Pediatric Urology Surgery

Paediatric Urology is subspecialty of Paediatric Surgery which deals with birth defects as well as after birth diseases of Kidneys, Ureters, Bladder, Urethra and Sexual organs (Penis and Testes in males and vagina, uterus and ovary in female)

Kidneys are made up of small units called as Nephrons. Birth defects (congenital abnormalities) of kidneys as well as acquired disease can lead to damage to developing nephrons of child.

However kidney has good regeneration capability hence early detection and correction can repair the damage.
Many urological problems now can be treated with watchful observation. Many of the diseases can be operated using minimal access surgery or endoscopic surgery thus avoiding open surgery. However many conditions need open surgery. Technical expertise, use of high end equipments and use of magnifying glasses (surgical loupes) has improved the results of open surgery.

Common urological problems are:

1. Phimosis
2. Undescended testis
3. Hypospadias
4. Hydronephrosis
5. Vesicoureteric reflux
6. Posterior urethral valves
7. Disorder of sexual differentiation (DSD)

Pediatric Surgery

“Child is not a small Adult”. Hence principles applicable for adults cannot be applicable for children. Treating children especially with surgical problems need empathy, compassion, caring attitude and most importantly passion. Another important aspect that comes with this branch is an emotion attached With the child. So moral support to parents is an added responsibility of the treating surgeon.

Whether it is a surgical expertise required to handle delicate and small structures or dealing with kids bodily or emotional response to disease and surgery every small thing in paediatric surgery needs special attention. That makes this branch separate from general surgery.

This speciality involves treating children from newborn period to 18 years of age. It is a team work of Pediatric Surgeon & Pediatric anaesthetist (Technical excellence), intensives (medical Expertise), paramedical staff (loving support) and counsellor (moral Support).
We offer a full range of surgical services to our patients working all hand in hand.

Common problems we treat:

1. Congenital Inguinal hernia and hydrocele
2. Umbilical hernia
3. Umbilical granuloma
4. Rectal polyp
5. Intussusceptions
6. Congenital Diphragmatic Hernia
7. Esophageal Atresia

Pediatric Minimal Access Surgery

The field of minimal access surgery (MAS) is rapidly evolving. It is associated with less painful incisions, shorter hospitalizations, faster return to normal activity, and a shorter recovery period. Naturally, infants, children, and adolescents represent an ideal population who will benefit from MAS techniques. Parents favor eliminating the surgical insult and want improved cosmetic outcomes.

The pediatric surgical community has embraced MAS, and most common procedures in children are carried out via a telescopic approach through incisions as small as 3 mm. In fact, surgery for appendicitis, cholecystitis, pyloric stenosis, gastroesophageal reflux disease, and inguinal hernias are common procedures performed by pediatric surgeons using MAS.

HYPOSPADIAS AND DISORDER OF SEXUAL DIFFERENTIATION (DSD)

Hypospadias means opening of peephole on under surface of penis and not at the tip. Depending on location of opening, it can be distal (near the end of penis), mid – penis or proximal (near the base of penis).
Hypospadias surgery is highly skilled and technically demanding surgery. It should be done only by paediatric urologist who has been extensively trained for this surgery. Since specific surgery to be performed differs from patient to patient. Hence who has got experience and witnessed all types of surgeries for hypospadias, should only attempt this surgery.

Principally this anomaly include three abnormalities

1. Abnormal opening of meat us (on under surface of penis)
2. May be associated with chordee (that is bending of penis)
3. May be associated with small size penis

Small size penis can be managed by local application or intramuscular injections of sex steroid hormones. However other two abnormalities need surgery.

DISORDERS OF SEXUAL DIFFERENTIATION (DSD)
This is the set of disorders in which there is difference in external and internal sexual organs. Clinical features can be confused appearance of genitalia (external sex organs), menstrual irregularities in adolescent girls or abnormal sexual orientation.

We are privileged to have a team compromising of Pediatric Urologist (dr. Dinesh Sarda), Paediatric Endocrinologist (Dr. Hari Mangtani), Gynaecologist (Dr. Swati Sarda) and Counsellor.
In last 3 years more than 60 cases have been registered. Out of them 23 cases has been corrected surgically.

FAQs

1. Why this abnormality has happened?

Answer: There is no specific reason why your child developed this abnormality.

2. What is the treatment of this abnormality?

Answer: This abnormality can be corrected by surgery.

3. Can this be managed without surgery and what if we do not operate?

Answer: No medicine can cure this abnormality. If we do not operate his penis will keep on growing in bent position. In such circumstances child will not be able to pee in standing position like any other normal child. In adult life, there may be difficulty in sexual intercourse because of bent penis.

4. What should be appropriate time to operate?

Answer: Appropriate time to operate is 1 to 1.5 years of age. This is because in case if he requires 2nd step surgery , that can be done at 2.5 years of age (1 year later) so that he is free before his schooling starts at 3 years of age.

5. Do you mean that he will need more than one stage? Can it not be done in one step?

Answer: Most of the surgeries can be done in single step. However few times two stage surgery may be required for severe cases of hypospadias. Or in case some complication arises, second surgery may be required.

6. Oh… What can be complications of this surgery?

Answer: Two major complications are disruption or fistula formation. Many of fistulas heal by themselves spontaneously. However persistent fistula or disruption requires second surgery. Chances of this complication is around 5 to 10 %.

7. How big is surgery? What is the risk?

Answer: Surgery is not high-risk provided child is not having concomitant medical illness like sickle cell disease, heart conditions, convulsions, asthma etc. However, surgery is highly skilled need to be done delicately and with great expertise.

8. For Any other queries author may be contacted.

PEDIATRIC RECONSTRUCTIVE UROLOGY:

Majority of by birth defects of urinary and genital system involve some or other deviation from mormal structure leading to complications.

Reconstructive urology means redefining and reconstructing the abnormal anatomy into normal/near-normal anatomy or making in function in normal way.

This involves high expertise, analysis and anticipation of bio-physics, team support, proper preoperative evaluation, and high end medical gadgetries.

We offer following reconstructive surgeries.

1. Hypospadias surgery (Simple to complex)
2. Genitoplasty (Sex reversal surgery)
3. Ureteric reimplantation for Vesicouretericreflux
4. Pyeloplasty for PUJ ObstructionExtrophy Bladder Repair.

PEDIATRIC ENDOUROLOGY

Now with latest new technology, small size telescopes are available. We have smallest elescope 1.8 mm and cystoresectoscope 8 F which can be used even for infants as well. Many surgeries can be done using end urology, thus avoiding open cuts for surgery.

1. Cystoscopy: it is process in which a small instrument is passed through pee hole (under anaesthesia) and interior of urethra and bladder can be examined. Many surgeries can be done through cystoscope itself like
a. Fulgration of Posterior Urethral Valves (PUV)
b. Incision for Stricture Urethra
c. Polyp in Urethra
d. DJ Stenting
e. DJ stent Removal
f. Incision for Ureterocele
g. Deflux Injection for Vesicoureteric Reflux
h. Botox injection on bladder neck (Incontinence of urine)

2. Ureterorenoscopy: It is a procedure by which interior of ureter (Kidney pipe) and kidney can be examined. Stones in lower ureter can be removed.

3. PCNL (Per cutaneous Nephro Lithotomy) : It is a surgery done through small hole in back for removal of kidney stone.