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Thoracoscopic Surgery In Children: What Is It?

Thoracoscopic Surgery In Children: What Is It?

Thoracosopic surgery is a type of minimally invasive surgery that is appropriate for children who require surgery for a variety of chest diseases. Today, a variety of straightforward and complicated surgical chest problems are regularly treated with thoracoscopy. Small incisions allow for minimally invasive surgery, which prevents damage to the muscles and nerves of the chest wall. On the other hand, huge incisions like those utilized in open surgery are uncomfortable and may eventually result in chest wall deformities.

During a thoracoscopic surgery, to see the structures inside the chest, the surgeon uses a thorascope (a small tube with an eyepiece that the surgeon sees through during surgery) and/or an endoscope (a small video camera).

The surgeon can now do procedures that would often require big thoracotomy incisions by using an endoscope to view through them. In order to undergo surgery, patients must be put under general anaesthesia in an operating room.

What are the advantages of thoracoscopic surgery in children?

On the contrary, large incisions as used in open surgery are painful and can cause chest wall deformity in the long run. Patients who have had minimally invasive surgery report the following outcomes when compared to those of regular surgery:

Reduced postoperative discomfort

Reduction in hospital stay

Faster healing and return to work

Less bleeding and a lower chance of infection are two other advantages.

How does thoracoscopic surgery in children work?

Thoracoscopic surgery is carried out by paediatric laparoscopic surgeon. During this procedure, a small incision is made to allow the surgical team to introduce a trocar into an intercostal space. Pumping carbon dioxide into the thoracic cavity creates an interior area for the surgeon to work by separating the body wall from the organs. The surgeon next inserts a thorascope and/or endoscope to view the structures of the chest. The use of tiny instruments is made possible by a number of additional incisions or tiny ports.

For whom is minimally invasive surgery appropriate?

A minimally invasive procedure can be used to perform almost all conventional thoracic procedures.

If thoracic surgery needs to be done, a minimally invasive surgical approach is the first that is considered. However, some procedures are still best carried out using the conventional “open” method. Your surgeon will thoroughly examine you to decide the safest surgical procedure to be used to treat your ailment.

Various thoracoscopic surgery procedures:

Dr. Prashant Jain, one of the finest paediatric surgeons in Delhi, has had great success in removing chest malignancies using minimally invasive surgery. He also performs a few other procedures listed below:

Mediastinal tumor removal

Mediastinal cysts removal

Lung malformations

Empyema

Lung biopsy

Spontaneous Pneumothorax

How can I get a thoracoscopic surgery evaluation?

Your physical exam and treatment choices will be discussed when you visit the laparoscopic surgeon. He will go over the advantages and possible drawbacks of the surgery that is suggested for you.

Preoperative exams typically include:

Blood test

Pulmonary function test

MRI

Electrocardiogram

Depending on the kind of treatment being performed, your surgeon will decide if any extra preoperative testing is required. A cardiologist’s visit will be arranged if a cardiac (heart) assessment is required.

You will consult with an anesthesiologist as part of your preoperative evaluation. During this time, you will talk about postoperative pain management and anesthesia.

In Delhi, Dr. Prashant Jain is a well-known paediatric laparoscopic surgeon. Call (+91) 8766 350 320 to schedule an appointment and get all your questions answered from the expert.

Tag = Thoracoscopic Surgery In Children in Delhi, Pediatric laparoscopic surgeon in Delhi, Best pediatric surgeon in delhi

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Imperforate anus or absent anal opening, also called anorectal malformation, is a birth defect that happens during the development of baby in early in pregnancy, when the baby is still developing.

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Dr. Prashant Jain provides the Treatment for Anorectal Malformation in India

Imperforate Anus/Absent Anal Opening Treatment Delhi, India

Imperforate anus or absent anal opening, also called anorectal malformation, is a birth defect that happens during the development of baby in early in pregnancy, when the baby is still developing. In this defect, the baby’s anal opening (where stool exits) and the rectum (the last part of the large intestine), do not develop properly, preventing the child from to pass stool.

