What parents need to know about UTIs, undescended testicles and other childhood urology issues

When it comes to toilet troubles, your little ones can’t always tell you what’s wrong. Older children might feel embarrassed about things like bedwetting. These situations can be stressful for parents.

Don’t worry. You’re not alone, and it’s rarely anyone’s fault. I always encourage families to contact their pediatrician for guidance; they can help figure out what’s going on and whether a pediatric urologist is needed.

The University of Chicago Medicine Comer Children’s Hospital offers expert urologic care and the latest treatments and techniques, including minimally-invasive robotic surgery.

Here are a few common concerns and what parents should know: 

1. Urinary tract infections (UTIs)

About 2.5% of all children will get a UTI — a bacterial infection in the bladder or kidneys — and they are most common in ages 5 and under, according to the American Urological Association.

These infections require prompt diagnosis and care. Even one UTI in a child less than a year old is significant, and it could signal a kidney abnormality.

UTI symptoms in babies can be difficult to spot. The signs may include:

• Refusal to urinate
• Pungent-smelling urine
• Unexplained fever

Older kids with a UTI might feel burning, see blood in their urine or simply not want to go.

We treat these infections with antibiotics and often do an ultrasound to look for kidney or bladder abnormalities.

For children who don’t have kidney issues, their pediatrician may ask parents to make sure their child is drinking enough water and urinating regularly. Parents should also check that their child is not constipated because stool can put pressure on urine flow.

2. Hypospadias

Hypospadias is a birth condition in males where the urethra (the tube that carries urine out of the body) doesn’t end at the tip of the penis. Instead, it can be located anywhere from below the end of the penis to the scrotum.

It affects about one in 150 infant boys, according to the Centers for Disease Control and Prevention.

Infants with hypospadias may have:

• Trouble urinating
• Underdeveloped foreskin
• Curved penis
• Undescended testicles

Except for those with very mild cases, children with this condition will need surgery, typically before a child starts toilet training.

Depending on the placement of the urethra and severity of the abnormality, surgery may be done all at once, or in stages. Most children will make a full recovery in six to eight weeks after surgery.

3. Vesicoureteral reflux (VUR)

Normally, urine flows from the kidney to the ureters, which carry urine to the bladder.

But vesicoureteral reflux, or VUR, occurs when urine travels in the opposite direction through the ureters — from the bladder into the kidneys. This is either because the child’s ureters are too short or because the bladder doesn’t fully empty.

Left untreated, VUR can cause infections that lead to recurring UTIs, kidney damage and even renal failure.

VUR is rare, occurring in about one to two percent of children, according to the National Kidney Foundation. But for children with UTIs, it’s the common cause behind their infection, with 30% to 40% of children with such an infection also having VUR, a 2024 study found.

Like with UTI prevention, parents can make sure their child is drinking enough water, going to the bathroom regularly and having normal, consistent bowel movements so that stool is not affecting urine flow (a probiotic may be prescribed to help).

Mild VUR cases can improve over time, but serious cases with kidney damage need surgery. Our team uses minimally-invasive robotic techniques with great success.

4. Undescended testicle (cryptorchidism)

Testicles need to be in the scrotum to develop properly.

Undescended testicles are located in the abdomen, which is where they develop during pregnancy. The temperature here, however, is too hot for a testicle to function, and it can lead to infertility and testicular cancer in adulthood.

Undescended testicles are likelier to develop under any of these factors:

• Children born early or at a low birth weight
• Family history of undescended testicles
• Child has another health condition like cerebral palsy
• Child’s mother smoked or drank during pregnancy, or was subjected to secondhand smoke

Undescended testicles are typically diagnosed by physical examination of the child at or soon after birth. We often wait up to six months after birth to see if they descend on their own; otherwise, surgery may be necessary.

5. Bedwetting (nocturnal enuresis)

Bedwetting is common: About 20% of 5-year-olds and 10% of 7-year-olds experience it, according to the American Academy of Child and Adolescent Psychiatry. It affects boys at a higher rate than girls, and it’s more common if one or both parents also wet the bed.

Bedwetting can often be resolved with simple changes, like monitoring fluid intake and going to the bathroom before bed. If a child has issues with their tonsils and adenoids, which can cause sleep apnea, having their tonsils removed may help with bedwetting.

If bedwetting occurs in a child who is 6 years or older, who is having issues with daytime toilet training, or has regressed since being toilet-trained, talk to your doctor. It could be a sign of an underlying stressor or a kidney or urethra abnormality, like VUR.