Our task in paediatric urology is to treat infants, children, adolescents and adults with congenital and acquired diseases, malformations and functional disorders of the urogenital system as individually and gently as possible. To this end, we offer the complete range of diagnostic, conservative and surgical paediatric urology procedures. Depending on the clinical picture, we also work on an interdisciplinary basis with colleagues from the Department of Paediatrics and Adolescent Medicine, Paediatric Nephrology, Paediatric Surgery, Paediatric Neurosurgery and the Department of Anaesthesia, which is particularly important for the holistic care of young patients and their families. We regularly exchange information with our specialist colleagues in interdisciplinary conferences. Thanks to our experience and expertise, we received two international certifications in 2022: Ulm Paediatric Urology is a member of the European reference network eUROGEN together with Paediatric Surgery, and we also offer EBPU-certified training to become a European specialist in paediatric urology (FEAPU). In addition to professional expertise, a child-friendly environment, sufficient time, empathy for the child's reactions and outpatient care whenever possible are of great importance for children and parents. It is particularly important to us to provide medical support for people with urogenital malformations beyond childhood into adulthood and, if necessary, to provide surgical treatment.
The entire paediatric urology team is at your disposal!
Our team looks forward to getting to know you and your child and providing you with medical care.
Please also note the further information:
Consultation appointments: Paediatric urology consultations take place at Michelsberg either in the paediatric clinic or in the paediatric urology outpatient clinic. Please ask exactly where you are scheduled when you register. The paediatric urology outpatient clinic at Michelsberg (Prittwitzstraße 43, 89075 Ulm) is open during normal working hours on weekdays. You can reach us by telephone on 0731/500-58056 or by email at info.kinderurologie@uniklinik-ulm.de. Please arrive punctually for the agreed consultation appointment, as there may be waiting times for the admission formalities.
Please always register first at the patient registration desk of the paediatric clinic, Eythstraße 24, 89075 Ulm. If the consultation takes place in the paediatric clinic (especially on Thursday mornings), please go directly to the outpatient clinic of the paediatric clinic. If the consultation takes place in the paediatric urology outpatient clinic, please leave the paediatric clinic after registration and turn right along Prittwitzstraße. Please walk past the entrance to the Clinic for Gynaecology and Obstetrics until you reach the parking bay. There you will find the entrance to the paediatric urology secretariat. Patients of the paediatric urology section must ring the bell. You can download directions here.
Planned operations, urodynamics (bladder pressure measurements) and X-ray examinations: Information on operations and preliminary anaesthetic consultations are generally valid for 6 months. If the preparation appointment was made longer ago due to postponements, it may be necessary for you to be seen again for an operation consultation and anaesthesiological preparation. This will be decided by your doctor! We will inform you of this by telephone.
Emergencies: Emergencies are always treated! In case of emergencies, we will be happy to help you at any time in our outpatient clinics or by telephone (paediatric urology outpatient clinic 0731/500-58056 or university outpatient clinic of the paediatric clinic 0731/500-57444). Paediatric urological emergencies at weekends, on public holidays and at night will continue to be treated at Oberer Eselsberg (Albert-Einstein-Allee 23, 89081 Ulm) in the interdisciplinary emergency department of the surgical clinic or via the emergency department of the paediatric clinic (Eythstraße 24, 89075 Ulm - Michelsberg).
Team
Dr. med. Anna-Katharina Winkler
Oberärztin der Kinderchirurgie mit dem Schwerpunkt Kinderurologie, in Ausbildung zum FEAPU
Consultation appointments
Phone 0731 500-58056
Fax 0731 500-58096
You can reach us by telephone
Mon to Fri: 08:00 - 12:00
or by e-mail: info.kinderurologie@uniklinik-ulm.de
Consultation hours
Thursdays
08:00 - 12:00 (paediatric clinic)
14:00 - 15:30 (Paediatric Urology at Michelsberg in the former Urology Clinic)
or by individual appointment
Wednesdays
08:30 - 14:30 Bladder school
(Paediatric Urology at Michelsberg in the former Urology Clinic)
PLEASE NOTE THE FOLLOWING INFORMATION!
