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Definition of the subspecialty
Paediatric Urology is the subspecialty of both Urology and Paediatric Surgery concerned with clinical recognition, prevention, treatment (surgical and non-surgical) , and the rehabilitation of congenital and acquired diseases, malformations and functional problems of the genitourinary system in children and adolescents. It also encompasses the promotion of good genitourinary system health in children.
General aspects of Training in Paediatric Urology
Paediatric Urology Training is a subspecialty training which is done at Fellowship level for Urologists or paediatric surgeons. The Multidisciplinary Joint Committee of Paediatric Urology(JCPU) will be the monitoring authority for recognition of quality, accreditation and certification. The JCPU is the equivalent of the European Boards of full specialists (UEMS). The JCPU will be responsible for defining regulations concerning required training, conducting site-visits to training programmes, and certifying examinations.
The European Academy of Paediatric Urology (EAPU) has an advisory role to the JCPU. The JCPU and the EAPU will also supervise in a systematic way the training of Paediatric Urologists in order to assure quality. Paediatric Urology training must be performed in a Training Programme recognized by JCPU . The training programme can be established under a Paediatric Urology, a Urology, or a Paediatric Surgery programme.
The selection procedure of a trainee should be transparent and application should only be open to the candidates who are certified as Urologists or Paediatric Surgeons. The length of training is at least two years with both years being spent in recognized programmes.
It is strongly recommended that the trainee should have spent at least 6 months in Paediatric Surgery (for accredited Urologists), or 6 months in Urology (for accredited Paediatric Surgeons).
Syllabus of the subspecialty
| Code | |
| 1. Normal and pathological embryology of the urinary and genital tract 1.1. Development of the kidney and ureter 1.2. Development of the bladder and the urethra 1.3. Development of the female genital tract 1.4. Development of the male genital tract |
CON |
| 2. Nephrology 2.1. Normal physiology of the urinary tract and kidney 2.2. Pathophysiology of pre and postnatal hydronephrosis 2.3. Haematuria 2.3.1. Definition 2.3.2. Analysis 2.3.4. Aetiology 2.3.5. Diagnostic 2.4. Parenchymal pathology 2.4.1. Glomerular diseases (glomerulonephritis, hemolytic-uraemic-syndrome) 2.4.2. Tubular diseases (acute renal insufficiency, hereditary diseases) 2.4.3. Interstitial nephritis 2.5. Renal insufficiency and dialysis 2.5.1. Aetiology of chronic renal insufficiency 2.5.2. Clinic (pyuria, anaemia, hypertension, bone metabolism; growth disorders) 2.5.3. Dialysis (indication, peritoneal-haemodialysis) 2.6 Renal transplantation 2.6.1. Indication 2.6.2. Selection, risks and contra-indications 2.6.3. Preparation and diagnostic work-up 2.6.4. Transplantation-immunology (HLA) 2.6.5. Cadaveric and living donor kidney 2.6.6. Surgical technique of explantation, implantation and postoperative technical complication 2.6.7. Working of Euro-Transplant-organization 2.6.8. Posttransplant immunosuppression technique |
NEPH |
| 3. Infection 3.1. Definition of UTI (asymptomatic bacteriuria, bacterial cystitis, pyelonephritis) 3.2. Diagnosis of UTI (microbiology, culture media, preparation techniques) 3.3. Specific infection clinical features (abscess, tuberculosis, candida, eosinophilic cystitis, cystitis-cystica) 3.4. Orchitis, epididymitis |
INF |
| 4. Principles in diagnosis of the urinary tract 4.1. History and physical examination of the child at different ages 4.2. Associated clinical signs with anomalies of the urinary tract 4.3. Urinalysis (stix, microscopic, chemical, culture) 4.4. Serum-analysis 4.5. Imaging of the urinary tract 4.5.1. Ultrasound, color Doppler: theory, possibilities and limitations 4.5.2. X-ray: protection principles, urography, cystography, video-urodynamics 4.5.3. Contrast media: principles, indication and contra-indications 4.5.4. Computerized tomography (principles, interpretation, possibilities, limitations) 4.5.5. Magnetic Resonance Imaging (priniciples, interpretation, possibilities, limitations) 4.6. Special imaging of the urinary tract using radio-isotopes 4.6.1. Principles 4.6.2. Static imaging: DMSA 4.6.3. Dynamic imaging: DTPA, MAG-3 4.6.4. Interpretation of clearance and glomerular filtration rate: principles and limitations 4.6.5. Direct and indirect cystography 4.6.6. Extrarenal imaging: neuroblastoma 4.7. Prenatal diagnostic 4.7.1. Ultrasound 4.7.2. Urinalysis (electrolytes, tubular markers) 4.8. Non-invasive diagnostic of the lower urinary tract 4.8.1. Uroflowmetry (principles, methods, interpretation) 4.8.2. Electromyography (principles, methods, interpretation) 4.9. Invasive diagnostic of the lower urinary tract 4.9.1. Antegrade and retrograde cystography (technique, interpretation) 4.9.2. Video-urodynamic study (technique, interpretation) 4.9.3. Cystometry (ambulatory and non-ambulatory) |
