Hypospadias is a common congenital urological disease, it could be left without treatment if the condition is not too bad. Doctors may suggest a surgery to fix the problem if needed. Urine and sperm travel through the urethra, that tube which opens at the tip of the penis. Boys who have Hypospadias have that opening on the underside of the penis. Depend on the location that where the opening is, it may be a reason for mild or more serious issues like redness or infection. There are three kinds, depending on urethra location
There is no surety about causes of hypospadias, however, some of the reasons are
Doctors can identify hypospadias by examining the baby’s penis. It could be grasped easily if the opening is at a wrong place.
In some of the cases, penis also curves in a downward arc, which doctors call chordee, it can be seen at the time of erection.
For Hypospadias, surgical procedure take place as a treatment option, At Pushya Hospital experienced urologists carefully examine the children and then plan whole surgical procedure , so that there will be best expected results only.
PUV is one of the most common causes of severe types of urinary tract diseases in children. It is an abnormal condition of the urethra. Urethra is the tube which drains urine from the bladder to the outside of the body for elimination. Abnormality takes place when urethral valves, which are small leaflets of tissue, consist of a thin slit-like opening which hampers urine outflow. When a reverse flow of urine occurs it can affect all of the urinary tract organs as urethra, bladder, ureters, and kidneys, generally, these organs swell, causes’ tissue and cell damage. Level of urinary outflow obstruction will determine the severity of urinary tract problems.
Symptoms of PUV can be noticed in different degrees from mild to severe. However, each child experiences different symptoms. Following are most common symptoms as
At Pushya Hospital, we use specific and suitable surgical procedures and medications so that your child could go home free from his PU Valve, generally, our urologists use following for PU Valve treatment
Medicines - Medicines only, cannot work efficiently for treatment of PUV, medicines use additionally with a surgical procedure for severe problems, as in the case of severe hyperactivity of that muscle, which makes bladder muscle stiff. Anticholinergics/Antimuscarinics, Antispasmotics or sympathomimetics.
Surgery - In the maximum of the cases, PUV is treated with a surgical procedure called endoscopic incision of valves. It is also known as valve ablation or posterior urethral valve ablation, in this surgical procedure, the surgeon trims down the excessive tissue of valves. It is a minor and minimally invasive procedure and requires a small incision at the site of the ablation (removal ) of the valves.
When the child is in the impact of anesthesia, a surgeon inserts a small telescope called a cystoscope into the urethra. With the help of cystoscope, the surgeon could view the interior lining of the bladder and urethra on the monitor.
Now, the surgeon can use imaging to examine the obstruction and remove the valves.
Phimosis is condition seen in children, it is related with the foreskin of the penis. It is the condition when the foreskin of the penis cannot be pulled back (retracted) from the tip of the penis. Phimosis has been noticed as a common problem in young boys.
Phimosis is the cause of tightening of an opening of the foreskin. This condition is considered normal for the newborn baby. With the time, the foreskin loosens and can be pulled down more easily. Generally, by the age of 17, most boys will be able to fully retract their foreskin. This problem can also occur if the foreskin is pulled forcefully before it is ready, it can cause the fibrous scar to form. It can keep the foreskin from retracting in future.
Investigation for Phimosis include child’s physical examination, this physical examination includes penis and foreskin.
At Pushya Hospital we prefer surgical treatment for phimosis. In children general anesthesia and in elder patients spinal aneasthesia is preferable.
An undescended testicle (cryptorchidism) is a testicle which does not move into its proper position in beg of skin, hanging below the penis before birth. In these cases usually one testicle is affected, but in some chances both testicles are undescended. This condition is not a very general one but common among premature baby boys. Usually, the undescended testicle moves into the proper position of its own, in some months after birth. If it do not happen naturally then surgery can relocate a testicle into the scrotum.
An exact reason for the undescended testicle is not known but a combination of genetics, maternal health, and other environmental factors may affect or disrupt hormones. Physical changes or nerve activity also influence the development of testicles.
Risk factors for lower birth weight, premature birth, family history, conditions in which fetus growth effects as abdominal wall defect, smoking or alcohol usage or parent's exposure to some pesticides.
An undescended testicle can be identified during after birth examination. If the testicle is not moved into the scrotum till 4 months of birth, the problem probably would not correct itself. Treating this condition at an early age lowers risk of complications later in life as infertility and testicular cancer.
From infants to pre-adolescent boys- who have normally descended testicles at birth could be with “missing” a testicle later. This condition may be as
Laparoscopy:- A small tube which contains a camera is inserted through the small incision in the baby’s abdomen. Laparoscopy is done to check an intraabdominal testicle. There are chances that doctor can fix undescended testicle in this surgical procedure but an additional surgery could be necessary according to the case.
In other cases, laparoscopy might show no testicle present or a small remnant of which have nonfunctioning testicular tissue than it could be removed.
Open surgery - Direct examination of abdomen or groin through larger incision may be necessary in some cases.
If after birth it remains difficult to detect any testicles in the scrotum, further testing could be done.
An undescended testicle is generally corrected with surgery, the surgeon carefully places correct testicle into the scrotum and stitches it (orchiopexy). This procedure can be done with both open and laparoscopic surgery. Child’s surgery depends on the number of factors as his health and how difficult would the procedure be. Surgery is preferable when the child is 6 months old and before completing 12 months. At this age surgical treatment has a lower risk of complications.
In the case when testicle is poorly developed, having abnormal or dead tissue, then the testicular tissue is removed during the surgical procedure.
If the child has an inguinal hernia associated with an undescended testicle, the hernia can be repaired during the surgery.
