Pediatric Urology

The Pediatric Urology Service at MassGeneral Hospital for Children provides state-of-the-art urologic care ranging from very simple circumcisions to the most complex of urinary and genital anomalies encountered in children form birth to young adulthood.

Conditions Treated

Pediatric Urology at MassGeneral Hospital for Children provides comprehensive diagnostic and therapeutic services for the broad spectrum of surgical diseases affecting the urinary and genital tracts:

• Vesicoureteral reflux (including minimally invasive endoscopic treatment with Deflux), urinary tract infection
• Voiding dysfunction, enuresis, urinary incontinence
• Neurogenic bladder
• Obstructive uropathies: congenital hydronephrosis, congenital megaureter, ureteral duplication/ureterocele, posterior urethral valves
• Prenatal consultation for antenatal hydronephrosis and other obstructive uropathies
• Inguinal hernia, hydrocele, undescended testicle (including laparoscopy for diagnosis and treatment of non palpable testis), varicocele
• Hypospadias
• Ambigous genitalia (Intersex), genital reconstruction in males and females
• Bladder exstrophy, cloacal exstrophy, epispadias
• Anorectal malformations: imperforate anus and persistence of the cloaca
• Penile agenesis
• Complex urinary tract reconstruction (undiversion, bladder augmentation, incontinence procedures)
• Prune belly syndrome
• Ectopic kidney, horseshoe kidney, crossed fused ectopia
• Multicystic dysplastic kidney
• Testicular torsion
• Tumors
• Trauma
• Renal transplantation including minimally invasive nephrectomy for organ donation

Ambiguous Genitalia / Intersex Clinic

We conduct an Ambiguous Genitalia/Intersex clinic, which is backed by over forty years of experience in this field, beginning with the seminal contributions of William Hardy Hendren, MD, and Patricia Donahoe, MD.

Dr. Rafael Pieretti, acting chief of Pediatric Urology, has significant interest and experience in the surgical treatment of these conditions. The work of the clinic is furthered by the research work produced by the Pediatric Surgery Research Laboratories headed by Dr. Donahoe and David MacLaughlin, PhD, whose work has resulted in numerous publications dealing with the molecular mechanisms causing intersex abnormalities. Based on this combination of clinical and research experience, MassGeneral Hospital for Children has become a recognized referral center for ambiguous genitalia. In our clinic patients are evaluated by a multidisciplinary team of pediatric urologists, pediatric endocrinologists, geneticists, psychiatrists, and basic science investigators, who strive to provide our patients and their families with state-of-the-art medical and surgical treatment.

Clinic for Complex Reconstructive Pediatric Urology

This clinic is devoted to the management of complex urological and surgical cases such as imperforate anus, persistence of the cloaca, bladder exstrophy, cloacal exstrophy, urinary diversions and undiversions, Prune Belly Syndrome, and tumors of the genitourinary system.

The complexity of these conditions requires the involvement of highly experienced surgeons, with a thorough understanding of its embryology, anatomy, and resulting functional problems. Our surgeons use their background and experience in pediatric urology and pediatric general surgery to provide said patients with state-of-the-art surgical treatment.

Hypospadias Clinic

Hypospadias is a very common condition, in which the male urethral opening (urethral meatus) does not reach the tip of the penis. Hypospadias occurs in about 1 in 200-300 male births and presents in a broad clinical spectrum. Surgical repairs require considerable experience and the use of a meticulous technique to achieve good results. The vast majority of cases can be repaired in a single stage procedure using local tissues. The use of newer surgical techniques, fine absorbable suture material and visual magnification has significantly improved the success rate in hypospadias surgery. Complex cases might require the use of grafts; these may be taken from sites such as the buccal mucosa, bladder mucosa, or skin.

Our pediatric urologists run a busy hypospadias clinic, and when indicated our patients are evaluated by a team expanded to include pediatric endocrinologists and geneticists.

Minimally Invasive Pediatric Urology

• Endoscopic treatment of vesicoureteral reflux: the advent of tissue bulking agents, in particular dextranomer/hyaluronic acid has resulted in a valid, minimally invasive alternative to the open surgical, and medical treatment of vesicoureteral reflux. We have been performing this technique as an outpatient procedure in selected patients with a high success rate.
• Laparoscopic surgery: laparoscopic procedures have resulted in faster recovery time, less pain, and better cosmetic results. We are performing laparoscopic procedures in an increasing number of conditions.