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From Hydration to Urination: When to Consult a Pediatric Urologist · Meaningful Medicine with Novant Health

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  Dr Mike Smith (Host): This is Meaningful Medicine, where we dive
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  into medical topics that matter.
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  I'm Dr.
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  Mike, and with me today is Dr.
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  Nicole Belko from Novant Health.
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  And today we're going to be discussing insights and valuable
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  information about pediatric urology straight from the expert.
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  Dr.
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  Belko, welcome to the show.
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  I wanna start off with the age ranges that you see the most.
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  Where does that, fall for you?
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  Dr Nicole Belko: Hi, thank you?
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  so much for having me.
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  I'm so excited to be here today to discuss pediatric urology.
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  so the age range I will see up, you know, zero to 21 years old.
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  see, prenatal consults as well.
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  Dr Mike Smith (Host): So pretty big.
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  You see everybody almost, right?
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  The whole, the whole, the whole, age range thing there.
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  So that's fantastic.
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  how common is it that children experience childhood urinary issues
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  that may prompt further review?
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  Like how, how often are we talking about here?
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  Dr Nicole Belko: Yeah, I think that people don't quite understand
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  or realize how common, urinary or voiding issues are in childhood.
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  You know, up to 40% of children can experience some sort of disruption
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  in the way that they void, and that often prompts urologic evaluation.
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  It's certainly one of the most common things that I
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  see as a pediatric urologist.
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  Dr Mike Smith (Host): And so what are some of the more common, issues that
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  you see out in general pediatrics versus the issues that actually
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  require the specialist like you
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  Dr Nicole Belko: depends on the severity of the issues.
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  You know, so a lot of these issues that general pediatricians see,
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  such as nocturnal enuresis, can often be managed in that setting.
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  if it gets to a point where the parents are feeling like there's no progress being
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  made or the symptoms are so severe that it, they are impacting their lives, and
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  then often that will prompt an evaluation.
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  Another condition, it, that often prompts evaluation is urinary frequency
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  in the pediatric population because that often can be cumbersome to the
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  family if the patient is having to void every several minutes to an hour.
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  And so that is something that I will often commonly see.
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  Dr Mike Smith (Host): You know, with some of the symptoms that present to
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  you, do you ever play kinda let's, let's wait it out, let's see how it
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  goes type of approach before jumping right in to a specific treatment?
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  Dr Nicole Belko: Yes.
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  And so most often and most frequently these urinary disruptions and
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  dysfunctional voiding does resolve with age, and so that is part of the counseling
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  that I will do to, for, with the parents is kind of discuss that although this
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  can be challenging and feel frustrating and sometimes scary, that these issues
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  often do resolve themselves with time.
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  Dr Mike Smith (Host): So, voiding issues, voiding dysfunction, you
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  mentioned nocturnal frequency.
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  These are some of the common things you see.
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  what, are the, in most cases, the causes?
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  You know, if this is something you need to treat, it's not going away with age,
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  what are some of the things driving,
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  the symptoms
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  Dr Nicole Belko: often these symptoms are due to dietary
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  factors and behavioral factors.
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  the largest issue that causes pediatric urinary issues is actually constipation.
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  And so a lot of the work that I do with the parents is educating about the,
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  impact of appropriate stooling habits that have on patient's ability to void.
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  And I also speak about the importance that different food and
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  beverages have on that as well.
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  So dietary modifications and managing constipation are often the standard and
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  the starting point for any treatment with any sort of voiding issues.
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  Dr Mike Smith (Host): but how does that change with-- 'cause you
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  mentioned the age range that you see is pretty much, you know, zero to 21.
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  So how does that change though, with the age ranges?
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  So, you know, so, you know, from a toddler to a teenager.
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  Dr Nicole Belko: the management doesn't often change all that much because
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  the, baseline issue is still the same.
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  And so although, so, but I would say the management shifts a bit to educating
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  the patient themselves in the teenage years because often, you know, teenagers,
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  just as toddlers, are not wanting to drink water or go to the bathroom.