The condition affects one in 5,000 babies, and it is slightly more common in males than in females. In a baby with anorectal malformation, any of the following can happen:

The anal opening is too small or in the incorrect location

The anal opening is absent and the rectum enters other parts like urethra, the bladder, vestibule or vagina, which can lead to infections and bowel obstruction.

The anal opening may be absent and the rectum, reproductive system, and urologic system form a single common opening called a cloaca, where both urine and stool are passed.

At birth, doctors check the position and size of anal opening. New-borns pass their first stool within 48 hours of birth, so internal malformations are detected quickly. If an issue is found, we do a number of tests to better understand the problems and develop a long-term plan for the best outcome. This problem can be associated with other malformations. Various tests which are performed include:

X-rays of the abdomen to show how far the rectum reaches, and to see if there are any problems with the way the lower backbone has developed.

Abdominal ultrasound to find any problems in kidney.

Spinal ultrasound or MRI to look at the spine for a tethered spinal cord, which can cause neurological problems, such as incontinence and leg weakness as the child grows.

Echocardiogram to find heart defects.

These malformations will always require surgical repair by pediatric surgeon in single or multiple stage, but the exact procedure will depend on the type and severity of the defect, any associated health conditions, and the child’s overall health. Depending on the type and severity these babies may require a stoma formation (a temporary diversion of stools from abdominal wall).

Even though corrective surgery may restore some function, important nerves and muscles that tell your child when the rectum is full of stool and help keep the contents inside may be missing or damaged, so we start a bowel management program when they reach toilet-training to help them become clean.

Tags - Anorectal malformation in india, best pediatric surgeon in india, best pediatric surgeon in delhi

For more information link - www.pedsurgerydelhi.com

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Dr. Prashant Jain Provides The Treatment For Thoracoscopic Surgery In Children

Thoracoscopic Surgery For Children

Thoracosopic surgery, is a Minimally Invasive Surgery which uses multiple small incisions, and is suitable for children who need to undergo surgery for various  chest conditions. Thoracoscopy is now very frequently used for various simple and complex surgical chest conditions. Since a Minimally Invasive Surgery can be done with small incisions, this avoids injury to chest wall muscles and nerves. On the contrary, large incisions as used in open surgery are painful and can cause chest wall deformity in long run. Minimally Invasive Surgery have shown great results, with lesser pain, reduced hospitalization, lesser complications and a better cosmetic result  as compared to traditional thoracotomy. However, Thoracotomy will still be needed in some select cases. Dr. Prashant Jain, is one of the best paediatric surgeon in Delhi (India), who has achieved excellent results in the removal of chest tumors through minimally invasive surgery. Following are some other procedures that he performs:

Excision of mediastinal tumors: Thoracoscopy has been found to be very useful in excision of mediastinal tumors/ masses like neuroblastoma, thymoma, teratoma etc. The advantage of thoracoscopy is it gives excellent magnified vision which helps in complete excion without damaging adjacent vital structures.

Excision of Mediastinal cysts: Various mediastinal and lung cysts can be safely removed in newborns, infants and pediatric patients with excellent results. This include bronchogenic cyst, enteric duplication cyst, thymic cyst, hydatid cyst etc. Some of these cyst are diagnosed during antenatal period.

Lung Malformations: Thoracoscopy excision of lung malformation involves CCAM, CLE and lung sequestration.

Empyema: Empyema is an infection due to pus formation in the chest cavity or the pleural space. Children with empyema requires treatment with antibiotics, thoracostomy and thoracoscpic decprtication. For thoracoscopic decortication, three to four small incisions (3-5mm) are made to access the pleural space. Following which, the pleural space is cleansed off all debris and infected material, using a camera to see inside. Thus making the lung re-expand. Thoracoscopy addresses the symptoms and aids in a faster recovery, thereby reducing the patient’s stay in the hospital, especially when it is done in the initial stages of the illness.

