Urological problems in children are different from those in adults: many of them are a variation of normal development and need only monitoring, while others must be treated at the right time so that they do not leave lasting effects. Dr Penev sees children and teenagers in Plovdiv and Karlovo, and the examination is gentle, painless and always takes place with a parent present.
When it is recommended
It is a good idea to see a urologist when:
- the foreskin does not pull back, balloons when your child passes urine or becomes inflamed – phimosis in children;
- one or both testicles cannot be felt in the scrotum or “ride up” – undescended testicle;
- the scrotum is swollen or its two halves are different sizes;
- a child over five regularly wets the bed at night or starts again after being dry;
- there is stinging when passing urine, frequent urges, cloudy or smelly urine, or an unexplained temperature – signs of a urinary tract infection;
- an ultrasound scan during pregnancy or later has shown a dilated kidney;
- there is blood in the urine or pain in the lower back.
Sudden severe pain in a testicle with swelling, nausea or vomiting may be testicular torsion – a twisting in which every hour counts. Do not wait for a booked appointment: go to an emergency department straight away or call 112 (the European emergency number). Being unable to pass urine, and a high temperature with vomiting in a baby with a suspected urinary infection, are also emergencies.
What happens during the consultation
The consultation begins with a conversation with the parent and, with older children, with the child as well, in language they can understand. Dr Penev asks about the pregnancy and birth, past infections, habits around passing urine and drinking, and when the problem started. This is followed by a careful examination of the tummy and the external genitals – quick and without forcing the foreskin back. The ultrasound scan of the kidneys, bladder and scrotum is done at the practice with gel and is completely painless. If needed, a urine test and a urine culture are arranged, and in more complex cases additional imaging. The consultation takes about 20 to 30 minutes.
Preparation
- Calmly explain to your child that the doctor will talk to them and look at their tummy, and that it will not hurt.
- Bring the child’s health record book and any previous ultrasound scans, test results and hospital discharge summaries.
- For bedwetting, keep a two-week calendar of dry and wet nights and of the fluids drunk.
- If possible, the child should not pass urine just before the consultation, so that the bladder is full.
- Dress your child comfortably and bring a favourite toy or book.
After the consultation and results
At the end of the visit Dr Penev explains to the parents what he has found and what happens next. For physiological phimosis, waiting and correct hygiene are most often recommended; if there are problems, creams at the doctor’s discretion; and surgery only when this does not help. For an undescended testicle, surgical treatment in early childhood is recommended – usually between 6 and 12 months of age and no later than 18 months – which is why a timely consultation is important. Hydrocele in babies often resolves on its own. Bedwetting responds to a fluid routine, motivational measures and an alarm system, while urinary tract infections are treated according to the urine culture, and the reason why they keep coming back is looked for. When an operation is needed, Dr Penev discusses the options with the parents and, if necessary, refers the child to a specialist paediatric surgical unit.
Where it is done
Children’s consultations take place at Dr Penev’s private practice at 5 Anri Barbyus St, Plovdiv, by appointment. Families from Karlovo and the surrounding area can book at Vita Med Medical Centre, 18 Todor i Ana Pulevi St, Karlovo, on a schedule confirmed when you book.
Price
Initial consultation €50; follow-up consultation €30. The price of any additional tests is confirmed when you book.
Most paediatric urological problems have a good solution when they are recognised in time, and a calm consultation spares both the child and the parents a lot of worry. Book a paediatric consultation with Dr Penev.
Frequently asked questions
From what age does Dr Penev see children?
Dr Penev sees children and teenagers. For babies and very young children, it is best to check when you book, and for conditions that require an operation under general anaesthetic the doctor decides case by case and, if necessary, refers you to a specialist paediatric surgical unit.
Does our boy need to be circumcised because of phimosis?
In most cases, no. In young boys the foreskin is naturally tight and loosens with age. Treatment is needed only if there are problems – infections, pain, ballooning when passing urine or scarring – and it often starts with creams rather than surgery.
Is it normal for a five-year-old to wet the bed at night?
Up to about the age of five, bedwetting is considered a variation of normal development. After that age, or if the child had been dry and starts wetting the bed again, a consultation is a good idea.
How do I collect a urine sample from a young child?
For older children, a midstream sample of the morning urine is collected into a sterile container after washing. For babies and toddlers you will get specific instructions when you book – the way the sample is collected affects the accuracy of the result.
Can the consultation be held in English or German?
Yes. Dr Penev also sees patients in English and German, which is convenient for families from abroad living in the Plovdiv area.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.