Ask the Experts: Summer 2023

My child is going to have chemotherapy. Will they be able to have children?

Chemotherapy (chemo) for cancer in children is often very effective. These drugs do come with side effects, some of them long-term. This includes the risk of infertility, or not being able to have biological children.

Some chemo drugs are more likely than others to lead to infertility. These include drugs called alkylating agents, which are used to treat many types of cancer, like some lymphomas. Doctors try to use the lowest possible dose of these drugs for children. This lowers the risk of permanent damage to reproductive organs. In some rare cases, the reproductive organs may have cancerous tumors and need to be removed.

Before your child starts treatment with chemo, ask your doctor whether it is likely to affect your child’s future fertility. Ask if there is something that can be done to protect their fertility during treatment. Also, find out how you will know whether your child’s fertility was affected by the treatment.  If your child’s fertility is likely to be affected, ask yourself and your child (if they are old enough to understand) if a procedure to preserve fertility is right for your child.

Girls who have gone through or are going through puberty can freeze their eggs. This requires about two weeks of fertility drug treatment in advance. For girls who have not gone through puberty, freezing ovarian tissue for later transplantation may be an option. This is an outpatient procedure with a general anesthetic. In some cases, the doctor may advise against tissue freezing.

Boys who have gone through puberty can bank their sperm. Sperm banking is when sperm is collected and frozen after a boy masturbates. For boys and younger teens, sperm banking may not be possible for many reasons. These can include spinal cord disease or being unable to masturbate. In these cases sperm can be extracted or aspirated, or electroejaculation is used. For prepubertal boys, the only option for fertility preservation is testicular tissue cryopreservation.  In this case, a wedge biopsy of testicle is obtained in the operating room under general anesthesia. The specimens are frozen for future use.

The ability to preserve ovarian or testicular tissue may require the institutional review board to get involved.  Ask your child’s oncologist who will know these details. Also, it is of value to know that there may be an annual charge to keep the sperm, eggs or tissue frozen.

Always talk to your doctor about which option is best for your child.

Dr. Rosalia Misseri, a pediatric urologist at Riley Hospital for Children, specializes in management of adolescent patients and adult patients with congential urogenital abnormalities.

How common is urologic cancer in kids?

Cancer in children and teens is rare.  Fewer than 16,000 children and teens are diagnosed with cancer each year in the United States. The most common types of cancer in children and teens are leukemia, brain and central nervous system tumors and lymphoma.

Urologic cancer in children and teens is even more rare. The most common types are kidney, testicular, bladder and prostate cancer. There are about 650 to 750 cases of children’s kidney cancer in the U.S. each year. There are 500 to 1,000 cases of testicular cancer and about 100 cases of bladder or prostate cancer in children and teens each year.

The most common type of kidney cancer in children is called Wilms’ tumor. It affects a total of 450 to 500 children every year in the U.S. It occurs a little more often in girls. Wilms’ tumor is most often found in children younger than 5. It has a high cure rate with treatment.

Testicular tumors rarely happen in boys before puberty. The odds of a boy having a testicular tumor are about 1 in 100,000. In infants and boys, they make up about 1 to 2% of all tumors.

Depending on the type of cancer and whether it has spread, testicular cancer may be treated with surgery. In some cases the surgeon can remove the cancer without removing the testicle. In other cases, the cancer is removed along with the testicle. Treatment may also involve chemotherapy and radiation. Most boys who had one testicle removed and still have one healthy testicle can father children later in life. 

Dr. Amanda North, a pediatric urologist at The Children’s Hospital at Montefiore, specializes in the care and treatment of children with all forms of congenital anomalies of the urinary tract, as well as complex voiding problems of childhood.

What is prenatal hydronephrosis?

Hydronephrosis is when urine backs up into the kidney. This causes swelling in the kidney's drainage system. When found during pregnancy, it is called prenatal hydronephrosis.

Prenatal hydronephrosis is pretty common and affects about 1 in 100 babies. In fact, it is the most common issue found in a scan before birth.

Most cases are diagnosed before birth. If a scan finds the problem, the doctor may suggest more scans to find out if it is getting better or worse.

If the scans suggest the baby may need surgery, the doctor may suggest the mother give birth at a hospital in a special unit so the baby can go right into surgery. In less severe cases, the baby may need surgery, but not right away.

In other cases, the doctor may suggest watchful waiting or drugs to prevent urinary tract infections. In about half the cases, the problem goes away by the time the baby is born.

In some cases, hydronephrosis that is severe or left untreated can cause urinary tract infections, kidney scarring and loss of kidney function that may cause long-term problems. Most cases go away within a child's first few years, often without need for surgery.

Dr. Eric Kurzrock, a pediatric urologist at the University of California, Davis School of Medicine, specializes in the diagnosis and treatment of hypospadias, prenatal and congenital hydronephrosis, hernias, hydroceles, neurogenic bladder, sexual ambiguity, undescended testicles, urinary infection and vesico-ureteral reflux.