paediatric Urology (such as in Birmingham Children’s Hospital).

Some centres provide what are referred to as supra-regional services.  These are services  which manage patients with certain conditions that came from outside their normal catchment area.  For example, Manchester Children’s Hospital and Great Ormond Street Hospital are the only 2 centres in England which manage Bladder Exstrophy and Epispadias.

 

What training does a Paediatric Urologist Have?

Paediatric Urologists have sub specialised in Paediatric Urology.  All UK consultants in Paediatric Urology have completed their training as either a Paedatric Surgeon or an Adult Urologist.  They then spend further time training in Paediatric Urology.  The majority of Paediatric Urologists have trained as Paediatric Surgeons.

The typical training that a UK medical school graduate has to go through in order to become a Paediatric Surgeon and then a paediatric urologist, may look something like this.

5 years Medical School

2 years Foundation Training
This is where the person has graduated as a doctor and is learning on the ward.  They will work in a number of different specialties in this time.  The specialities may include surgery, medicine, general practice.  In their second year they may spend time in Paediatrics.  All Foundation doctors are closely supervised.  In order to progress in their training they need to prove that they have acquired a number of core skills and abilities.

2 Years Core Training

To get into Core Training, the doctor has to compete against other doctors.  The Core Training Program lasts for 2 years.  They will spend time in a number of surgical specialities.  If they want to train in Paediatric surgery, they will need to complete at least 6 months in Paediatric Surgery.  During this time the doctor has to:

  • Gain a number of key skills and abilities in order to complete the Core Training Program
  • Complete a number of courses
  • Pass their Membership Exam for a Surgical College (e.g. Royal College of Surgeons of Edinburgh.)

During the second year of their Core Training, they can apply for a National Training Number (NTN) in Paediatric Surgery.  In the UK there are around 10 - 15 training posts per year.  Around 60 - 70 doctors apply for these posts.  It is very rare for a doctor to be awarded an NTN as a Core Trainee.  In most cases the doctor spends an additional 1 or 2 years gaining further experience in areas such as Paediatric Surgery, Neonatology or Paediatric Intensive Care.

Some Doctors spend between 1 - 3 years doing research during their training.  The research time maybe taken at any time before the doctor becomes a consultant surgeon.  Many surgeons continue to have a research interest when they become consultants.

6 Years - Higher Surgical Training

Whenever a doctor is awarded a National Training Number (NTN) they enter Higher Surgical Training.  This lasts for a minimum of 6 years.  This is where the doctor specialises in Paediatric Surgery.  They are trained to perform investigations and operations. They also learn how to manage the conditions that they will be treating.

There are very strict guidelines about how they are trained.  There are a number of operations that trainees must show they can do by the end of training.   There are a number of other requirements that must be fulfilled in order to successfully complete their training.  Once a trainee completes training, they will be awarded as Certificate of Completion of Training by the GMC.  This allows the doctor to be added to the Specialist Register for Paediatric Surgery.  The standards are overseen by a body called the Paediatric Surgery SAC (Specialist Advisory Committee) and the JCST (Joint Committee on Surgical Training) - a body that oversees the SAC.

NHS Consultants must be on the GMC’s Specialist Register for their speciality.

A Paediatric Surgical Trainee must successfully pass the Intercollegiate Exam in Paediatric Surgery in order to complete  their training.  This exam is taken in the last 2 years of their training.  It tests their knowledge and ability to manage patients.  The exam consists of 2 parts.  The first part is a ‘written paper’ which test knowledge of Paediatric surgery.  The second part is made up of a clinical exam and a viva exam.  In the clinical exam, the candidate sees and exams patients.  They ares tested on how they would manage them.  For the viva, the candidates are questioned by experienced consultants.  They can be questioned on any topic in the Paediatric Surgery Syllabus.  The standard to pass this exam is high.  This means that only people who are knowledgable enough to become a consultant pass it.  If a trainee fails the exam too many times they may not be able to complete their training.

2 Years - Paediatric Urology Fellowship

To become a Paediatric Urologist, a Paediatric Surgeon needs to complete a 2 year dedicated Fellowship.

There are a number of nationally recognised fellowship posts in the UK (4 in London, 1 in Birmingham, 1 in Manchester, 1 in Nottingham, 1 in Leeds).  Fellowships are awarded with competitive entry.

There are national training guidelines, which have been developed by British Association of Paediatric Urologists. The guidelines lay out the requirements for these fellowship posts.  The fellows progress is reviewed yearly.  This ensures they are getting adequate training.

After successfully completing a fellowship it is then possible to apply for a Consultant's post.  It often takes around 18 - 20 years of training (including Medical School) to reach this point.

What happens after becoming a consultant?

Learning does not stop when a doctor becomes a consultant.

Most Paediatric Urologists spend time developing expertise in certain areas of Paediatric Urology - eg reconstructive urology, key hole surgery etc.

All consultants are appraised every year.  This ensures that they are continuing to develop their practice.  They are appraised by a peer in order to highlight any issues with outcomes.

Most consultants in the UK are members of British Association of Paediatric Urologists (BAPU).  BAPU provides a forum for ongoing education, research and support.  BAPU has an annual meeting in September every year and the majority of consultant Paediatric Urologists attend this meeting.

There are other meetings that the consultants may also attend such as:

Many paediatric urologists have a very busy NHS practice.  They tend to have longer waiting lists than their Paediatric Surgical Colleagues.  This can make it difficult to access a Paediatric Urology Service, and can be frustrating for patients.

In Summary

Paediatric Urology is a specialty that looks after a wide range of conditions by specialists that have spent a long time training.  It can be hard to know how to access a paediatric urologist and I will write an article about How to See a Paediatric Urologist in the near future.

 

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