Although it may seem a simple question, there is more to it than meets the eye.
Paediatric urology is not recognised as either a specialty or a subspecialty in most countries around the world.
According to the European Society for Paediatric Urology, the leading scientific society for paediatric urology in Europe and possibly worldwide, a paediatric urologist is someone who devotes 80 to 100% of their work to treating children’s genitourinary conditions. This definition may seem unusual: you might imagine that some paediatric urologists spend 20% of their time doing something else, like watering plants or writing blogs.
To explain this, we need to look back in time. When scientific knowledge was limited and one person could remember all, or nearly all, that was known about medicine, doctors commonly did a little of everything: extracting a tooth, delivering a baby or treating a fever with a potion. As knowledge expanded, doctors had to specialise: respiratory physicians, cardiologists, gastroenterologists and so on. Surgeons, although later because technical progress was slower, also had to specialise: gastrointestinal surgeons, neurosurgeons, urologists and others.
But what happened to children? Adult specialists were wary of treating them. They were small and fragile, and their conditions were very different from those the specialists knew. Children do get infections, but these differ from adult infections. They also develop tumours, but these are developmental tumours which behave very differently from those in adults. Unlike adults, children also have congenital malformations, very different from the typical diseases of old age.
Adult specialists therefore left all childhood conditions to paediatricians, whether they affected the lungs, heart, nervous system or genitourinary system. Children received medical treatment from paediatricians and surgical treatment from paediatric surgeons.
Medical and surgical subspecialties for children emerged much later than those for adults. Fields such as paediatric neurology, paediatric cardiology and paediatric oncology are relatively recent. Likewise, paediatric surgical subspecialties are also very recent.
Paediatric urology is a surgical subspecialty that treats children’s genitourinary abnormalities, from fetal life to adolescence.
If it is a subspecialty, does that mean it branches from another ‘parent’ specialty? Exactly. In Europe, paediatric urologists are generally paediatric surgeons who work exclusively or almost exclusively in children’s urology. In the Americas, they are usually adult urologists who specialise in treating children. There are exceptions, and some adult urologists in our country also treat children exclusively.
This explains why a paediatric urologist is defined as someone who spends more than 80% of their time in paediatric urology. They should not spend more than 20% treating adults, if trained as an adult urologist, or treating other body systems, if trained as a paediatric surgeon.
The high level of technical and scientific development today requires doctors to subspecialise increasingly. This is particularly true at hospitals and departments with greater expertise: the higher the complexity, the greater the need for subspecialisation.
Even though it is ‘only’ a subspecialty, paediatric urology is an extremely broad field…
We will explore this throughout the blog…
Best wishes, and see you soon!