After surgery surgeon keeps monitoring on testicle for proper functioning and stays properly, it may include physical examination, ultrasound examination of scrotum and hormone level examination.
Ureteropelvic junction obstruction is a blockage in the territory which associates the renal pelvis (some portion of the kidney) to one of the tubes (ureters) that move urine to the bladder. In most of the cases, Ureteropelvic junction obstruction happens when a child is developing in the womb. This is known as an inherent condition (present from birth).
More often, the blockage is caused when the association between the ureter and the renal pelvis does not grow ordinarily and makes urine develop, potentially harming the kidney. The condition can likewise be caused when a vein is situated in the wrong position over the ureter, causing a twist or kink in the ureter. In youngsters and grown-ups, ureteropelvic intersection check can be because of scar tissue, contamination, past medications for a blockage or kidney stones.
Ureteropelvic junction obstruction is the most analyzed reason for urinary impediment in kids. It is one of the most commonly done pre-birth ultrasound procedures. Sometimes, the condition is not noticed until after birth. Kids may have a stomach mass, urinary tract disease, or torment in the stomach or side.
Ultrasound examination during pregnancy may reveal kidney problems in an unborn baby. However, there are some tests which include:
Surgery takes place to correct the blockage which allows urine to flow normally and it can take place through open or laparoscopic methods. Both of the methods are called a pyeloplasty and it includes removing the abnormal part of a ureter and connecting it again to the kidney for a normal urine flow.
Open and laparoscopic surgery both have the similar success rate, but laparoscopic procedure allows to return home sooner in the comparison of open surgery.
Vesicoureteral reflux is the abnormal flow from your bladder back up the tubes (ureters) which connects kidneys to the bladder. Normally, urine flows only down from the kidneys to the bladder. This problem is usually diagnosed in infants and children. This disorder of urine flow, increase the risk of urinary tract infections, which can lead to kidney damage.
Infants may have a fever in the condition of Vesicoureteral reflux, it is the common symptom in them:
At Pushya Hospital, we have urological experts, who can catch the issues with slight observation and prescribe the perfect solution for delicate children as:-
Medications - Doctors prescribe antibiotics with immediate effect to keep the infection in control from moving to kidneys. A child who is being treated with medication needs to be monitored as long as he/she is taking antibiotics. Monitoring includes periodic physical examination and urine tests so that your doctor could detect infections or UTIs. UTIs which occur despite the antibiotic treatment could be tracked with the help of radiographic scans of bladder and kidneys which ultimately turns vesicoureteral reflux.
Surgery - Surgery for vesicoureteral reflux repairs the defect in the valve between bladder affected ureter.
Open Surgery - Using Anesthesia, surgeon gives an incision in the lower abdomen, by which the surgeon repairs malformation which is the ultimate cause of a problem. This surgery demands a few days stay in the hospital, a catheter generally placed so that the bladder could be drained.
Robotic assisted laparoscopic surgery - This procedure also involves procedure of repairing valve between ureters and bladder as open surgery, but Robotic surgery uses small incision. This surgery includes some advantages as smaller incision and possibly less bladder spasm than open surgery. But not as successful as an open surgery however it includes longer operating time but a shorter hospital stay.
Endoscopic surgery - In this surgical procedure, the surgeon inserts a lighted tube (cystoscope) through the urethra to see inside the bladder, then injects a bulking agent around the opening of affected ureter so that surgeon could check and try to strengthen the valve’s ability to close properly.
When this surgical method is compared with open surgery and presents fewer risks and requires general anesthesia.
Megaureter is an abnormal condition of one or both ureters of the child. Ureters are two funnel-shaped tubes which carry urine from a kidney to bladder. A megaureter refers to an expanded or widened ureter which is not working normally. Usually, the size of a megaureter is greater than 10 millimeters in diameter.
Complications which are related with this disease include reverse flow of urine into the kidneys and pooling of urine inside ureter which does not drain. This pooling can cause a child to develop a urinary tract infection, which can lead to kidney damage and failure.
A megaureter occurs during fetal development, it occurs when a section of ureters which is a normal muscular layer of tissue, is replaced by stiff, fibrous tissue. In the absence of muscular layer, normal peristalsis (worm-like movement of ureters which help to move urine toward bladder) cannot occur. Megaureter can occur alone but usually occurs in combination with other disorders, like prune belly syndrome.
Generally, megaureter can be detected on prenatal ultrasound but sometimes a child is referred to a pediatric urologist or pediatric surgeon after noticing one of the following symptoms during early childhood.
At Pushya Hospital, we use specific treatment options perfectly suitable according the case, so that every child would be recovered from Megaureter. If the investigation proves a block or impaired kidney function, in this case, the child may be needed a surgery to fix it. Surgery for megaureter involves putting ureters back into the bladder (ureteral reimplantation) and trimming the widened ureter. If the child does not have a urinary tract infection, surgery can be delayed till the age of 12 months. Till that time antibiotics can be given to child to prevent infection.
Open Surgery - In the case of kidney function problem, open surgery requires an incision; it is one of the preferred surgical method. The surgeon makes a cut in the lower belly. Depends on specific condition, surgeon will get to the ureter either through bladder (transversal) or from outside the bladder (extravesical) and then removed.
If ureters are very wide, it may need to be trimmed (tapered) and blockage also can be removed.
For refluxing megaureters, the reflux (urine back-up) is corrected and for wide ureters, the ureters can be trimmed.
Baloon Dilation - Baloon Dilation
Laparoscopy surgery - This surgical procedure is done through thin tubes which insert by the surgeon through small cuts. For the procedure, the surgeon uses a special camera to see inside the body and miniaturized tools. This surgical procedure does not come in easy surgeries and requires highly skilled surgeons.