If you have an appointment in the paediatric urology consultation in the outpatient clinic of the paediatric clinic, you must go to the patient registration desk of the paediatric clinic (Eythstr. 24, 89075 Ulm) and stay there.
If you have an appointment in the paediatric urology office, you must go to the patient registration desk of the Women's Clinic (Prittwitzstr. 43, 89075 Ulm) and then come to the former Urology Clinic.
You can find the directionshere.
Contact for doctors
Dear colleagues,
At the Paediatric Urology Section in Ulm, we treat the entire spectrum of paediatric urology. It is very important to us to treat all children and adolescents well, regardless of whether surgical treatment or conservative counselling is necessary. Unfortunately, our consultation and operating theatre capacities are limited at the moment. As a result, we can only offer regular appointments with a few months' notice.
If you are treating patients in your consultation hours who require a prompt paediatric urological assessment, we would ask you to register by telephone or in writing (using the forms provided by us) so that we can enable these patients to be seen more quickly.
Paediatric Urology Office: Telephone: 0731-50058056
Fax: 0731-50058096
The term undescended testicle is used when the testicle is not permanently located in the scrotum. This occurs in around 3% of boys born at term and in up to 30% of premature boys.
The testicles migrate from their original position below the kidneys through the inguinal canal into the scrotum before birth. In the case of undescended testicles, they can be located anywhere along this route, usually in the inguinal canal, but also in the abdominal cavity.
The testicles can still find their way into the scrotum on their own up to the age of around 6 months. This is checked regularly at the paediatrician's U-examinations.
If the testicle can be brought into the scrotum with a slight pull, but is then immediately returned to the groin, this is known as a sliding testicle. This must be surgically moved into the scrotum.
This is to be distinguished from the so-called pendulum testicle, in which the testicle can be moved into the scrotum without tension or is spontaneously in the scrotum and only disappears from the scrotum due to an excessive muscle reflex (for example when it is cold). The pendulum testicle does not need to be treated. However, there is an approx. 30% risk of acquired undescended testicles with pendulous testicles, which is why an annual check-up by the paediatrician is particularly important.
If one or both testicles are not regularly located in the scrotum by the age of 6 months, surgical relocation to the scrotum (orchidopexy) before the age of 1 year is the treatment of choice. This can prevent or reduce the risk of malignant degeneration or a reduction in fertility later on. The use of hormone therapy between the 6th and 12th month of life, which was previously recommended, is increasingly viewed critically and should only be carried out in exceptional cases and after detailed medical consultation.
Diagnosis
The diagnosis is made on the basis of a physical examination and, if necessary, an ultrasound scan.
You can also write down the position of the testicles yourself at home(testicle position protocol). It is important that your doctor instructs you well on how to do this.
Surgical therapy (orchidopexy)
In most cases, the testicle is located in the inguinal canal so that an operation can be performed with a small incision in the groin area. The testicle, the spermatic cord and the vessel supplying the testicle are dissected until the testicle can be moved into the scrotum without tension. The access to the scrotum is narrowed so that the testicle cannot slide back into place.
If the testicle is located in the abdominal cavity, an examination under anaesthetic and a minimally invasive laparoscopy (= laparoscopy) is required to find the testicle. Depending on the findings in the abdominal cavity, the operation is continued. The aim is to move the testicle from the abdominal cavity into the testicular compartment with as little tension as possible. This is possible in combination with a small incision in the groin.
Depending on the time of surgery, the procedure can be performed on an outpatient basis (without an overnight stay) or an inpatient stay with an overnight stay (with a parent) is required.
Before birth, there is a natural connection between the abdominal cavity and the scrotum. If this remains open after birth, the scrotum repeatedly fills with fluid from the abdominal cavity and a painless swelling is observed. Normally, this connection closes by the 2nd birthday at the latest and no treatment is required. If the testicular swelling persists after the 2nd birthday, surgical closure is recommended in order to prevent a permanent increase in the temperature of the testicle or the entrapment of a loop of intestine.