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  And so really educating the patient and kind of imploring them to take
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  control over their dietary habits more so than educating the parent and just
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  pr- trying to provide guidance for them.
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  Dr Mike Smith (Host): Now, do you find if, if you're focused on the, the
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  lifestyle issues, the dietary issues, and, to your knowledge that the patient,
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  the family, they're being compliant with that, does that pretty much resolve
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  the issue or how often do you have to actually go to maybe a pharmaceutical?
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  Dr Nicole Belko: It's very rarely that I have to go to medications,
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  although there are, of course, instances where, after several
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  months of consistent, modifications that that's not quite enough.
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  Typically, these, the medications are used as an adjunct to the modifications.
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  but more often what I will discuss with the parents is the role of
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  actually something called pel- pelvic floor physical therapy and
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  biofeedback with the family, which is far more successful than medications.
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  Because of course, in the pediatric population, we really try to limit the
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  medications we use and try to use them as sort of a bridge while working on the
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  other methods of therapy that we discuss.
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  Dr Mike Smith (Host): Let's move into some of the other urological
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  conditions that you treat.
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  what, are some of the, you know, top two or three that you see often
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  besides what we've already talked about with nighttime urination frequency?
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  Dr Nicole Belko: yeah, I would say that there are several penile and
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  scrotal conditions that are extremely common in the pediatric population.
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  a large amount of pop- patients come in to discuss, something called penile
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  adhesions, and this is what can occur after a newborn circumcision is performed.
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  Over time, the, the foreskin tends to grow a bit, bit quicker than the penis, and so
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  there is often a little bit of an excess.
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  And if that is not cared for during the period, then it can get stuck
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  to the head of the penis, and then I discuss treatment for that.
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  also some other, a scrotal condition I see often is something called an undescended
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  testicle, where the testicle is not within the scrotum, and so I talk to them
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  about the management for that as well.
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  Dr Mike Smith (Host): obviously, in those cases, there's probably a multi,
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  modal approach to treatment with other, other, I would assume other specialties?
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  Dr Nicole Belko: well, for undescended testicle, that is
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  typically just a urologic issue.
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  it's very common.
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  I would s- there are patients who do require multidisciplinary care
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  for other issues where, who commonly have an undescended testicle.
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  But an undescended cu- testicle in itself is a very common isolated
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  pediatric urology condition.
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  Dr Mike Smith (Host): How often do you see
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  that?
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  Dr Nicole Belko: I would say multiple times a week, for sure.
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  it's very common because when the baby is a fetus in the prenatal
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  period, the testicles are actually formed within the abdomen.
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  And while it grows within the abdomen, the testicles are supposed
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  to descend into the scrotum.
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  And so it commonly, the testicle can commonly not make it all the way.
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  and then if it has not descended in the first six months of life, then we talk
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  about surgical approaches to manage that.
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  Dr Mike Smith (Host): Let's talk a little bit about drinking enough water.
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  That seems to be a problem for a lot of kids.
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  how can parents and other adults support kids, e- especially like the
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  athletes, right?
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  In making sure they're getting enough
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  water?
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  Dr Nicole Belko: Yeah, I mean, that's a great question and it's obviously, you
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  know, very-- can be very challenging, to encourage the child to drink enough
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  water, especially when there are a lot of other beverages out there.
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  I really just try to voice the importance to parents and, have them
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  try to lead by example and p-providing water as the mainstay in the household.
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  And now, you know, with how the popularization of water bottles these
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  days, I really, you know, emphasize and try to encourage the parents to g-go and
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  just purchase a water bottle to-- for their child to carry around with them.
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  And, you know, a lot of schools, a lot of schools allow them to do that.
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  the, same thing with the athletes, you know, just really trying to encourage
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  the family to switch over the majority of the fluids in the house to water-based
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  water products and treat other beverages more as like a, a treat or a, a special
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  beverage, and really encourage the use of a water bottle throughout the day.
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  Dr Mike Smith (Host): seems to have been an explosion of, flavored
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  waters, you know, little drops
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  that you can put into water.