DIA |
| 5. Pre-, peri- and postoperative management of the child - Anesthesia principles 5.1. Selection, pre-operative studies 5.2. Parental information pre- and postoperative 5.3. Ambulatory surgery 5.3.1. Selection 5.3.2. Local anesthesia techniques (methods, pharmacology) 5.4. Pain management (oral, rectal, parenteral) 5.5. Postoperative fluid management 5.6. Anaesthesia (principles, premedication) |
FLU |
| 6. Anomalies of the kidney and the upper urinary tract - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 6.1. Prenatal hydronephrosis and associated problems (pulmonary hypoplasia) 6.2. Renal agenesis 6.3. Renal hypoplasia 6.4. Renal dysplasia (multicystic dysplastic kidney, cystic dysplasia with obstruction) 6.5. Renal duplication : incomplete 6.6. Polycystic infantile and adult renal disease 6.7. Horseshoe-kidney 6.8. Renal ectopia 6.9. Uretero-pelvic junction obstruction (UPJ) 6 10. Megacalycosis 6.11. Ureterocele ( intra- and extravesical) 6.12. Ectopic ureter |
UPP |
| 7. Anomalies of the lower urinary tract - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 7.1. Urachal pathology (open urachus, cysts, sinus, diverticulum) 7.2. Exstrophy – Epispadias - Complex 7.3. Bladder diverticulum 7.4. Vesico-ureteral reflux 7.5. Urethral valves 7.6. Urethritis posterior 7.7. Urethral strictures 7.8. Duplication of the urethra 7.9. Urethral diverticulum 7.10. Meatal prolapse 7.11. Urogenital sinus anomalies 7.12. Cloacal anomalies |
LOW |
| 8. Anomalies of the upper and lower urinary tract - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 8.1. Prune-Belly-Syndrome |
LOW |
| 9. Anomalies of the penis - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 9.1. Hypospadias 9.2. Phimosis (lichen sclerosus) 9.3. Epispadias 9.4. Buried penis 9.5. Penoscrotal web 9.6. Micropenis |
PTS |
| 10. Anomalies of the testis and the scrotum - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 10.1. Maldescent of the testis (cryptorchism, ectopia, retractile) 10.2. Anorchia, polyorchia 10.3. Hydrocele, hernia 10.4. Varicocele, 10.5. Spermatocoele |
PTS |
| 11. Sexual differentiation problems 11.1. Embryology and physiology of genital differentiation 11.2. Hermaphroditism, female and male pseudohermaphroditism 11.3. Mixed gonadal dysgenesis 11.4. Chromosomal abnormalities |
SEX |
| 12. Function disorders of the lower urinary tract 12.1. Normal anatomy and physiology 12.2. Classification of functional disorders 12.3. Urinary diversion techniques 12.4. Non-neuropathic function disorders 12.5. Neuropathic function disorders : conservative treatment, bladder augmentation 12.6. Management of associated problems of neurogenic disorders (bowel, tethered cord, pubertas praecox, latex allergy, amnesia) |
FUN |
| 13. Primary monosymptomatic nocturnal eneuresis 13.1. Pathophysiology 13.2. Treatment options |
FUN |
| 14. Paediatric urology emergencies - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 14.1.Renal infectious problems (pyonephrosis, renal abscess) 14.2.Renal non-infectious problems (trauma, renal vein thrombosis) 14.3. Ureteral trauma 14.4. Adrenal haemorrhage 14.5. Renal colic (acute upper urinary tract obstruction) 14.6. Urinary retention 14.7. Testicular torsion 14.8. Torsion of the appendix testis 14.9. Incarcerated hernia 14.10. Testicular rupture 14.11. Orchitis 14.12. Epididymitis 14.13. Paraphimosis 14.14. Priapism 14.15. Penile and scrotal trauma 14.16. Bladder trauma (intra- and extraperitoneal rupture) 14.17. Urethral rupture 14.18. Trauma of the female genital tract 14.19. Infection of the female genital tract (vulvovaginitis, foreign body) 14.20. Acute hydro- and haematocoele 14.21. Idiopathic scrotal oedema |
EME |
| 15. Urolithiasis 15.1. Aetiology 15.2. Metabolic disorders 15.3. Chemical characteristics 15.4. Clinical, diagnostic and management 15.5. Treatment options |
LIT |
| 16. Paediatric urology oncology - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of: 16.1. Wilms tumour 16.2. Neuroblastoma 16.3. Rhabdomyosarcoma 16.4. Testicular tumours (Leydig cell, Yolk Sac, Leukaemia) 16.5. Hypernephroma 16.6. Pheochromocytoma |
ONC |
| 17. Management and social aspects of the care of the child as a patient 17.1. Communication skills with the child and its family 17.2. Knowledge of the psychosocial and sexual development of a child |
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