Diagnosis
The diagnosis is made on the basis of a physical examination and, if necessary, an ultrasound scan.
Surgical therapy
The open connection to the abdominal cavity is accessed via a small incision in the groin area and sutured closed. The operation can be performed on an outpatient basis (without an overnight stay) or with an overnight stay as an inpatient (with a parent).
In hypospadias, the urethra does not end at the tip of the penis but, depending on the severity, further down in the area of the glans, on the shaft of the penis or even in the area of the scrotum or perineum. The foreskin is shortened on the underside of the penis and enlarged on the upper side of the penis (so-called foreskin apron). In some cases, the penis is bent downwards (ventral penile shaft deviation) or twisted to one side.
One in 200-300 boys is affected by hypospadias. This makes hypospadias one of the most common malformations of the male genitalia.
Minor hypospadias does not always require treatment. However, if symptoms such as a deviation of the urinary stream, a curvature of the penis with limited sexual functionality or a subjective cosmetic impairment with possible psychosocial consequences occur, surgical correction is necessary. We will be happy to advise you on this in our consultation hours.
Surgical correction is normally always necessary for higher-grade hypospadias. This procedure is recommended by the guidelines .
Diagnosis
The diagnosis is made on the basis of a clinical examination.
In the case of high-grade hypospadias, further diagnostics may be required in our paediatric endocrinology consultation, which we will initiate in consultation with the parents.
Surgical therapy
There are many different ways of operating on a hypospadias. The surgeon will choose the best method for your child on a case-by-case basis. The aim of the operation is to move the opening of the urethra into the area of the glans and, if necessary, to straighten the penis. The foreskin is needed to lengthen the urethra, so that the foreskin is shortened after the operation as if it had been circumcised. In some cases, a second operation may be necessary after approx. 6 months or a small piece of oral mucosa may need to be removed.
During the operation, a catheter is inserted into the urethra and in some cases another catheter is inserted into the bladder via the abdominal wall. These remain in place until the wound has healed sufficiently, which can take from one to 14 days depending on the extent of the operation. An inpatient stay (with a parent) is usually necessary for this period. In individual cases, you can also go home with the catheters in place after a few days.
Phimosis is a narrowing of the foreskin in which the foreskin cannot be pushed back completely over the glans.
This is not initially a disease, but occurs naturally (=physiologically ) in all boys. At around the age of 7, around half of all boys are able to retract most of the foreskin, but it can take until the onset of puberty for the adhesions between the foreskin and the glans to loosen.
Treatment of phimosis is only necessary if symptoms occur. These include
- Recurrent, also purulent inflammation of the foreskin
- Repeated bladder infections
- Scarring that leads to a weakening of the urinary stream.
In some cases, the cause of a scarred, whitish discoloured foreskin is lichen sclerosus et atrophicans, an autoimmune disease of the foreskin which, if left untreated, can spread to the glans and urethra and cause a narrowing of the urethra.
Diagnosis
The diagnosis is made on the basis of a clinical examination.
Therapy
Only if symptoms persist and an operation would actually follow is the foreskin initially creamed twice daily with a cortisone ointment for 4 to 6 weeks. Only if the foreskin cannot be pulled back permanently is the foreskin surgically circumcised. This can be a complete circumcision (circumcision) or a partial circumcision. Outpatient surgery (without an overnight stay) is usually possible.
In our department, circumcisions are only performed for medical reasons.
In the case of visible lichen sclerosus, local treatment is also carried out first and then surgery is performed if necessary.
IMPORTANT: The aim of treatment before puberty is to have no symptoms; the foreskin should only be freely retractable after puberty.
