Congenital Diaphragmatic Hernia (CDH) is a rare but serious birth defect where a hole in the diaphragm allows abdominal organs to move into the chest cavity, impacting lung development. Though primarily a surgical and neonatal concern, CDH often has ripple effects on various systems—including the urinary tract, requiring evaluation by a pediatric urology clinic, especially in cases presenting with bedwetting, child fever, or foul-smelling urine.
What is Congenital Diaphragmatic Hernia (CDH)?
- CDH occurs when the diaphragm (the muscle separating chest and abdominal cavities) does not fully form during fetal development.
- This creates a gap through which abdominal organs (intestines, liver, spleen) can migrate into the chest.
- It results in underdeveloped lungs (pulmonary hypoplasia) and respiratory distress in newborns.
Types of CDH
- Bochdalek hernia – Most common (posterolateral defect), usually on the left side.
- Morgagni hernia – Rarer (anteromedial defect).
- Diaphragmatic eventration – Diaphragm is thin and poorly muscularized, not a true hernia.
Symptoms of CDH in Newborns
- Difficulty breathing immediately after birth
- Cyanosis (bluish color due to low oxygen)
- Fast heart rate and rapid breathing
- Scaphoid (sunken) abdomen
- Decreased breath sounds on one side
- In some chronic or delayed-diagnosed cases:
- Feeding issues
- Recurrent pneumonia
- Straining or pressure symptoms that may affect urinary function like bedwetting, daytime wetting, or painful urination (dysuria)
Diagnosis and Evaluation
- Prenatal ultrasound often detects CDH during pregnancy
- Fetal MRI or echocardiography may assess severity
- Postnatal chest X-ray confirms herniation
- If urinary issues are present, the following may be evaluated:
- Urinalysis (for UTI, foul-smelling urine)
- Renal ultrasound to check for associated kidney anomalies
- Functional tests for child nephrolithiasis or urinary incontinence
CDH may be associated with other congenital anomalies—including genitourinary malformations, requiring a multidisciplinary approach involving pediatric nephrology and pediatric urology.
Complications and Associated Conditions
- Pulmonary hypoplasia (underdeveloped lungs)
- Pulmonary hypertension
- Gastroesophageal reflux (GERD)
- Delayed growth
- Urinary tract abnormalities, including:
- Dysfunctional voiding
- Neurogenic bladder due to thoracic pressure
- Pediatric UTI
- Recurrent bedwetting or daytime wetting
- Foul-smelling urine and risk of child nephrolithiasis
Treatment Options for CDH
Stabilization After Birth
- Oxygen or mechanical ventilation support
- Correction of pulmonary hypertension
- Nutritional support via IV or feeding tube
Surgical Repair
- Once the baby is stable, surgical closure of the diaphragmatic defect is performed
- In severe cases, patch grafts may be used
- Minimally invasive or open surgery depending on size and complexity
Post-Surgical Monitoring
- Respiratory rehabilitation
- Nutritional therapy
- Kidney and urinary function surveillance to prevent long-term complications such as:
- Urinary incontinence
- UTI
- Painful urination (dysuria)
- Renal scarring or hydronephrosis
When to See a Pediatric Urologist?
Children recovering from CDH may need to consult a pediatric urologist in Nagpur if they develop:
- Bedwetting or daytime wetting beyond age norms
- Signs of pediatric UTI (pain, odor, fever)
- Painful urination or blood in urine
- Symptoms of child nephrolithiasis (kidney stones)
- Bladder dysfunction due to chronic pressure or surgery
An expert pediatric urology clinic can perform bladder function tests, kidney ultrasounds, and provide both medical and surgical interventions if needed.
Why Pediatric Urology Follow-Up Matters After CDH Repair
- CDH can indirectly affect kidney and bladder function due to pressure on thoracic and abdominal structures
- Post-surgery children may develop bladder dysfunction, reflux, or incontinence
- Early urology care prevents renal damage, recurrent UTIs, and urinary stress
- A combined care model with nephrology and pulmonary specialists ensures the child grows with full support
Congenital Diaphragmatic Hernia is a serious condition that requires prompt diagnosis, surgery, and long-term care. While the lungs are primarily affected, pressure on abdominal organs may also impact urinary function. If your child shows symptoms of urinary problems, such as foul-smelling urine, bedwetting, or painful urination, after CDH repair—consulting a pediatric urology expert like Dr. Sadashiv Bhole is critical.
Early intervention ensures your child breathes easy and grows healthy—inside and out.
