Urology
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Urology Referrals
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When a child needs urology care and services, their needs are very different from an adult patient. CHOC urology program has dedicated doctors, specialists and treatments just for kids.
As Orange County’s only dedicated center with fellowship-trained pediatric specialists, our multidisciplinary care team offers diagnosis, ongoing treatment and surgical intervention for all pediatric urological concerns. Our physicians and health care professionals are all specially trained to work with pediatric patients with the focus to preserve childhood, no matter what the condition.
The CHOC Difference
The CHOC Urology Center provides our patients with the most innovative, comprehensive and clinically advanced care available.

The CHOC Urology Center is ranked among the Best Children’s Hospitals by U.S. News & World Report.

We are committed to develop evidence-based management and treatment plans and to individualize each child’s care.

Our four world-renowned fellowship-trained pediatric urologists, Dr. Antoine Khoury, Dr. Elias Wehbi, Dr. Kai-wen Chuang and Dr. Heidi Stephany are held in the highest regard for their skills as surgeons and healthcare providers.

What We Treat
As one of the top-ranked children’s hospitals in the nation for urology by U.S. News & World Report, we are committed to providing the highest quality of care for children and teens with urological issues.
- Balanitis
- Bladder exstrophy
- Bladder stones
- Chordee
- Cloacal anomaly
- Circumcision
- Congenital adrenal hyperplasia
- Constipation
- Cross-fused ectopic kidney
- Disorders of sex development
- Diverticulitis
- Duplicated kidney
- Duplicated ureter
- Dysfunctional bladder
- Dysuria
- Ectopic ureter
- Epididymal head cyst
- Epididymitis
- Epispadias
- Hernia
- Hematuria
- Horseshoe kidney
- Hydrocele
- Hydronephrosis
- Hypospadias
- Kidney laceration
- Kidney stones
- Labial adhesions
- Meatal stenosis
- Meatal webs
- Megaureter
- Micropenis
- Multicystic dysplastic kidney
- Neurogenic bladder
- Nocturnal enuresis (bed wetting)
- Posterior urethral valves
- Parameatal cyst
- Paraphimosis
- Pelvic kidney
- Phimosis
- Preputial adhesions
- Prune belly
- Pyelonephritis
- Undescended testicle
- Urachal reminant
- Urethral prolapse
- Urinary retention
- Urinary frequency
- Uretheral stricture
- Urinary tract infections
- Urinary urgency
- Urogenital sinus
- Ureteropelvic junction obstruction
- Ureterovesical junction obstruction
- Ureterocele
- Retractile testicle
- Scrotal pain
- Skin bridges
- Solitary kidney
- Spermatocele
- Spina bifida
- Testicular cancer
- Testicular atrophy
- Torsion
- Varicocele
- Vesicoureteral reflux
CHOC Urology Center uses a number of tests to accurately diagnose patients. If you have further questions regarding the ultrasounds, X-rays or other radiological studies, please call our radiology specialists at 714-744-8775. Once the test has been completed at CHOC or St. Joseph’s, the child’s caregiver will be notified with the results within two weeks. If you have not heard from the Urology Center with the test results within two weeks, please call the center at 714-509-3919. If the study was done at a different facility, please contact the Urology Center upon its completion so our staff may obtain the results.
Scrotal Ultrasound
Most parents are familiar with ultrasounds from pregnancy. Ultrasounds are noninvasive tests that produce sound waves that transmit a picture onto a screen. Scrotal ultrasounds are used to further investigate the testicles.
Renal/Bladder Ultrasound
Most parents are familiar with ultrasounds from pregnancy. Ultrasounds are noninvasive tests that produce sound waves that transmit a picture onto a screen. With a renal ultrasound, a transducer (the wand) is passed over the kidney and allows us to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst or other obstruction or abnormalities.
Voiding Cystourethrogram (VCUG)
A VCUG is a specific X-ray that examines the urinary tract and allows specialists to see a direct image of the bladder and a refluxing ureter if present. A catheter (hollow tube) is placed in the urethra, and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The images show if there is a reverse flow of urine into the ureters and/or kidneys. The images also show the size and shape of the bladder and the urethra. VCUGs are a common procedure, but because some children and parents find the catheter to be unpleasant, a numbing gel may be used to ease any discomfort. Speaking with the child before the procedure about what they should expect to experience can help ease anxiety. The more relaxed the child is during the procedure, the less discomfort they will feel.
Flow Rate and Post Void Residual
A flow rate is often completed at a child’s visit who has incontinence, urinary urgency or frequency, UTIs, hypospadiasis, vesicoureteral reflux or meatal stenosis. The child will be asked to drink water before the procedure so that they are comfortably full of urine. The child will then urinate in a special toilet that has a small cup at the base to collect the urine. This cup sits on a small scale (like a kitchen scale) which is connected to a computer. The computer is able to analyze information about the urination stream for the providers. This test is not invasive and the patient will be voiding as they do regularly. A postvoid residual (PVR) measurement may be performed to determine if the patient is able to empty the bladder. This is commonly done directly following a flow rate. After a patient urinates, a small scan of the bladder, using ultrasound, will be completed. This allows the providers to see how much urine was left in the bladder after the child voided. This test is not invasive.