Guideline "Phimosis and paraphimosis in children and adolescents"(https://register.awmf.org/assets/guidelines/006-052l_S2k_Phimose-Paraphimose-Kinder-Jugendliche_2022-03_02.pdf)
A varicocele refers to the widening of the veins in the testicles, similar to varicose veins in the leg. For anatomical reasons, varicocele occurs predominantly on the left side and is particularly common in adolescents during puberty (7.8% of 11-14-year-olds; 14.1% of 15-19-year-olds) and adults. Symptoms may include visible, tortuous veins on the scrotum, pain or a feeling of heaviness, especially during physical exertion.
A varicocele can lead to impaired fertility due to an increase in temperature in the scrotum and the accumulation of harmful metabolic products.
Diagnosis
The diagnosis is made on the basis of a physical examination and an ultrasound scan. A blood sample may be taken to determine the hormone levels.
Treatment
If a varicocele is new and does not cause any symptoms, regular ultrasound examinations are initially carried out to check the growth of the testicles. Reasons for surgical treatment include discomfort, a delay in testicular growth and poor hormone and semen values. The reasons for surgery are regularly reviewed in order to prevent a reduction in fertility.
In surgical treatment, a small incision is made in the scrotum to access an affected vein and a drug is injected into the vein under X-ray control, which leads to the blockage of the vessel until it branches off into the renal vein.
The operation can be performed on an outpatient basis (without an overnight stay) or with an overnight stay.
Vesicoureterorenal reflux is the backflow of urine from the bladder into the ureters and, depending on the severity (1-5), into the kidneys. This is normally prevented by the oblique course of the ureters through the bladder muscles. The backflow (reflux) of urine into the kidneys can cause bacteria to ascend and lead to pyelonephritis, which can result in scarring and functional impairment of the kidneys. Reflux can occur unilaterally or bilaterally.
Diagnosis
The diagnosis is made using MCU/MUS(micturating cystourethrography/micturating urosonography). In addition, an ultrasound examination of the kidneys and possibly a renal scintigraphy to determine kidney function is always carried out.
Therapy
The treatment of reflux depends on the age and gender of the child, the symptoms (urinary tract infections, pyelonephritis), the bladder and bowel function and the severity of the reflux.
Modern reflux therapy includes both conservative and surgical aspects. Your doctor will discuss a completely individualised concept with you. In the case of persistent reflux, breakthrough infections (urinary tract infections despite antibiotic prophylaxis) or severe reflux, surgical treatment may be necessary.
Surgical therapy
Endoscopic ureteral injection
A cystoscopy is performed and a mixture of substances (dextranomer/hyaluronic acid) is injected into the bladder wall with a cannula in the area of the ureteral opening (ostium), which changes the course of the ureter in the bladder wall and thus prevents urine from flowing back. A bladder catheter is then inserted and left in place for one night. The catheter is removed the following day and the patient is discharged. The success rates are good.
Antirefluxplasty according to Lich-Gregoir
Lich-Gregoir anti-reflux surgery is used in particular for unilateral VUR. A tunnel for the ureter is formed in the bladder wall from the outside via an incision of approx. 3-4 cm in the lower abdomen. The bladder itself is therefore not opened (extravesical procedure). A bladder catheter is inserted into the bladder via the urethra.
The inpatient stay is approx. 2-3 days.
Ureteral reimplantation according to Cohen
In the case of bilateral VUR, the bladder is opened via a 3-4 cm incision in the lower abdomen (intravesical procedure), both ureters are detached and each is sutured into the bladder wall via a separate tunnel. Ureteral stents are inserted, which are either removed immediately or after approx. 6 weeks in an outpatient cystoscopy. A bladder catheter is inserted via the urethra.
The inpatient stay is approx. 5-7 days.
Open surgical procedures have a very high success rate.
In renal pelvic outlet stenosis (stenosis = narrowing), a usually congenital narrowing in the area of the transition between the kidney and ureter prevents the outflow of urine from the kidney into the bladder. This leads to a permanent build-up of urine in the renal pelvis, which can be seen on ultrasound and can restrict the function of the kidney.
A widening of the renal pelvis is usually detected during ultrasound examinations before birth, as the constriction forms early in pregnancy during kidney development. A vessel can also squeeze the ureter.
