Massachusetts General Hospital | MassGeneral Hospital for Children

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 from birth to young adulthood.

Conditions Treated

Through a number of specialized clinics, we provide 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
• Disorders of sexual differentiation, 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: renal, retroperitoneal, bladder, prostate and testicular
• Trauma
• Renal transplantation including minimally invasive nephrectomy for organ donation
• Kidney stones

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.

Disorders of Sexual Differentiation Clinic

Our clinic is backed by more than 40 years of experience in this field, beginning with the seminal contributions of William Hardy Hendren, MD, and Patricia Donahoe, MD.

Rafael Pieretti, MD, acting chief of Pediatric Urology, has significant interest and experience in the surgical treatment of these conditions. Research work produced by the Pediatric Surgery Research Laboratories, headed by Dr. Donahoe and David MacLaughlin, PhD, 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 their 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.

Preparing for Your Appointment

The family should bring relevant medical records, test results, and X-rays to the appointment to avoid duplications. A recent urinalysis and urine culture is convenient in cases of urinary tract infection.

Instructions for specific tests may be provided when an appointment is scheduled.

Treatment is provided in close communication and cooperation with the patient's referring physician.

Exstrophy of the Bladder and Epispadias

Exstrophy of the bladder is a complex combination of disorders that occurs during fetal development. The disorder usually involves many systems in the body, including the urinary tract, skeletal muscles and bones, and the digestive system.

Hypospadias

Hypospadias is a malformation that affects the urethral tube and the foreskin on a male's penis. It is a disorder that primarily affects male newborns.

Megaureter

Megaureter (dilated ureter) is an abnormality of one or both of the ureters of a child.

Micropenis

Micropenis is defined as a normally structured penis that is below the normal size range for an infant.

Neurogenic Bladder

The following problems are often associated with a neurogenic bladder: urine leakage, urine retention, damage to the tiny blood vessels in the kidney, and infection of the bladder or ureters.

Pheochromocytoma

A pheochromocytoma is an adrenal gland tumor that secretes epinephrine and norepinephrine hormones. These hormones are responsible for regulating heart rate and blood pressure, among other functions.

Posterior Urethral Valves (PUV)

Posterior urethral valves (or PUV) are an abnormality of the urethra, which is the tube that drains urine from the bladder to the outside of the body. The abnormality occurs when the urethral valves, which are small leaflets of tissue, have a narrow, slit-like opening that partially impedes urine outflow.

Testicular Torsion

Testicular torsion is a twisting of the testicles and the spermatic cord (the structure extending from the groin to the testes that contains nerves, ducts, and blood vessels).

Ureterocele and Ureteral Duplication

A ureterocele involves the kidney, ureter, and bladder. Children who have a ureterocele may also have an ureteral duplication.

Urinary Incontinence

Urinary Tract Infection

Urinary tract infections describe a health problem that results from a bacterial infection along the urinary tract.

Vesicoureteral Reflux

Vesicoureteral reflux occurs when urine dwelling in the bladder flows back into the ureters and often back into the kidneys.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

MGHfC Pediatric Urology Service

Phone: 617-724-0518
Fax: 617-726-2167

Public Transportation Access: yes
Disabled Access: yes

International and Non-English-Speaking Patients

Families and patients enjoy expert and prompt assistance from our International Patient Center regarding multilingual translation services, appointments, transportation, hotel accommodations, and health costs.

We have particular expertise in caring for international patients and their families. Several of our surgeons and office staff are fluent in Spanish and have a Hispanic family background.

To schedule an appointment with a MassGeneral for Children pediatric specialist, please call 888-644-3248 or complete our online appointment form to request an appointment.

Physicians may call 888-644-3211 or use the online referral form and the Access & New Appointment Center will call your patient within 1 business day.