Lung Biopsy: Lung Biopsy is carried out for children with chronic lung conditions, which may be difficult to diagnose, even after numerous tests. The Lung Biopsy is done using three small incisions, through which, the targeted area of the lung is biopsied. Diagnosis is achieved in almost 95% of the biopsies. It eliminates the requirement a large incision and its associated complications, while providing the same amount of tissue for analysis, as that of thoracotomy. Due to limited post-operative pain, and discomfort which does not compromise respiration, this procedure is well tolerated, even in children with advanced lung disease.

Spontaneous Pneumothorax:  Pneumothorax is a life-threatening condition in which the lung collapses. Teenagers progressing through their adolescent growth spurt and children with underlying lung diseases, like apical cysts or cystic fibrosis are more prone to pneumothorax. The lungs need to be re-expanded to allow healing and removal of symptoms. Thoracoscopy is recommended for children with a recurring pneumothorax. The apical cysts (if present) are removed with an endoscopic stapling device. To carry out this procedure, three small incisions of 5mm – 12mm are made. To avoid air leaks in the future, the pleural cavity lining is abraided so that the lung adheres to the chest wall.

Tags - Thoracoscopic Surgery In Children, best pediatric surgeon in india, best pediatric surgeon in delhi

For more information link - www.pedsurgerydelhi.com

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An undescended testis is a defect that happens before birth when a testicle has still not moved to its correct position, which is the scrotum or the bag of skin hanging below the penis. Treatment helps in moving the undescended testicle in to it's appropriate position in the scrotum.

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Undescended Testis In Children, Treatment of an Undescended Testicle In Delhi, India by Dr. Prashant Jain

What is an Undescended Testis?

An undescended testis is a defect that happens before birth when a testicle has still not moved to its correct position, which is the scrotum or the bag of skin hanging below the penis. This condition usually affects one testicle, but, in a few cases, the condition may effect both testicles, thereby keeping them undescended. An undescended testis is commonly seen in premature male child. In most cases, Undescended testis gets rectified on its own, as the undescended testis moves to its appropriate position within the first few months of life. However, if this condition is not corrected on its own till 6 months of age, then a surgery is required to move the testicle in to its correct position.

What are the signs or symptoms of an Undescended Testicle

If you cannot see or feel a testicle in the baby’s scrotum, then this may be due to an undescended testicle. When the foetus is still developing, testicles are formed inside the abdomen. In normal development of the foetus, the testicles descend from the abdomen, into the scrotum, through the tube-like passage, into the groin (inguinal canal). The above process, happens in the last couple of months of normal foetal development. When this process is halted or delayed, it leads to the condition called Cryptochordism or Undescended Testicle.

When should you consult a doctor an undescended testicle ?

An undescended testicle gets identified in the post birth examination of the baby boy. If this happens, the baby boy will need to be examined regularly, and you should check with your doctor on the frequency of the baby boy’s examination. It is often noticed, that if the testis has not moved to the scrotum within 6 months, chances are, the condition may not get rectified on its own. Getting the baby boy treated for undescended testicle may lower the risk of complications in the future, like testicular cancer and infertility. Some boys may have been born with normal testicles at birth, but the same might appear missing later. This may happen due to the following reasons:

Retractile Testicle – In this, the testicle moves back and forth, between the scrotum and groin. This may happen due to a muscle reflex in the scrotum, and may be easily guided into the scrotum with the hand, during the physical examination.

Ascending testicle – In this condition, the testicle moves back to the groin and cannot be guided back to the scrotum with the hand. This is also called acquired undescended testicle.

The corrective surgery is orchidopexy means fixing the testis in scrotum. The testis lying inside the abdomen needs laparoscopic orchidopexy. It is best to speak to your paediatrician or doctor if you see any changes in your son’s genitals or are concerned about his developments. To book an appointment with Dr. Prashant Jain, the best paediatric surgeon in Delhi, Call (+91) 8766350320.

