Urology

• Seattle Children’s is known worldwide for our research and skill in caring for children with bladder exstrophyand is named a Center of Excellence in the treatment of bladder exstrophy and cloacal exstrophy by the Association for the Bladder Exstrophy Community (A-BE-C). We are the region’s only referral center for patients born with bladder exstrophy.
• Our Differences in Sex Development Program is named a Center of Excellence by the National Institutes of Health (NIH).

• Our dedicated team at Seattle Children’s includes pediatric urologists, advanced practice providers, nurses and social workers. We care for babies, children and teens.
• To make sure your child gets complete care, we work closely with other specialties. Your child’s team may include experts in reconstructive pelvic medicine, nephrology, endocrinology, genetics and infectious disease. Together with you, we decide the best treatment plan for your child.
• By combining the knowledge and skills of experts from many specialties, we give your child care to improve their quality of life, not just meet their medical needs.
• When your child needs to see several specialists, we work to schedule those appointments on the same day.
• Our program is a national leader in caring for children, adolescents and teens with complex pelvic conditions.

• A complete team cares for your child to meet both their early and long-term needs. We provide the right treatment for your child at the right time, from birth until age 21.
• Care starts before birth if your baby is diagnosed by an ultrasound during pregnancy. Finding problems early in pregnancy gives you more time to make decisions and plan care. Learn how our Fetal Care and Treatment Center can help.
• Children don’t react to illness, pain, surgery or medicine in the same way as adults. They need – and deserve – care designed just for them. We offer educational, social and emotional support that fits your child’s or teen’s needs.
• Many of our patients come to us as newborns. We also treat many older children, including children who have had surgery somewhere else. We provide second opinions, too.

• Seattle Children’s surgeons have done more robot-assisted procedures for children than any other surgeons in the region. Because of our expertise, we can use the robot for a wide range of surgeries and with young children as well as teens. We use robotic surgery to repair blocked kidneys, stop backflow of urine into the kidneys, do bladder surgery and rebuild parts of the urinary tract.
• Our method of repairing bladder exstrophy with a single surgery was developed by Dr. Michael Mitchell, former chief of pediatric urology at Seattle Children’s. It allows surgeons to correct the condition in one stage instead of requiring 3 surgeries over several years. We use one-stage repair to give your child the best results for a better quality of life.
• We provide compassionate, evidence-based care for children with differences in sex development (DSDs). Some children need urgent care after birth to treat a condition that threatens their life or health. Other treatments can be safely delayed so a child has time to express their gender identity and be actively involved in choosing treatment options.

• We take time to explain your child’s condition and answer all your questions. We help you fully understand your treatment options and make choices that are right for your family.
• Our doctors, nurses, child life specialists and social workers help your child and your family through the challenges of your child’s condition. We connect you to community resources and support groups. We can also connect you and your child with other families dealing with similar conditions.
• At Seattle Children’s, we work with many children and families from around the Northwest and beyond. We can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

• Improve robot-assisted surgery. We track the results of robotic surgery in children so we can improve techniques. 
• Protect fertility in cancer patients. Dr. Margarett Shnorhavorian leads a study to learn more about how chemotherapy affects male fertility. Her goal is to identify boys at high risk of losing their fertility so they can take steps to protect it before treatment.
• Understand how diet affects kidney stones. Dr. Jonathan Ellison studies the bacteria in the digestive systems (microbiome) of children with a history of kidney stones. He looks at how the microbiome changes when kids eat diets designed to prevent kidney stones.
• Improve doctor-patient communication. Dr. Kathleen Kieran looks at ways to teach urology residents to communicate better. She also studies how conversations change when an interpreter takes part.
• Provide evidence-based care. Dr. Paul Merguerian leads efforts to create clinical pathways to provide care the best way, the same way, to every child with a specific condition. The team is creating clinical pathways for a broad range of conditions, based on scientific research and expert opinion.
• Train surgeons worldwide. A Seattle Children’s pediatric urologist, Dr. Rich Grady, started efforts to teach surgeons in other countries to repair bladder exstrophy with a single surgery. The procedure was developed here at Seattle Children’s. Dr. Grady has passed away, but the work continues.
• Take part in numerous international cohorts pioneering research and improving outcomes for complex urological conditions.
• Research and design new treatments, share them with patients and introduce them into clinical practice.