If renal pelvic outlet stenosis is diagnosed early, there are often no clinical symptoms (yet). Later, unspecific symptoms such as flank pain, a palpable bulge in the upper abdomen, failure to thrive, blood in the urine, kidney stones or urinary tract infections may occur.
Diagnosis
The diagnosis is made by means of an ultrasound examination. Whether an operation is necessary is always decided on the basis of various aspects such as a kidney scintigraphy to assess kidney function, the clinic and the ultrasound examination.
Therapy
In many cases, a urinary transport disorder heals with increasing age. No further therapy is then necessary, only regular ultrasound or renal scintigraphy checks.
If symptoms occur, the renal pelvis enlarges on ultrasound or kidney function deteriorates, surgical treatment is required.
Renal pelvis plastic surgery (pyeloplasty)
In a pyeloplasty, the constriction in the area of the ureter is removed and a sufficiently wide passage to the renal pelvis is created. The renal pelvis and the ureteral constriction are accessed via an approx. 4-5 cm long incision in the upper abdomen (smaller children) or flank (larger children) and the constriction is removed. The renal pelvis bridges the constriction. A ureteral stent is then inserted so that the ureter can heal properly. This is removed approximately 6 weeks after the operation using an outpatient cystoscopy (bladder endoscopy). A bladder catheter is inserted via the urethra. The operation has a success rate of approx. 95%.
The inpatient stay is approx. 3-5 days.
After the operation, it usually takes several months or even years for the dilated renal pelvis to recede. Your child will therefore have regular ultrasound and, if necessary, scintigraphic checks.
The ureter connects the kidney to the bladder. A megaureter is defined as a widening of the ureter of > 7 mm. This dilatation can only occur for a short distance before the bladder (pre-vesical) or affect the entire length.
A distinction is made between the primary (=congenital) and the secondary (=acquired) megaureter. In the primary megaureter, there is a narrowing at the junction of the ureter and the bladder, so that the urine accumulates in the ureter and expands it.
The secondary (=acquired) megaureter occurs when, for example, urethral valves or a neurogenic bladder emptying disorder make it difficult to empty the bladder, resulting in a widening of the ureter.
Diagnostics
The diagnosis is made by means of an ultrasound examination. A micturating cystourethrography (MCU)/micturating urosonography (MUS) is performed to visualise any additional vesicoureterorenal reflux or constrictions in the urethra. In some cases, a renal scintigraphy is also required to visualise the kidney function and a possible constriction.
Therapy
The primary megaureter has a high chance (approx. 80%) of healing spontaneously. Your doctor will discuss with you whether low-dose antibiotics should be administered over a longer period of time to prevent urinary tract infections. Regular check-ups are necessary.
Ureteral reimplantation (ureterocystoneostomy) after Psoas Hitch
If symptoms such as repeated urinary tract infections occur despite antibiotic prophylaxis or the dilation of the ureter does not resolve on its own, surgical treatment is required. If possible, this is performed after the child reaches the age of 1.
The ureter is separated from the bladder, the constriction is removed and the ureter is reconnected to the bladder. Access is gained via a 3-4 cm long incision in the lower abdomen on the affected side. During the
ureteral reimplantation (ureterocystoneostomy) according to Psoas Hitch, the bladder is also attached to the psoas muscle at one point in order to achieve a tension-free ureter-bladder connection. A ureteral stent is then inserted to prevent the ureter from swelling and is removed approximately 6 weeks after the operation by means of an outpatient cystoscopy (bladder endoscopy). A bladder catheter is inserted via the urethra.
The inpatient stay is approx. 4-5 days.
Regular ultrasound checks continue after the operation.
The bladder exstrophy-epispadias complex consists of a large spectrum of differently pronounced urogenital malformations.
Epispadias refers to a urethra that is not closed at the top. The urethra thus appears as an open channel instead of the normal tube. In girls, the clitoris is also split.
In classic bladder exstrophy, the bladder is not closed in a spherical shape, but is open towards the abdominal wall. In addition, the symphysis (= pubic bone) is split, as is the clitoris in girls and the urethra is not closed at the top.