KUB X-ray
A kidney, ureter, and bladder (KUB) X-ray may be performed to assess the abdominal area for causes of abdominal pain, or to assess the organs and structures of the urinary and/or gastrointestinal (GI) system. A KUB X-ray may be a diagnostic procedure used to assess the urinary system or intestines. X-rays use invisible electromagnetic energy beams used to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially treated plates (similar to camera film) and a “negative” type picture is made (the more solid a structure is, the whiter it appears on the film). Learn more about KUB X-rays.
MRI
MRI is a diagnostic procedure that uses a combination of a large magnet, radio frequencies and a computer to produce detailed images of organs and structures within the body. Learn more about MRI.
Video Urodynamics (VUDS) and Urodynamics (UDS)
Urodynamic testing is performed to measure the pressure inside the bladder when it is empty, filling and voiding. Two thin catheters are used in this test. One catheter is inserted through the patient’s urethra and into the bladder. The other catheter is placed into the patient’s rectum and the bladder is then filled with water. The pressure inside the bladder, rectum and abdomen is monitored. This test allows the healthcare provider to measure the pressures, muscle contraction and capacity of the bladder. During a video urodynamic test, a VCUG is done during the urodynamic procedure to visualize the urethra, bladder and ureters.
DMSA Renal Scan
This is a nuclear medicine test completed to provide images of the kidneys that will help to identify if there are areas of damage to the kidney. There are no dietary or activity restrictions before or after the test. This test may take several hours and our team recommends bringing toys and books from home for the child. Learn more about the DMSA renal scan.
Mag 3 Lasix Renal Scan
A Mag 3 Lasix renal scan is a nuclear medicine test that provides images of the kidneys to look for kidney function, size, shape, position and blockage of urinary flow. There are no dietary or activity restrictions before or after the test. Because this test can take up to two hours, please bring books and toys from home for the child. Learn more about Mag 3 Lasix renal scan.
Biofeedback
Biofeedback is completed by a specialized nurse who teaches patients how to use their pelvic floor muscles correctly. A child will use their pelvic floor muscles to play computer games to help increase their control of these muscles. Biofeedback is non-invasive but does require the placement of stickers with sensors onto their skin around the pelvic area.
Urine Dip
A urine dip is completed in the office with a sterile sample of the child’s urine. If the child is toilet trained the sample will be taken in a small sterile cup while your child urinates regularly in the restroom. If the child is not yet toilet trained a catheter or a small bag placed over the genitals is used to collect the urine. This urine is then examined in the office to look for the particular abnormalities such as blood or proteins.
Microscopic Urine Analysis
Using the same technique to collect urine from the child as in a urine dip, the urine sample is then sent to an outside laboratory for more in-depth examination. A microscope is used to look at the urine to identify if there are particular abnormalities. This test is performed if a urinary tract infection is suspected.
Urine Culture
If a urine specimen shows bacteria, a urine culture is often completed. The bacteria is then grown in a laboratory for 24 hours to determine what type of bacteria and what medications will treat the bacteria most effectively.
24-Hour Urine Collection
A 24-hour urine collection is often completed in children with a history of renal or bladder stones. Urine is collected in a designated container for a full 24-hour period. When collecting urine for the 24-hour period, the child’s first urination for the day is not included. The urine is then collected for the remainder of that day and night and the first urination the next morning is included. This collection is then sent out to a laboratory that analyzes the urine to help determine what may be causing the body to produce stones.
Creatinine level
A creatinine level is requested in some children with concerns of renal disease. This is a standard blood test completed at an outside laboratory. Creatinine is filtered out of the blood by the kidneys. If a kidney is filtering poorly, the creatinine levels in the blood will rise.
In-Office Procedures
At CHOC Urology Center, we are able to perform a number of procedures that are often associated with outpatient hospital visits. Procedures done in our center not only provide children with the comfort of our office atmosphere and friendly staff, but also alleviate the need to drive to more than one location to get a child’s care.
Many procedures can be completed on the same day as a child’s initial visit (if the patient’s insurance allows). In-office procedures also allow the entire urology team to be present and provide patients and their families with the most current education and post-operative instructions. All procedures done in the office are done with the use of topical anesthetic creams, which can take up to 40 minutes to take effect, and not general anesthesia or needle sticks. There is little to no bleeding with these procedures, and we work hard to minimize the child’s pain.
Please note that not all children with these conditions may be good candidates for in-office procedures. Some children may need to have these procedures done in an operating room as an outpatient surgery. Our specialists carefully evaluate the overall health needs of each child before determining the most appropriate setting for the patient’s treatment. Learn more about how to prepare for your child’s upcoming appointment .Circumcision
Newborn circumcisions can be completed in healthy infants in our office with a fellowship-trained pediatric urologist. We use local anesthesia for infants to minimize their discomfort during and after the procedure. Our office uses the plastic bell circumcision method. The procedure generally is done within 30 minutes and the child comfortably goes home. The plastic bell remains on the penis for a set amount of days.