Many children wet the bed. Most outgrow bedwetting by the time they are about 7 years old. If your child is older and wets the bed more than once in a while, you may want to check with your doctor. Sometimes the cause is a urinary tract infection, diabetes or nerve problems. Often the cause is not known. A night training program helps many children. Learn more about bedwetting. (PDF) (Spanish)

Bladder exstrophy is a bladder that is not formed right. In most cases, the bladder and genitals are split in half, are turned inside out and sit outside the body. Seattle Children’s pioneered repairing this condition with a single surgery. There are many kinds of exstrophy. A less severe form (epispadias) affects the tube that carries urine from the bladder to the outside of the body (urethra). A more severe form (cloacal exstrophy) affects the urethra, bladder, genitals and bowel. The Association for the Bladder Exstrophy Community (A-BE-C) has named our program a Center of Excellence. Read more.

Congenital adrenal hyperplasia (CAH) is a group of conditions that affect your child’s adrenal glands and hormone levels. In some children, CAH affects how their genitals look and work. Sometimes this means they need or want surgery. Seattle Children’s has a team of doctors and surgeons, including urologists, to care for children with CAH and provide a full range of treatment options. Read more.

Daytime incontinence refers to wetting accidents after a child has gone through toilet training. Causes include waiting until the last minute to go to the bathroom, not peeing often enough during the day or not emptying their bladder all the way. Daytime Wetting (PDF), (Spanish) (PDF)

DSDs are medical conditions that affect how the genitals form. Some of these conditions are called “intersex.” In some children, their genitals do not look typical of a boy or a girl. In other children, there is a mismatch between their sex chromosomes and their genitals. Sometimes a child’s external genitals (penis or vulva) may not match with their internal genitals (testes or ovaries). The causes may be changes in genes or chromosomes or problems with hormones. Sometimes there is a problem with how the testicles or ovaries develop before birth. Read more.

This rare birth defect affects the opening of the tube that drains urine from the body (urethra). The malformation varies from child to child. In boys with epispadias, the urethra opening usually is on the top or side of the penis rather than the tip. In girls, the opening is usually between the clitoris and the labia or in the belly.

Hernias occur when part of the intestine or other tissue bulges through a weak spot in the belly. A hernia is not an emergency unless the tissue or intestine becomes trapped, which can cut off blood supply. This is called incarceration and needs medical attention right away. Read about our Hernia Program.

A hydrocele (HY-druh-seel) happens when fluid collects in the tissue surrounding the testicles. Hydroceles may cause swelling in the sac around the testicles (scrotum). The condition usually causes no pain. Some boys need surgery to correct it. Read more.

Hydronephrosis (hy-dro-ne-FROH-sis) is when one or both kidneys get bigger because pee (urine) backs up or is blocked. The condition can make it more likely that your child will get urinary tract infections. Sometimes doctors prescribe low doses of antibiotics to prevent infection. Read more. (PDF)

Hypospadias (hi-poe-SPAY-dee-us) happens when the opening of the penis is not at the very tip, but somewhere along the underside. Read more. (PDF)

Kidney stones form when minerals and other solid materials normally found in pee (urine) clump together. Larger stones can be very painful when they block the kidney or the tubes that carry urine. Although kidney stones most often affect adults, the rate in children has increased over the past 10 years. Read more. (PDF)

In neurogenic bladder, a child’s bladder does not empty properly due to damage to part of their nervous system. Depending on the cause, your child may not be able to control urination (incontinence) or may have trouble emptying their bladder completely.

A condition where 1 or both testicles do not move down into the sac below the penis (scrotum) before birth. Most undescended testes move down on their own by the time a baby is 6 months old. If they do not move into the scrotum by the time your child is 6 months old, see a doctor with training in problems affecting the genitals and urinary tract (urologist). See Undescended Testicles (PDF) (Amharic) (Russian) (Spanish) (Vietnamese).

Urinary tract infections (UTIs) are common in children. They occur when bacteria get into the urinary tract and infect the bladder, urethra, kidneys or the tubes that connect the bladder to the kidneys (ureters). Some signs of UTI are fever, pain when peeing, pain in the belly or pelvic area, nausea and vomiting, frequent urination and changes in the look or smell of urine. Read tips to avoid UTIs (PDF). Learn more about UTIs in females.

In vesicoureteral reflux, urine travels backward: from the bladder to the kidney instead of from the kidney to the bladder. This increases the chance of kidney infections. This condition is also called urinary reflux (PDF).