This type of malformation can be detected during a prenatal ultrasound scan or directly at birth, so that a presentation to a suitable centre can be made during pregnancy or after birth. A detailed paediatric urology consultation about the condition and how to proceed in each individual case will take place there.
Urethral valves are membranous protrusions in the urethra (usually at the back, in the area of the prostate) that prevent the unimpeded flow of urine from the bladder. The disease only affects boys. Depending on its severity, this can lead to a build-up of urine in the kidneys, which can be detected by ultrasound before birth. However, symptoms such as a weakening of the urinary stream, urinary tract infections or symptoms of enuresis may only occur in older children.
Diagnosis
The diagnosis is made by ultrasound examination and MCU(micturating cystourethrography). A renal scintigraphy may be necessary to visualise the kidney function.
Therapy
As a permanent obstruction to the outflow of urine can lead to damage to the kidneys and bladder, prompt surgical treatment is essential. In most cases, a direct bladder catheter is inserted into the bladder via the abdominal wall immediately after birth. In the case of severe findings, an open connection can be temporarily created from the bladder to the abdominal wall (bladder-skin stoma), which relieves the kidneys and bladder. The urine then flows out of the bladder directly into the nappy.
A few weeks later, when the child has gained height and weight, the urethral valves can be slit endoscopically (as part of a cystoscopy). A permanent bladder catheter is inserted.
After the operation, regular ultrasound checks and, if necessary, a new kidney function diagnosis using kidney scintigraphy are carried out. The care of these children is interdisciplinary.
Wetting during the day (infantile incontinence) or at night (enuresis) is often a shameful topic. Enuresis is considered normal up to the age of 5, but even at the age of 7, 10% of children still wet themselves regularly at night. The perception of a full bladder is a process that has to be learnt. Many circumstances can lead to a child wetting. It is often made up of several components such as learned misbehaviour, hereditary factors, psychosocial factors or organic (= physical) causes.
The diagnosis should therefore take all possible causes into account in order to optimise individual therapy. At the first appointment, the medical history form and the urination, drinking and faeces records brought along will be discussed and a physical examination and ultrasound examination of the bladder and kidneys will be carried out. A uroflow examination (link) or uroflow EMG is carried out so that our urotherapist, Ms Remziye Sirin, can then provide detailed and individual advice.
Special examination methods
The MCU or MUS is used to detect vesicoureterorenal reflux (= backflow of urine from the bladder into the ureters) and to assess the urethra, e.g. to recognise constrictions.
For this purpose, a catheter (=thin tube) is first inserted into your child's bladder via the urethra in an examination room. The urethra is anaesthetised with a gel so that the procedure is unpleasant but not painful. You will then go with your child to the radiology department (= X-ray department). They will answer any questions you may have about the examination. You will fill out an information sheet.
For the examination, your child will be given a contrast agent via the catheter into the bladder. In an MCU, X-ray fluoroscopy is performed during bladder filling and during micturition (urination). In an MUS, sonography is performed instead of fluoroscopy. The examination usually takes 10-20 minutes. Your doctor will decide which of the two examinations is useful and suitable for your child.
Your child does not need to be fasting for the examination, but should be well hydrated. A non-pregnant accompanying person may accompany the child during the entire examination. This is acceptable due to the low radiation exposure.
Renal scintigraphy is used to visualise the lateral renal function and to assess possible obstacles to drainage from the kidneys to the bladder. This is an outpatient examination.
For this purpose, your child will first have an access into the vein in an examination room at Michelsberg. If necessary, we will take blood from the vein at the same time. In young children who do not yet have reliable bladder control, a catheter (=thin tube) can also be inserted into the bladder via the urethra. The urethra is anaesthetised with a gel so that the procedure is unpleasant but not painful. The doctor will decide on a case-by-case basis whether this is necessary for your child. You and your child will then be taken by taxi to the nuclear medicine centre at Oberer Eselsberg.