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  Are you-- What do you think about
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  those?
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  Dr Nicole Belko: Yeah, I do tell patients that I am okay with the drops being added
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  to the water to provide with some flavor.
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  I do caution parents, and teenagers about sparkling water, as there is
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  still carbonation in that water, which can be irritating to the bladder,
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  which can perpetuate their symptoms.
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  and I try to caution them about, you know, flavored waters because often they
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  have sugars, like a lot of sugar in them.
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  But the drops I find to be a suitable alternative.
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  Dr Mike Smith (Host): Okay.
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  Yeah.
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  If it gets the kids to drink water, it, it, it's, it's a good solution, right?
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  At the end of the day, if it's safe.
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  it's funny you mentioned the w- water bottles.
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  I mean, it-- There was a time, Dr.
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  Belko, where they were unheard of.
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  And now, and now you find it every…
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  Now, now apparently, if you don't have one, you're not in or something
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  Dr Nicole Belko: E-exactly.
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  And so I really just try to ride that, that, you know,
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  ride that as much as I can because, having water
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  bottles is hip these days.
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  And so, and with that, they're very affordable at,
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  the local stores around town.
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  And so I pr- often provide some examples of stores that have, you
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  know, high-quality water bottles for a very reasonable price
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  Dr Mike Smith (Host): Now, when it comes to water, do you like to give
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  a specific amount that kids should be drinking, or are you just more
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  about more hydration in general?
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  H- how do you talk to that?
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  Dr Nicole Belko: Well, with children since, you know, their weight is often
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  changing, I don't like to give a, hard stop amount as I would in adults.
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  But I do try to encourage them to substitute all the fluids that they
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  were be, would be drinking with all of their meals with water and make sure
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  that they're at least having, you know, several large cups of water a day.
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  Dr Mike Smith (Host): Now, what about, other conditions that you treat?
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  Now, we've touched on few things.
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  Is there anything else you'd like the listening audience to know about,
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  when it comes to your specialty and, and treatment of disease?
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  Dr Nicole Belko: pediatric urology at the end of the day is
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  actually a, a very vast field.
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  some other conditions that I can touch on, you know, that people may
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  not know about is, you know, there's conditions of the kidneys as well
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  that I see, such as hydronephrosis.
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  Many babies are born with congenital swelling of the kidney, and so
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  that is something that I follow.
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  there are children who get something, recurrent urinary tract infections, and
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  so those often are, can be due to several anatomical diseases, one being where when
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  you pee, instead of the pee going out, the pee, some of the pee can go backwards.
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  That's called vesicoureteral reflux.
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  And then, you know, another really common penile condition I see that, you know,
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  people are not super educated about is something called hypospadias, where
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  the urethra or where the tip of the pee comes out of does not, is not on the
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  lo- correct location of, on the penis.
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  And so it, it can be, anywhere else alongside the penis.
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  And so that's something that I often treat as well.
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  Dr Mike Smith (Host): Dr.
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  Belko, this has been great information.
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  As we kinda wrap things up here, I'd like to ask you got into urology.
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  How did you know this was your passion?
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  Dr Nicole Belko: Yeah, you know, great question.
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  You know, I think that often urologists do get asked this question for sure.
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  for me, I really wanted to do a surgical field that would impact the quality of
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  life for people, and I wanted to have a close, you know, working relationship with
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  patients with good continuity of care.
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  And in urology, you know, voiding complaints can be very intimate
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  and be very stressful for people to go through and have to talk about.
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  and wanting to support people through some uncomfortable times in their lives.
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  Dr Mike Smith (Host): That was fantastic.
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  Dr.
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  Nicole Belko, thank you so much for coming on the show today.
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  This has been fantastic.
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  I really enjoyed the information that you shared.
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  For more information, you can go to novanthealth.org,
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  and you can explore healthyheadlines.org
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  for wellness tips from our experts.
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  If you enjoyed this podcast, please share it and check out
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  our entire podcast library for more topics of interest to you.
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  This has been Meaningful Medicine.
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  Thanks for listening.