Risk factors of Undescended Testicles

Factors that might increase the chances of having an undescended testicle are:

Premature birth of the baby boy

Low birth weight of the infant

Complications associated with Undescended Testicles

Testicles need to be cooler than the normal body temperature, so they can develop and function normally. This environment is provided by the scrotum. In case of an incorrect placement of the testicle, following are the complications that may arise:

Testicular Cancer – develops in the cells of the testicles that produce immature sperms. Men with undescended testicles are at a higher risk of having testicular cancer. This risk increases if the testis is located in the abdomen instead of the groin, and when both testicles are affected. While the cause of cells developing into testicular cancer is still unknown, surgical correction may reduce the chances but does not eliminate the risk completely.

Fertility problems – Men with undescended testicles may develop low sperm count, poor quality sperm and reduced fertility the condition is ignored or left untreated for a long time. Other complications associated with Undescended testicles are:

Testicular Torsion – This condition is painful as it cuts off the blood supply to the testicle. This happens when the spermatic chord, which contains blood vessels, nerves and the tube which carries semen, gets twisted. If left untreated, it may result in the loss of the testicle. Men with Undescended Testicles are ten time more prone to testicular torsion than the ones with normal testicles.

Inguinal Hernia – Happens when a part of the intestine pushes into the groin, if the opening between the abdomen and the inguinal canal is too loose.

Trauma – The testicle may be prone to damage from the pressure against the pubic bone, if it is located in the groin.

To know more or to book an appointment with Dr. Prashant Jain, the best paediatric surgeon in India, Call (+91) 8766350320.

Diagnosis of Undescended Testicle

Doctors may recommend the following types of surgery for the diagnosis and treatment in case of an undescended testicle.

Laparoscopy – Laparoscopy helps find out an intra-abdominal testicle. A small incision is made in the abdomen, post which, a small tube containing a camera is inserted. In some cases, an additional surgery may be needed if the doctor cannot rectify the testicle’s position during laparoscopy. In case laparoscopy shows the absence of a testicle or a small remnant of the testicular tissue,  then the same is removed.

Open surgery – This type of a surgery, requires a slightly bigger incision when testis is lying in groin. Post the birth of a boy, if the doctor notices that the boy’s testicles are missing in the scrotum,  he may do a few tests to see if the testicles are undescended or are absent. If left untreated or undiagnosed, absence of testicles may cause serious medical problems post  birth. It is not recommended to go for an ultrasound or an MRI for the diagnosis of an Undescended  Testicle.

Treatment of an Undescended Testicle

Treatment helps in moving the undescended testicle in to it’s appropriate position in the scrotum. It is recommended that surgical intervention happens before 18 months of the child’s age. Earlier the treatment happens, better it may be, as treating the infant before one year, may reduce complications. Following are the different treatment for Cryptochordism or Undescended Testicle: Surgery The process of the surgeon, moving the testicle back into the Scrotum and stitching it to place, is called Orchiopexy. Laparoscopy or surgery is used to carry out this process. A number of factor’s, such as, the infant’s health or the level of the surgery’s complication, may determine how soon the surgery or correction of the undescended testicle can be carried out. The surgery may be recommended when the child is between 6-12 months old. Early surgery reduces the risk of complications in the future. The surgeon removes the tissue, in case he sees that the tissue has not developed properly or is an abnormal or a dead tissue. The surgery also repairs an Inguinal Hernia that may occur due to the Undescended Testicle. Post surgery, the testicles are regularly monitored to confirm if it is staying in place and is developing properly. This is done through physical exams, Ultrasound examination of the scrotum and by testing of hormonal levels.

Other Treatments

Saline Testicular Prosthesis treatment, which gives the scrotum a normal appearance, may be considered, if one or both testicles are missing or did not survive post surgery. An Endocrinologist or a hormone specialist may be referred if the child does not have even one testicle which is healthy. Endocrinologist helps with future hormone treatments that are necessary to bring about puberty and physical maturity. Results Orchiopexy, mostly has a 100% success rate. Post surgery, the fertility for males with Undescended Testicle is nearly normal, however, for males with two Undescended Testicles, the chances are 65%. While surgery might reduce the risk of testicular cancer, it still does not eliminate it.