There, any questions you may have about the examination will be answered. Young children who are not yet able to lie still for a long period of time will require a short anaesthetic for the examination, which is carried out by experienced anaesthetists. A small amount of radioactive substance is injected into the vein, which is then excreted via the kidneys. If necessary, a diuretic drug (furosemide) is injected. The radiation emitted by the substance is recorded by a special camera. This allows both kidney function and the flow of urine from the kidneys into the bladder to be assessed. The examination usually takes about 50-60 minutes. A non-pregnant accompanying person may be with the child during the entire examination.
Once the examination is complete, you will be taken back to Michelsberg, where the results of the examination will be discussed either immediately afterwards or by appointment, depending on staffing levels.
Uroflow is used to assess the urinary stream. The examination can provide indications of an obstruction to the outflow, such as a narrowing in the urethra.
Your child should have drunk enough for the examination so that a meaningful measurement is possible. The measurement takes place during micturition on a special toilet, which measures the speed of the urine stream and the volume of urine, among other things.
In combination with electromyography (EMG-Uroflow), in which additional measuring electrodes are attached to the pelvic floor area, the relationship between micturition and pelvic floor relaxation and any bladder dysfunction can be visualised.
A urodynamic examination provides information about the function of the urinary bladder. It is used in particular for neurogenic bladder emptying disorders in order to prevent possible kidney damage caused by excessive pressure in the bladder through medical or surgical interventions and to regularly check the success of the therapy afterwards.
It is important that a urine culture is taken approx. 10 days before the examination, as bacteria in the urine harbour a high risk of renal pelvic inflammation as a result of the examination. When measuring bladder pressure, a measuring catheter is first inserted into the bladder via the urethra and then a measuring probe is inserted into the rectum. Adhesive electrodes are also placed in the area of the pelvic floor. The measuring catheter in the bladder measures the pressure in the bladder (intravesical pressure), the measuring probe in the rectum measures the pressure in the abdomen (abdominal pressure). The detrusor pressure (= bladder muscle pressure) is calculated from the difference between the intravesical and intra-abdominal pressure. The activity of the pelvic floor is recorded using adhesive electrodes.
The bladder is first emptied completely. The bladder is then slowly filled with saline via the bladder catheter. In normal findings, the bladder muscle (detrusor) shows no activity during the filling phase. During the filling phase, the patient is asked to indicate when they feel a slight urge to urinate for the first time, when they feel a stronger urge to urinate and when the bladder is so full that they really want to urinate. The detrusor pressure is documented at each of these times.
When the bladder is emptied, the pressure conditions in the bladder and pelvic floor activity are also recorded. If involuntary loss of urine occurs beforehand, this time is also measured.
Based on the measurement, statements can be made about the compliance (= distensibility) of the bladder, the bladder capacity and the (intrinsic) activity of the bladder muscle, from which direct therapeutic consequences can be derived.
Bladder school (urotherapy)
Parents whose children come to our paediatric urology consultation due to enuresis or childhood urinary incontinence are asked to bring a micturition record with them.
You can download the form and instructions on how to complete this record here.
--> Instructions
--> Stool record
Please download the relevant information here.
Patient/parent information
Mrs Oechsle from the paediatric urology office will coordinate the appointments in consultation with you and inform you of these in writing. We usually organise the preparations for the operation a few days in advance to ensure that the admission goes smoothly. If your child is being treated as an inpatient, please bring an inpatient referral with you on the day of admission. Paediatric urology children are admitted either to Paediatric Clinic Ward 2 or to the Paediatric Surgery Ward.
If your child is admitted to the paediatric clinic, they will first be admitted by colleagues from paediatrics. If no outpatient preparation for the operation has yet taken place, you and your child will be given anaesthesiological information about the anaesthetic and urological information about the operation on the day of admission. You will then be given anaesthesiological information about the anaesthetic and urological information about the operation. Please call 0731/50057380 (Ward 2, Paediatric Clinic) on the day of admission to find out the exact time of admission! After admission, your child will be cared for jointly by paediatricians and paediatric urologists on Ward 2 of the Children's Hospital.
