Dr. Mike Smith (Host): This is Meaningful Medicine, where we dive into medical topics that matter. I'm Dr. Mike. And with me today is Dr. Nicole Belko from Novant Health. And today, we're going to be discussing insights and valuable information about pediatric urology straight from the expert. Dr. Belko, welcome to the show. I want to start off with the age ranges that you see the most. Where does that fall for you?
Dr. Nicole Belko: Hi. Thank you so much for having me. I'm so excited to be here today to discuss pediatric urology. So, the age range, I will see up, you know, zero to 21 years old. I also see prenatal consults as well.
Host: So, pretty big. You see everybody almost, right?
Dr. Nicole Belko: Yes.
Host: The whole age range thing there. So, that's fantastic. How common is it that children experience childhood urinary issues that may prompt further review? Like, how often are we talking about here?
Dr. Nicole Belko: Yeah, I think that people don't quite understand or realize how common urinary or voiding issues are in childhood. You know, up to 40% of children can experience some sort of disruption in the way that they void, and that often prompts urologic evaluation. It's certainly one of the most common things that I see as a pediatric urologist.
Host: And so, what are some of the more common issues that you see out in general pediatrics versus the issues that actually require the specialist like you?
Dr. Nicole Belko: Depends on the severity of the issues. You know, so a lot of these issues that general pediatricians see, such as nocturnal enuresis, can often be managed in that setting. If it gets to a point where the parents are feeling like there's no progress being made or the symptoms are so severe that they are impacting their lives, then often that will prompt an evaluation.
Another condition that often prompts evaluation is urinary frequency in the pediatric population, because that often can be cumbersome to the family if the patient is having to void every several minutes to an hour. And so, that is something that I will often commonly see.
Host: You know, with some of the symptoms that present to you, do you ever play kind of let's wait it out, let's see how it goes type of approach before jumping right into a specific treatment?
Dr. Nicole Belko: Yes. And so, most often and most frequently these urinary disruptions and dysfunctional voiding does resolve with age. And so, that is part of the counseling that I will do to with the parents is kind of discuss that although this can be challenging and feel frustrating and sometimes scary, that these issues often do resolve themselves with time.
Host: So, voiding issues, voiding dysfunction, you mentioned nocturnal frequency. These are some of the common things you see. What are, in most cases, the causes? You know, if this is something you need to treat, it's not going away with age, what are some of the things driving the symptoms?
Dr. Nicole Belko: Often these symptoms are due to dietary factors and behavioral factors. The largest issue that causes pediatric urinary issues is actually constipation. And so, a lot of the work that I do with the parents is educating about the impact of appropriate stooling habits that have on patient's ability to void.
And I also speak about the importance that different food and beverages have on that as well. So, dietary modifications and managing constipation are often the standard and the starting point for any treatment with any sort of voiding issues.
Host: But how does that change with—because you mentioned the age range that you see is pretty much, you know, zero to 21. So, how does that change though with the age ranges? So, you know, from a toddler to a teenager.
Dr. Nicole Belko: The management doesn't often change all that much because the baseline issue is still the same. But I would say the management shifts a bit to educating the patient themselves in the teenage years because often, you know, teenagers, just as toddlers, are not wanting to drink water or go to the bathroom. And so, really educating the patient and kind of imploring them to take control over their dietary habits more so than educating the parent and just trying to provide guidance for them.
Host: Now, do you find if you're focused on the lifestyle issues, the dietary issues, and to your knowledge that the patient, the family, they're being compliant with that, does that pretty much resolve the issue or how often do you have to actually go to maybe a pharmaceutical?
Dr. Nicole Belko: It's very rarely that I have to go to pharmaceutical pharmaceutical medications. Although there are, of course, instances where, after several months of consistent modifications, that that's not quite enough. Typically, the medications are used as an adjunct to the modifications. But more often what I will discuss with the parents is the role of actually something called pelvic floor physical therapy and biofeedback with the family, which is far more successful than medications. Because of course, in the pediatric population, we really try to limit the medications we use and try to use them as sort of a bridge while working on the other methods of therapy that we discuss.
Host: Let's move into some of the other urological conditions that you treat. What are some of the, you know, top two or three that you see often besides what we've already talked about with nighttime urination frequency?
Dr. Nicole Belko: Yeah, I would say that there are several penile and scrotal conditions that are extremely common in the pediatric population. A large amount of patients come in to discuss something called penile adhesions, and this is what can occur after a newborn circumcision is performed. Over time, the foreskin tends to grow a bit quicker than the penis. And so, there is often a little bit of an excess. And if that is not cared for during the period, then it can get stuck to the head of the penis, and then I discuss treatment for that.
Also, a scrotal condition I see often is something called an undescended testicle, where the testicle is not within the scrotum. And so, I talk to them about the management for that as well.
