Definition and Syllabus of the Sub-Speciality Paediatric Urology

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

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
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
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
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)
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)
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
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
8. Anomalies of the upper and lower urinary tract - Diagnostic, management, therapeutic options, surgery selection, surgical techniques of:
   8.1. Prune-Belly-Syndrome
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
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
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
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)
13. Primary monosymptomatic nocturnal eneuresis
   13.1. Pathophysiology
   13.2. Treatment options
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
15. Urolithiasis
    15.1. Aetiology
    15.2. Metabolic disorders
    15.3. Chemical characteristics
    15.4. Clinical, diagnostic and management
    15.5. Treatment options 
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
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