If your child is admitted to the paediatric surgery ward or undergoes outpatient surgery, the necessary preparation for the operation is usually carried out on an outpatient basis with information from the urology department and presentation in the anaesthesia outpatient department. You then come to the paediatric surgery ward with your child on the day of the operation at 7.00 a.m. on an empty stomach and then register at the registration desk.
If your child is ill, please let us know in good time at 0731- 50058056 or in an emergency on the day of the operation by calling the telephone number of the planned admission ward: either paediatric ward KK2 0731/50057380 or paediatric surgery ward 0731/500-57430.
Everything is taken care of during your stay. Nevertheless, it would be nice if you could bring a few personal items for your child:
- Comfortable clothes (pyjamas, jogging bottoms, enough underwear, slippers)
- Familiar toiletries (toothbrush, toothpaste, hairbrush, care products that you also use at home)
- Special feeding bottle if your child does not like other teats
- Soother, cuddly toy, favourite toy, books
- It would be very helpful for us if you could bring us a list of the special foods and medicines that your child takes regularly.
If your child has to have an operation with us, an outpatient appointment will take place beforehand to prepare for the operation.
At this appointment, a medical colleague will provide you with detailed information about the planned procedure and what to do after the operation. He/she will also draw your attention to the necessary rules of behaviour and measures that you can take to support your child after the operation. You are welcome to make a note of your questions beforehand so that you feel well prepared for the operation.
Your child will be physically examined again, measured, weighed and their vital signs (blood pressure, pulse, fever) will be taken. We may need a urine sample from your child, so please give him or her plenty to drink before the appointment. For some children, a blood sample must also be taken in preparation for the operation. For younger children, the decision to take a blood sample depends in particular on the evaluation of our coagulation questionnaire. If possible, please bring this completed to the appointment. If you have any questions, we will be happy to answer them during the consultation.
Please bring all relevant previous medical findings such as doctor's letters, a list of medications (if your child is taking medication) and, if available, an allergy passport with you to the appointment.
You and your child will usually also have an appointment with the anaesthetist on the same day.
Currently, your child and the person accompanying your child to the ward need a negative COVID PCR test that is no more than 24 hours old before an operation/inpatient admission. This can be carried out free of charge at our clinic. Due to the regularly changing requirements, we will provide you with up-to-date information on this on a daily basis. You can also find this on our homepage. We will be happy to provide you with information regarding the current visiting regulations at any time, also by telephone.
Participating clinics & co-operation partners
Paediatric urology in Ulm: Prof. Dr A.-K. Ebert has been working in Ulm since 1 August 2013 following her appointment to the Berndt-Ulrich Scholz W3 endowed professorship for paediatric urology. The professorship was established thanks to the generous financial support of Mr Berndt-Ulrich Scholz, the Urological Research Foundation Berlin and the German Society of Urology.
Self-help groups
- Self-help group Bladder Ecstrophy/Epispadias e.V.(www.ekstrophie.de)
- SoMA e.V. - Self-help organisation for people with anorectal malformations(www.soma-ev.de)
- Network for congenital uro-rectal malformations (CURE-Net)(www.cure-net.de)
Prof. Ebert is a member of the scientific advisory board of the self-help group Blasenekstrophie/ Epispadie e.V. and the self-help organisation for people with anorectal malformations e.V.. She also heads the clinical sub-project bladder exstrophy of the CURE-Net consortium and, together with Prof E. Jenetzky, has campaigned for the continuation of CURE-Net through DFG applications. As part of the research activities, several long-term studies on important outcome parameters in adults born with the bladder ecstrophy-epispadias complex have been realised.
Downloads & Links
Micturition protocol
Bladder exstrophy
- bladderexstrophy.eu(animated short film of the children's book - in numerous languages)
- http://blasenekstrophie-kinderbuch.de ("The boy with the tiny belly button" - children's book, German)
Fax enquiry for urgent appointments