Lifestyle changes and remedies at home for Undescended Testicles:

It is important to ensure that the testicles are developing normally, even after the child’s surgery. Being aware of the development of your son’s body and checking the position of his testicles regularly, helps him in the long run. This can be done while changing the diaper or while bathing him. Talk to your son about the physical changes that are about to happen, when he reaches puberty. Teach and encourage him to check his testicles regularly, as self-examination can help with the early detection of tumors. How to cope with and support your son with Undescended Testicle Your son may be uneasy or sensitive about looking different, especially if he has to change his clothes in front of his friends or classmates, in a sports or in a school drama changing room. Guide him with the following tips, to help him deal with anxiety

Practice him to come up with a response if he is asked or teased about his condition

Let your son know that he is healthy, even if one or both the testicles are missing, and that there are two testicles in the scrotum

Teach your son to use the right words when he is talking about testicles or scrotum

To make the condition less noticeable, let your son wear loose-fitted swimming trunks or boxer shorts, so he is comfortable while changing clothes in front of others

Be watchful or aware of any behavioural changes, like not enjoying the sports or activities he he earlier used to

Speak to him about testicular prosthesis and discuss if it is a good option for him

What to ask your doctor if your son has undescended testicles

An undescended testicle is a birth defect, and is identified in the post birth examination. This condition is monitored through regular examination of your infant. Here are a few questions that you can ask your family doctor or your paediatrician:

What are the different tests that my son will need to undergo?

Which option would you recommend as a treatment?

Can you recommend a specialist, to whom i can show my son’s condition.

to build my knowledge about my son’s condition, can you recommend a few websites or give me some brochures that i can read at home

How frequent should my son’s appointments be?

To monitor any changes in the undescended testicle, how can i examine the scrotum at home?

Tags -Undescended Testis In Children, best pediatric surgeon in delhi

For more information link - www.pedsurgerydelhi.com

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Choledochal cyst is a birth defect, characterized by the swelling or cystic transformation of the bile duct. The treatment of choledochal cyst is surgical. It requires excision of cyst and joining the small intestine (duodenum or jejunum) with remaining bile duct.

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Choledochal Cyst In Children, Treatment of Choledochal Cysts with Minimally Invasive Surgery Done by Dr. prashant Jain

What is Choledochal Cyst ?

Choledochal cyst is a birth defect, characterized by the swelling or cystic transformation of the bile duct. The liver produces bile to digest food. Bile duct helps in transporting bile from the liver to the gall bladder and small intestines. In case of a choledochal cyst, due to the obstruction of drainage, passage of the bile is hampered, thereby causing pain, indigestion, jaundice. Child can repeated episodes of infection in bile duct characterised by fever, pain and jaundice. Early treatment of this condition, may reduce the risk of liver cirrhosis and bile duct cancer in adulthood. Choledochal cyst is a rare condition, as it’s presence is seen in only 1 out of 1,00,000-1,50,000 children in the western countries. Girls are 4 times more prone to it than boys.

Symptoms of Choledochal Cyst:

Even though Choledochal cyst is a birth defect, it’s symptoms may appear in infancy or in older children. Condition may be diagnosed on antenatal scan.

Pain sensation in upper right portion of the stomach or belly

Abdominal mass

Fever

Jaundice

Nausea and Vomiting

Causes of Choledochal Cyst:

Experts are of the view, that choledochal cysts occur when the junction between the bile duct and pancreatic duct is not normal.

Bile duct carries bile from the liver, to the duodenum which is the first part of the small intestine. Before joining duodenum it joins pancreatic duct. In case of an abnormality, pancreatic juice may flow backwards, into the bile duct, thereby causing the formation of cysts. Also obstruction at lower end of bile duct can cause this problem.

The different types of Choledochal Cyst and their locations:

Choledochal cysts can be intrahepatic, where it occurs in the bile duct inside the liver, or can be extrahepatic (outside the liver).