Voiding dysfunction means your child is not emptying their bladder normally. There are many types of voiding dysfunctions. For example, children may wait too long to pee (urinate), pee too often, dribble urine or have wetting accidents during the day or the night.

Our Bladder and Bowel Health Program diagnoses and cares for children and teens who have problems controlling their bladder or bowels. These are often called voiding or stooling disorders. Learn more.

Seattle Children’s is a Center of Excellence and Level 1 Comprehensive Care Center for congenital adrenal hyperplasia (CAH). Children with CAH need treatment with hormones to balance the levels their bodies do or don’t make. Some also want or need surgery if CAH affected how their genitals formed. We consult with families about surgery and how to make decisions on whether or when to have it. For families who choose surgery, our experienced urologists perform the operations. Learn more about our CAH Program.

We diagnose and care for babies, children and teens who have conditions that affect genital development. These include conditions where their genitals do not look typical of a boy or a girl or where their genitals do not match with their sex chromosomes. These are sometimes called intersex conditions. The National Institutes of Health has named our program a Center of Excellence. Learn more about the DSD program.

Our Kidney Stones Clinic is the only program in Washington state to focus on diagnosing and treating children and teens with kidney stones. We help get rid of stones your child has now. We also work with you and your child to prevent new ones. Your child can be seen by their entire health team in the same room, at the same time, to get complete care. Our team includes a dietitian plus doctors and nurses with special training in treating the kidneys (nephrology) and the urinary tract (urology). Read more.

Experts in many medical areas work together to care for children with a condition called myelomeningocele that can affect how the bladder and bowel work. If your child has special needs, we work with them to reach their full potential. We consider your family’s concerns, as well as those of your child’s doctor, schools and community services, when planning your child’s care. Learn about our Neurodevelopmental team.

The Reconstructive Pelvic Medicine Clinic treats children with problems affecting the pelvic area, including bladder exstrophy. The pelvic area includes the urinary tract, intestines, anus, rectum, and genitals. Children may have problems with the way these parts work because of how the parts formed before birth or because of an illness or injury that happened later. Learn more about Reconstructive Pelvic Medicine.

Some common urologic conditions may be treated successfully at home. Learn more about resources including videos, support groups and useful links.

Seattle Children's ofrece un servicio inclusivo de Urología en español con proveedores de atención médica bilingües que ven pacientes y crear resúmenes de la visita en inglés y español. El Dr. Nicolás Fernández, atiende en la sede central del hospital en Seattle y también en la Clínica y Centro de Cirugía de Bellevue. Atiende bebés, niños y adolescentes con afecciones comunes y complejas que afectan el sistema urinario o genital. Entre las más comunes: testículos no descendidos, hipospadias, hidronefrosis y reflujo vesicoureteral. Ofrecemos procedimientos para tratar afecciones que afectan los genitales, el sistema urinario y la vejiga: circuncisión, cirugía de corrección para testículos no descendidos, hipospadias, pieloplastía robótica y manejo de cálculos urinarios, entre otras. Si le gustaría una referencia para su hijo, hable con su proveedor de atención médica de cabecera. Si ya tiene una referencia, comuníquese con Urología al 206-987-2509 para programar una cita. Aprende más.

Seattle Children’s offers an inclusive Spanish Urology Clinic for our patients that includes bilingual providers who may provide care and after visit summaries in both English and Spanish. Dr. Nicolas Fernandez, is currently seeing patients at the Seattle Hospital campus and Bellevue Clinic and Surgery Center. The clinic treats babies, children and teens with common and complex conditions that affect their urinary tract or genitals. Common conditions seen include undescended testes, hypospadias, hydronephrosis, and vesicoureteral reflux. We offer common procedures to treat conditions affecting the genitals, urinary tract and bladder, including circumcision, surgery to correct undescended testes, hypospadias corrections, robot-assisted pyeloplasty, and management of urinary stones. If you would like a referral, talk to your primary care provider. If you already have a referral, please contact Urology at 206-987-2509 to schedule an appointment. If you need an interpreter, call 1-866-583-1527 and tell them to connect you to extension 7-2509. Learn more.

The Urology/Infectious Diseases Clinic cares for children and teens that experience frequent or difficult-to-treat urinary tract infections, typically associated with congenital abnormalities in the urogenital system. In this clinic, our specialists work together with patients and families to form individualized care plans that can involve antibiotic prophylaxis strategies to protect against infections while diagnostic testing or surgical planning is ongoing.