Host: Obviously, in those cases, there's probably a multi-modal approach to treatment with, I would assume, other specialties?
Dr. Nicole Belko: Well, for undescended testicle, that is typically just a urologic issue. it's very common. There are patients who do require multidisciplinary care for other issues, who commonly have an undescended testicle. But an undescended testicle in itself is a very common isolated pediatric urology condition.
Host: How often do you see that?
Dr. Nicole Belko: I would say multiple times a week, for sure. it's very common because when the baby is a fetus in the prenatal period, the testicles are actually formed within the abdomen. And while it grows within the abdomen, the testicles are supposed to descend into the scrotum. And so, the testicle can commonly not make it all the way. And then, if it has not descended in the first six months of life, then we talk about surgical approaches to manage that.
Host: Let's talk a little bit about drinking enough water. That seems to be a problem for a lot of kids. How can parents and other adults support kids, especially like the athletes, right, In making sure they're getting enough water?
Dr. Nicole Belko: Yeah, I mean, that's a great question and obviously, you know, can be very challenging, to encourage the child to drink enough water, especially when there are a lot of other beverages out there. I really just try to voice the importance to parents and have them try to lead by example and providing water as the mainstay in the household.
And now, you know, with the popularization of water bottles these days, I really, you know, emphasize and try to encourage the parents to go and just purchase a water bottle for their child to carry around with them. And, you know, a lot of schools allow them to do that. The same thing with the athletes, you know, just really trying to encourage the family to switch over the majority of the fluids in the house to water-based water products and treat other beverages more as like a treat or a special beverage, and really encourage the use of a water bottle throughout the day.
Host: There seems to have been an explosion of flavored waters, you know, little drops that you can put into water. AWhat do you think about those?
Dr. Nicole Belko: Yeah, I do tell patients that I am okay with the drops being added to the water to provide with some flavor. I do caution parents and teenagers about sparkling water, as there is still carbonation in that water, which can be irritating to the bladder, which can perpetuate their symptoms.
And I try to caution them about, you know, flavored waters because often they have sugars, like a lot of sugar in them. But the drops I find to be a suitable alternative.
Host: Okay. Yeah. If it gets the kids to drink water, it's a good solution, right? At end of the day, if it's safe. It's funny you mentioned the water bottles. I mean, there was a time, Dr. Belko, where they were unheard of. And now, you find it everywhere. Now, apparently, if you don't have one, you're not in or something that.
Dr. Nicole Belko: Exactly. And so, I really just try to ride that as much as I can, because having water bottles is hip these days. And with that, they're very affordable at the local stores around town. And so, I often provide some examples of stores that have, you know, high-quality water bottles for a very reasonable price
Host: Now, when it comes to water, do you like to give a specific amount that kids should be drinking, or are you just more about more hydration in general? How do you talk to that?
Dr. Nicole Belko: Well, with children since, you know, their weight is often changing, I don't like to give a hard stop amount as I would in adults. But I do try to encourage them to substitute all the fluids that they would be drinking with all of their meals with water and make sure that they're at least having, you know, several large cups of water a day.
Host: Now, what about other conditions that you treat? Now, we've touched on few things. Is there anything else you'd like the listening audience to know about when it comes to your specialty and treatment of disease?
Dr. Nicole Belko: Pediatric urology at the end of the day is actually a very vast field. Some other conditions that I can touch on, you know, that people may not know about is, you know, there's conditions of the kidneys as well that I see, such as hydronephrosis. Many babies are born with congenital swelling of the kidney. And so, that is something that I follow.
There are children who get recurrent urinary tract infections. And so, those often can be due to several anatomical diseases, one being where when you pee, instead of the pee going out, some of the pee can go backwards. That's called vesicoureteral reflux.
And then, you know, another really common penile condition I see that, you know, people are not super educated about is something called hypospadias, where the urethra or where the tip of the pee comes out of is not on the correct location on the penis.And so, it can be anywhere else alongside the penis. And so, that's something that I often treat as well.
Host: Dr. Belko, this has been great information. As we kind of wrap things up here, I'd like to ask how you got into urology. How did you know this was your passion?
Dr. Nicole Belko: Yeah, you know, great question. You know, I think that often urologists do get asked this question for sure. For me, I really wanted to do a surgical field that would impact the quality of life for people, and I wanted to have a close, you know, working relationship with patients with good continuity of care. And in urology, you know, voiding complaints can be very intimate and be very stressful for people to go through and have to talk about, and wanting to support people through some uncomfortable times in their lives.
Host: That was fantastic. Dr. Nicole Belko, thank you so much for coming on the show today. This has been fantastic. I really enjoyed the information that you shared. For more information, you can go to novanthealth.org, and you can explore healthyheadlines.org for wellness tips from our experts. If you enjoyed this podcast, please share it and check out our entire podcast library for more topics of interest to you. This has been Meaningful Medicine. Thanks for listening.
