When to Refer to Pediatric Urology

Vijaya Vemulakonda, MD, JD, is a pediatric urologist who treats children with urinary tract conditions, such as UPJ obstruction, vesicoureteral reflux, posterior urethral valves, and exstrophy. Often, urinary tract abnormalities can exist before birth and be detected on ultrasound. In these instances, Vemulakonda helps inform and educate families, and provide intervention when appropriate.

Her research includes developing guidelines to optimize surgical outcomes in children using multicenter collaborative research partnerships.

She shares why she decided to pursue pediatric urology, what makes it rewarding, and what providers should know about when and how to refer patients.

What made you decide to focus on pediatric urology?

I was interested in pediatrics but was drawn to procedural specialties. I never thought I would be a surgeon but had an incredible mentor in medical school whose practice showed me that pediatric urology allows me to intervene to help children lead their best lives and to develop relationships with children and their families over the course of their childhood. 

What’s your favorite thing about practicing as a specialist? 

The opportunity to meet families with children with congenital anomalies, often prior to birth, and to help them navigate the road to optimizing their health and well-being.

How can referring providers help their patients with early detection and diagnosis? 

Congenital hydronephrosis is one of the most commonly diagnosed anomalies on prenatal ultrasound, affecting up to 5% of pregnancies. It is important to know that this finding can be associated with a wide spectrum of underlying conditions and that severity of the dilation may not be indicative of the underlying diagnosis. We are always happy to help with navigating optimal evaluation and to see these children whenever the referring provider would appreciate additional specialty input.

What risk factors should indicate that a patient needs a referral to pediatric urology? 

Urinary tract infections can be associated with a wide variety of conditions, ranging from severe underlying congenital anomalies to voiding dysfunction. In the case of young children with febrile UTI or recurrent UTI, referral to a pediatric urologist to rule out underlying risk of renal injury is helpful. 

What’s something about your specialty you wish more people knew?

Care of the uncircumcised penis. The decision to circumcise is a cultural decision except in rare cases of underlying kidney and bladder anomalies. It is important to know that if the foreskin is retractile, the benefits of circumcision for prevention of UTI, STDs, or penile cancer are not significant after a year of age. However, parents are often unaware of how to care for the uncircumcised penis. As the number of children who are not circumcised increases, it is important to know that the foreskin may not retract until age 2-3 and that parents should not try to retract the foreskin until after age 1.  

What’s one thing doctors can do to help their patients? 

Obtain a history about voiding habits and counsel families about what is normal. Often, we see children with voiding dysfunction that is reinforced by inability to void regularly at school, lack of adequate hydration, or lack of time to fully relax with voiding. Reinforcement of what good bladder hygiene looks like helps us to get a head start on addressing refractory cases of voiding dysfunction.

When should providers refer their patient to your program? 

Whenever they have a patient where they would appreciate support for diagnosis or management. We are happy to see any pediatric patient with a urologic issue regardless of age and to provide support informally as needed.

How do you partner with referring providers?

I consider the referring provider to be a partner in care of our patients. They often have a longer standing relationship with the family and a better sense of the child’s overall health than I do as a specialist. As a result, partnering with the referring provider and the family allows us to provide the best care for each specific patient in a more holistic way.

How do you handle meeting a newly referred patient? 

I try to be very upfront about the fact that, while I have expertise in pediatric urology, the parents are experts in their child and so my goal is to have a partnership to share our experience to determine what is the best option for the care of their child.

What’s one thing UVA Health can offer these patients that you think makes their experience better? 

Coming from a free-standing children’s hospital, I am struck by the integration of care across adult and pediatric specialties at UVA. This allows us to offer collaborative multi-specialty care from pregnancy/in utero development through adulthood in a seamless way to ensure that we are supporting health across the lifespan of our patients.