Lysis of Preputial Adhesions
Labial adhesions occur in female children when their labial minora have failed to separate completely and there is a fibrous membrane connecting them. A child may appear to have a thin membrane covering her vaginal and/or urethral openings. In some cases, these adhesions are treated with creams or time. If the child’s urology specialist determines that a lysis of adhesions is necessary, the procedure is commonly completed in the office.
Once the local anesthetic cream has taken effect, one of our licensed physicians or nurse practitioners will lyse (remove) the adhesion with a small probe or clamp.
After the procedure, the patient may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for pain if needed. An antibacterial ointment will need to be applied between the labial four to five times per day for the first four to five days after the procedure to prevent the adhesions from reforming.
Lysis of Labial Adhesions
Labial adhesions occur in female children when their labial minora have failed to separate completely and there is a fibrous membrane connecting them. A child may appear to have a thin membrane covering her vaginal and/or urethral openings. In some cases, these adhesions are treated with creams or time. If the child’s urology specialist determines that a lysis of adhesions is necessary, the procedure is commonly completed in the office.
Once the local anesthetic cream has taken effect, one of our licensed physicians or nurse practitioners will lyse (remove) the adhesion with a small probe or clamp.
After the procedure, the patient may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for pain if needed. An antibacterial ointment will need to be applied between the labial four to five times per day for the first four to five days after the procedure to prevent the adhesions from reforming.
Meatotomy
After a circumcision, a membrane may heal across the urethra of the penis. This is often found during a physical examination by the child’s doctor or discovered when a child “sprays” urine when he begins toilet training. This small membrane is called a meatal web.
We will ask your child to urinate for us to obtain an uroflow and post void residual prior to the procedure. This allows us to determine the speed of his urinary stream and how much urine he empties. The child should come to the appointment with a comfortably full bladder.
After completing the urination tests, a local anesthetic cream is applied into and around the urethra. The web will be cut in the office and we will ask the child to urinate after the procedure to see if there is a change to his urine flow.
The child may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for pain as needed. The child should be encouraged to urinate frequently throughout the first three days to help the opening heal. Antibacterial ointment should be applied into the urethral opening several times each day to help reduce the chances of this web reforming for one week.
Separation of Skin Bridge
A skin bridge is a piece of skin that has adhered itself to the glans of the penis after a circumcision. This looks similar to a preputial adhesion with the difference being that the physician or nurse practitioner can place a probe or other device underneath the bridge of extra skin. These bridges often do not cause pain, but as a child ages, depending on the significance of the bridge, it may cause his penis to appear tethered, or bent, when erect.
Local anesthetic cream is applied around, over and under the bridge. This bridge will then be separated and taken down by either a physician or nurse practitioner in our office. After the procedure the child may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) as needed for pain. Our specialists will provide specific instructions on how to apply an antibacterial ointment in order to prevent the skin bridges from re-adhering.
The CHOC Urology Center provides patients and their families with the most current, evidence-based diagnoses and treatments.
Our division supports a robust research team, led by our clinical epidemiologist, Carol Davis-Dao, Ph.D., and supported by medical and undergraduate students from the University of California, Irvine and other local universities. As a part of our Pediatric Urology Fellowship Program with the University of California, Irvine, our Research Fellow is a key member of the research team.
UCI/CHOC Pediatric Urology Fellowship Program
As a fellow in the UCI/CHOC pediatric urology fellowship, you will be a part of one of the top urology programs in the country and will work alongside our physicians and nurse practitioners who see almost 900 patient each month. We perform approximately 1,200 surgical cases annually, with fellows involved in a majority of the cases to ensure you’re receiving the experience and guidance needed.
Learn more about the Pediatric Urology Fellowship Program.
Urology Clinical Studies
We are involved in a diverse range of urology clinical research studies, including the following:
- Founding member of the Western Pediatric Urology Consortium (WPUC), a group of leading institutions that have come together to conduct multi-center research focused on pediatric urology
- Prospective study of patients with vesicoureteral reflux focusing on treatment by risk stratification
- Society for Fetal Urology Prenatal Hydronephrosis Registry, a multi-center study focusing on patients with hydronephrosis
- Spina Bifida Registry supported by CHOC Foundation One Wish Grant, studying the population of patients with spina bifida and neurogenic bladder
- Hypospadias repair outcomes study, focusing on improving hypospadias surgical techniques and further understanding the causes of hypospadias
- Home bladder pressure and volume monitoring study to teach and learn more about home manometry for neurogenic bladder patients
- Multi-center randomized controlled trial of a new medication for treatment of neurogenic bladder
We also collaborate on basic science research with co-investigators in the Department of Urology at the University of California, Irvine.
For more information about our urology research program, please contact Dr. Davis-Dao at: [email protected]
CHOC Urology Location
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