Following are the 4 different types of Choledochal cysts that are identified by their location

Type 1 Choledocal Cyst – This accounts for upto 90% of all choledochal cysts. It is the cyst of the extrahepatic bile duct.

Type 2 Choledochal Cyst – This occurs as an abnormal pouch or a sac opening from the duct

Type 3 Choledocal Cyst – This cyst is found inside the wall of the duodenum

Type 4 Choledocal Cyst – These are cysts that are present on both intrahepatic and extrahepatic bile ducts.

Ultrasound and MRI are required to confirm the diagnosis.

Treatment of Choledochal Cysts with Minimally Invasive Surgery.

The treatment of choledochal cyst is surgical. It requires excision of cyst and joining the small intestine (duodenum or jejunum) with remaining bile duct. "Less pain, less scarring and faster recovery are some of the benefits of a Minimally Invasive Surgery (MIS)" – Says Dr. Prashant Jain, the best paediatric surgeon in India. Minimally Invasive Surgery is done through a small incision, using miniaturized surgical tools and cameras or telescopes. Laparoscopic Surgery is a popular form of Minimally Invasive Surgery (MIS) for the removal of Choledochal Cyst. In this, the surgeon uses small instruments, which are guided by a small telescope. The surgery is performed by the surgeon who manipulates the instruments while watching them on a video screen.

Tags - Choledochal Cyst In Children, best pediatric surgeon in delhi

For more information link - www.pedsurgerydelhi.com

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How to differentiate between Inguinal hernia and hydrocele?Inguinal hernia is usually a reducible swelling with cry/cough impulse while a hydrocele is a tense cystic, clinically irreducible swelling without any impulse. Transillumination test is not reliable as can be present in both the cases. Your browser does not support HTML5 video. Why hydrocele is irreducible swelling?The …

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Vesicoureteral Reflux Causes, Symptoms And Treatments Kidneys are important organ for urine formation. Normally, urine flows into the bladder through ureters. However, in some children, urine from the bladder flows back through the ureters. This condition is known as Vesicouretral reflux (VUR) and is common in infants and children. It can be unilateral or bilateral. …

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Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. Consult best pediatric urologist in delhi, India for hypospadias surgery.

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Dr. Prashant Jain Provides the Treatment for Vesicoureteral Reflux Surgery Child in Delhi

Vesicoureteric Reflux

Vesicoureteral Reflux Causes, Symptoms And Treatments

Kidneys are important organ for urine formation. Normally, urine flows into the bladder through ureters. However, in some children, urine from the bladder flows back through the ureters. This condition is known as Vesicouretral reflux (VUR) and is common in infants and children. It can be unilateral or bilateral. This could cause infections and damage your kidneys. VUR affects about 10% of children. Although most can grow out of this condition, people who have severe cases may need surgery to protect their kidneys.

This condition should not be ignored as it damages the function of kidneys and can lead to high blood pressure later in life. The risk of kidney damage is greatest during the first 6 years of life.

Causes of VUR:

A flap valve is located where the ureter joins with the bladder. Usually, the valve allows only a one-way flow of urine from the ureters to the bladder. Sometımes, a defective flap valve allows urine to flow backward. This can affect one or both ureters. This is called “primary vesicoureteral reflux.”

Sometimes VUR can be because of blockage at the bladder outlet(Posterior urethral valve or abnormality of the bladder functions (Neurogenic bladder) that can causes urine to push back into the ureters.

This back flow of urine is responsible for recurrent urinary tract infections and damage of kidney (Renal scarring).

Symptoms:

Urinary tract infection is one of the commonest presentation seen in children younger than the age of 5.

Common symptoms are:

Foul smelling or cloudy urine

Fever

Burning or pain while urinating

Frequency and urgency of urine

Vomiting

Infants may have following symptoms.

Diarrhoea.

Poor feeding.

Fever

Increased irritability

Also ultrasound scan done during pregnancy showing swelling in kidneys can be because of VUR.

