Paediatric Surgery & Paediatric Urology

 

 

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Phimosis/Circumcision

Undescended Testis, Hernia, Hydrocele

Hypospadias, Intersex

Hydronephrosis (PUJ) Pyeloplasty, Posterior urethral valves (PUV)

Urinary Tract Infection/ Vesico Ureteric Reflux

Urinary Stones in Children

Eneruresis, Bedwetting, Urinary Incontinence, Neuropathic bladder

Paediatric Laparoscopic Surgery (Key Hole Surgery)

Common Paediatric Surgical Problems

Bladder Exstrophy, Multi Cystic Kidney, Wilms Tumor, Emergencies

 

Multi Cystic Dysplastic Kidneys (MCDK)

Wilms Tumour

Testicular Tumours

Torsion Testis 

Kidney Injury

Pyonephrosis

Renal failure

 

Multi Cystic Dysplastic Kidneys (MCDK)

In this problem the entire kidney is replaced by a group of fluid filled cysts. It can present in two ways

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Diagnosed before birth (antenatal scans)

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Mass felt on examination

Ultrasound scan reveals multiple cysts and there is no function on that kidney when tested on DMSA scan. A vast majority of them resolve spontaneously. They may be associated with problems in the opposite kidney (reflux) which may require further tests. If the MCDK is causing pain, infection or hypertension, or if it fails to resolve then an operation is required to remove it. Laparoscopic surgery is possible to remove these.

Wilms Tumour

It often presents as a painless mass on routine examination of the child presenting with common cold and fever. It can also present with pain, fever or blood in urine. The child rapidly loses appetite and weight. CT scan is required to confirm the tumour and extent of spread. Surgery is the mainstay of treatment supplemented by chemotherapy (anti cancer drugs). Unlike adult cancers, it has a very good survival rate when treated carefully.

Testicular Tumours

Young children and adolescent boys can develop tumour of testis which often presents as painless swelling of testis. Surgical removal of testis is  required for diagnosis and treatment. With supplementary chemotherapy good survival can be expected.

Emergencies

Torsion Testis                               

The testis can go for a twist inside the sac it is held. This results in loss of blood supply. If left untreated for more than 6 hours the testis loses function. Typical presentation is a 14 year old boy who develops severe pain, red ness and swelling of the sac of testis suddenly. It is very tender to touch. It is necessary to do a surgery immediately. There is no point in wasting crucial time on different tests. Surgery is diagnostic and also curative; if blood supply returns after untwisting the testis is preserved. If the blood supply is lost the testis may have to be removed. In either case opposite testis has to be fixed to prevent twisting on that side.

Trauma

Kidney Injury

Children can sustain injury to kidney when there is blow to the loin either during a road traffic accident or a handle bar injury during cycling. The damage to the kidney can very from mild to serious type. There may be pain, blood in urine etc. CT scan is often required to confirm the extent of damage. Often the treatment is bed rest. Surgery is required only if there is continuous blood loss.

Urethral Injury

When boys fall on to a branch of a tree while climbing, or on cycle bar during cycling, the urethra located in between the legs is injured. When there is severe injury there will be blood from the tip of the penis and the child might not be able to pass urine; with urine accumulating in the bladder. A temporary diversion of urine directly from the belly may be required.

Pyonephrosis

This term refers to pus in the kidney. This can be a result of obstruction to the urine flow and infection developing in it. It is a very serious problem requiring admission, IV fluids and IV antibiotics. In addition prompt relief of pressure has to be done to prevent complete loss of function in that kidney. The conditions that can lead to this include

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Blockage at the upper end of ureter (PUJ obstruction)

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Blockage at the lower end of ureter (VUJ obstruction)

Renal failure

If both kidneys are blocked then it can rapidly lead to renal failure. There can be very low to absent urine output (anuria). The conditions that can lead to this serious problem, even in the newborn period, include

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Posterior Urethral Valves                                       

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Ureterocele blocking bladder outlet

They need to be carefully treated by experts in the field. Some times a simple catheter can revert the situation. Dialysis may be required before planning definitive surgery. Both of these problems can be tackled by a simple endoscopic surgery, relieving the blockage.

Dr. Ramesh Babu, MS, MCh, FRCS, Paediatric Surgeon, Paediatric Laparoscopic Surgeon and Paediatric Urologist Chennai. For further information contact: drrameshbabu1@gmail.com; Mobile 9840359062

 

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Last modified: 06/19/06