Dr. Nicole Belko: Hi. Thank you so much for having me. I'm so excited to be here today to discuss pediatric urology. So, the age range, I will see up, you know, zero to 21 years old. I also see prenatal consults as well.
Host: So, pretty big. You see everybody almost, right?
Dr. Nicole Belko: Yes.
Host: The whole age range thing there. So, that's fantastic. How common is it that children experience childhood urinary issues that may prompt further review? Like, how often are we talking about here?
Dr. Nicole Belko: Yeah, I think that people don't quite understand or realize how common urinary or voiding issues are in childhood. You know, up to 40% of children can experience some sort of disruption in the way that they void, and that often prompts urologic evaluation. It's certainly one of the most common things that I see as a pediatric urologist.
Host: And so, what are some of the more common issues that you see out in general pediatrics versus the issues that actually require the specialist like you?
Dr. Nicole Belko: Depends on the severity of the issues. You know, so a lot of these issues that general pediatricians see, such as nocturnal enuresis, can often be managed in that setting. If it gets to a point where the parents are feeling like there's no progress being made or the symptoms are so severe that they are impacting their lives, then often that will prompt an evaluation.
Another condition that often prompts evaluation is urinary frequency in the pediatric population, because that often can be cumbersome to the family if the patient is having to void every several minutes to an hour. And so, that is something that I will often commonly see.
Host: You know, with some of the symptoms that present to you, do you ever play kind of let's wait it out, let's see how it goes type of approach before jumping right into a specific treatment?
Dr. Nicole Belko: Yes. And so, most often and most frequently these urinary disruptions and dysfunctional voiding does resolve with age. And so, that is part of the counseling that I will do to with the parents is kind of discuss that although this can be challenging and feel frustrating and sometimes scary, that these issues often do resolve themselves with time.
Host: So, voiding issues, voiding dysfunction, you mentioned nocturnal frequency. These are some of the common things you see. What are, in most cases, the causes? You know, if this is something you need to treat, it's not going away with age, what are some of the things driving the symptoms?
Dr. Nicole Belko: Often these symptoms are due to dietary factors and behavioral factors. The largest issue that causes pediatric urinary issues is actually constipation. And so, a lot of the work that I do with the parents is educating about the impact of appropriate stooling habits that have on patient's ability to void.
And I also speak about the importance that different food and beverages have on that as well. So, dietary modifications and managing constipation are often the standard and the starting point for any treatment with any sort of voiding issues.
Host: But how does that change with—because you mentioned the age range that you see is pretty much, you know, zero to 21. So, how does that change though with the age ranges? So, you know, from a toddler to a teenager.
Dr. Nicole Belko: The management doesn't often change all that much because the baseline issue is still the same. But I would say the management shifts a bit to educating the patient themselves in the teenage years because often, you know, teenagers, just as toddlers, are not wanting to drink water or go to the bathroom. And so, really educating the patient and kind of imploring them to take control over their dietary habits more so than educating the parent and just trying to provide guidance for them.
Host: Now, do you find if you're focused on the lifestyle issues, the dietary issues, and to your knowledge that the patient, the family, they're being compliant with that, does that pretty much resolve the issue or how often do you have to actually go to maybe a pharmaceutical?
Dr. Nicole Belko: It's very rarely that I have to go to pharmaceutical pharmaceutical medications. Although there are, of course, instances where, after several months of consistent modifications, that that's not quite enough. Typically, the medications are used as an adjunct to the modifications. But more often what I will discuss with the parents is the role of actually something called pelvic floor physical therapy and biofeedback with the family, which is far more successful than medications. Because of course, in the pediatric population, we really try to limit the medications we use and try to use them as sort of a bridge while working on the other methods of therapy that we discuss.
Host: Let's move into some of the other urological conditions that you treat. What are some of the, you know, top two or three that you see often besides what we've already talked about with nighttime urination frequency?
Dr. Nicole Belko: Yeah, I would say that there are several penile and scrotal conditions that are extremely common in the pediatric population. A large amount of patients come in to discuss something called penile adhesions, and this is what can occur after a newborn circumcision is performed. Over time, the foreskin tends to grow a bit quicker than the penis. And so, there is often a little bit of an excess. And if that is not cared for during the period, then it can get stuck to the head of the penis, and then I discuss treatment for that.
Also, a scrotal condition I see often is something called an undescended testicle, where the testicle is not within the scrotum. And so, I talk to them about the management for that as well.
Host: Obviously, in those cases, there's probably a multi-modal approach to treatment with, I would assume, other specialties?
Dr. Nicole Belko: Well, for undescended testicle, that is typically just a urologic issue. it's very common. There are patients who do require multidisciplinary care for other issues, who commonly have an undescended testicle. But an undescended testicle in itself is a very common isolated pediatric urology condition.
Host: How often do you see that?
Dr. Nicole Belko: I would say multiple times a week, for sure. it's very common because when the baby is a fetus in the prenatal period, the testicles are actually formed within the abdomen. And while it grows within the abdomen, the testicles are supposed to descend into the scrotum. And so, the testicle can commonly not make it all the way. And then, if it has not descended in the first six months of life, then we talk about surgical approaches to manage that.
Host: Let's talk a little bit about drinking enough water. That seems to be a problem for a lot of kids. How can parents and other adults support kids, especially like the athletes, right, In making sure they're getting enough water?
Dr. Nicole Belko: Yeah, I mean, that's a great question and obviously, you know, can be very challenging, to encourage the child to drink enough water, especially when there are a lot of other beverages out there. I really just try to voice the importance to parents and have them try to lead by example and providing water as the mainstay in the household.
And now, you know, with the popularization of water bottles these days, I really, you know, emphasize and try to encourage the parents to go and just purchase a water bottle for their child to carry around with them. And, you know, a lot of schools allow them to do that. The same thing with the athletes, you know, just really trying to encourage the family to switch over the majority of the fluids in the house to water-based water products and treat other beverages more as like a treat or a special beverage, and really encourage the use of a water bottle throughout the day.
Host: There seems to have been an explosion of flavored waters, you know, little drops that you can put into water. AWhat do you think about those?
Dr. Nicole Belko: Yeah, I do tell patients that I am okay with the drops being added to the water to provide with some flavor. I do caution parents and teenagers about sparkling water, as there is still carbonation in that water, which can be irritating to the bladder, which can perpetuate their symptoms.
And I try to caution them about, you know, flavored waters because often they have sugars, like a lot of sugar in them. But the drops I find to be a suitable alternative.
Host: Okay. Yeah. If it gets the kids to drink water, it's a good solution, right? At end of the day, if it's safe. It's funny you mentioned the water bottles. I mean, there was a time, Dr. Belko, where they were unheard of. And now, you find it everywhere. Now, apparently, if you don't have one, you're not in or something that.
Dr. Nicole Belko: Exactly. And so, I really just try to ride that as much as I can, because having water bottles is hip these days. And with that, they're very affordable at the local stores around town. And so, I often provide some examples of stores that have, you know, high-quality water bottles for a very reasonable price
Host: Now, when it comes to water, do you like to give a specific amount that kids should be drinking, or are you just more about more hydration in general? How do you talk to that?
Dr. Nicole Belko: Well, with children since, you know, their weight is often changing, I don't like to give a hard stop amount as I would in adults. But I do try to encourage them to substitute all the fluids that they would be drinking with all of their meals with water and make sure that they're at least having, you know, several large cups of water a day.
Host: Now, what about other conditions that you treat? Now, we've touched on few things. Is there anything else you'd like the listening audience to know about when it comes to your specialty and treatment of disease?
Dr. Nicole Belko: Pediatric urology at the end of the day is actually a very vast field. Some other conditions that I can touch on, you know, that people may not know about is, you know, there's conditions of the kidneys as well that I see, such as hydronephrosis. Many babies are born with congenital swelling of the kidney. And so, that is something that I follow.
There are children who get recurrent urinary tract infections. And so, those often can be due to several anatomical diseases, one being where when you pee, instead of the pee going out, some of the pee can go backwards. That's called vesicoureteral reflux.
And then, you know, another really common penile condition I see that, you know, people are not super educated about is something called hypospadias, where the urethra or where the tip of the pee comes out of is not on the correct location on the penis.And so, it can be anywhere else alongside the penis. And so, that's something that I often treat as well.
Host: Dr. Belko, this has been great information. As we kind of wrap things up here, I'd like to ask how you got into urology. How did you know this was your passion?
Dr. Nicole Belko: Yeah, you know, great question. You know, I think that often urologists do get asked this question for sure. For me, I really wanted to do a surgical field that would impact the quality of life for people, and I wanted to have a close, you know, working relationship with patients with good continuity of care. And in urology, you know, voiding complaints can be very intimate and be very stressful for people to go through and have to talk about, and wanting to support people through some uncomfortable times in their lives.
Host: That was fantastic. Dr. Nicole Belko, thank you so much for coming on the show today. This has been fantastic. I really enjoyed the information that you shared. For more information, you can go to novanthealth.org, and you can explore healthyheadlines.org for wellness tips from our experts. If you enjoyed this podcast, please share it and check out our entire podcast library for more topics of interest to you. This has been Meaningful Medicine. Thanks for listening.