Diagnosis Of VUR:

VUR can often be suspected by ultrasound before a child is born or if child has urinary tract infection. Ultrasound may show dilatation of drainage system of kidney (Pelvi-calyceal system and ureter) called as hydronephrosis, but this does not prove that reflux is present.

VUR is diagnosed using an X-ray of the bladder known as voiding cystourethrogram (VCUG). In this procedure, a thin, soft tube (catheter) is placed in the bladder through the urethra. Dye is then introduced into the bladder through the tube. X-ray pictures are taken to see if the dye flows back into the ureters. Based upon the severity, VUR is categorized into five grades. Milder grade of VUR does not require any treatment. All infants with urinary tract infection and other older children with frequent urinary tract infections with or without hydronephrosis should a be considered for VCUG test.

Treatment Options For Management Of VUR:

There are 3 main options for managing or treating VUR. One should understand the risks, benefits, and follow-up of each treatment.

Antibiotic: It is used to prevent infections until VUR goes away by itself. This treatment may take several years, and children must take medication every day. These children need to be reassessed for VUR and renal damage on regular basis. However, long term treatment with antibiotics may cause the bacteria to become resistant, increasing the risks of recurrent infections.

Surgery: This type of treatment cures most children. Surgery is good option for high grade reflux. This can be performed by open or laparoscopic technique.

Endoscopic treatment (Deflux Injection): In this day care procedure, the medication is injected where the ureter joins the bladder. Deflux is a safe and effective treatment for VUR. A gel is introduced into the body where the ureters meet the bladder. This procedure is performed as a day care procedure. Deflux gel is placed at the spot where the ureters connect to the bladder with the help of a small camera called a cystoscope (a type of endoscope used to view the bladder). Eventually, new tissue grows around the gel, preventing the reflux of urine. Usually, there will be no pain after the procedure. Deflux is used for the treatment of all grades of VUR in children. Many children have success after one injection; while some may need more injection procedures. However lower the grade of VUR, the better it works. Also, the procedure works better for children who have reflux in only one ureter.

Tags - vesicoureteral reflux surgery child in delhi, best pediatric surgeon in india, best pediatric urologist in delhi

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Hypospadias Surgery in Delhi by Best Pediatric Surgeon in Delhi - Dr. Prashant Jain

Hypospadias Surgery In Delhi

What is hypospadias?

Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In boys with hypospadias, the urethra forms abnormally during 8-14 weeks of pregnancy. The abnormal opening can be anywhere, from just below the end of the penis to the scrotum. Depending on the site of the opening they are classified as distal (minor type)and proximal (major type).

Types of Hypospadias:

The types of hypospadias a boys has depends on location of the opening of the urethra:

Subcoronal: The opening of the urethra is located somewhere near the head of the penis.

Midshaft: The opening of the urethra is located along the shaft of the penis.

Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.  

Understanding the normal penis and urethra

The normal urethra is a tube through which that urine flows out of the bladder. It passes through the penis. The opening of the urethra (meatus) is normally at the end of the penis, partly covered by the foreskin.

What is the penis like in hypospadias?

The main problem is that the urethra opens on the underside of the penis instead of at the end of the penis. The opening can be anywhere from just below the normal position (mild) to as far back as the base of the scrotum (severe).

Hypospadias may also include the following:

A hooded appearance of the foreskin. This is because the foreskin does not develop on the underside of the penis.

Tightening of the tissues on the underside of the penis (called ‘chordee’). This pulls the penis down and it cannot fully straighten. This is commanly seen in severe hypospedias

What problems can hypospadias cause?

Problems are likely to occur if hypospadias is left untreated. The further back the opening of the urethra is, the more severe the problems are likely to be.

Passing urine is different to normal. A baby in nappies will have no problem. However, when older, the urine stream may not be able to be directed forward into a urinal. When going to the toilet the urine is likely to ‘spray’ backwards. Sitting on a toilet may be needed to pass urine without mess.

Chordee causes bending of the penis. This is more noticeable when the penis is erect. Sexual intercourse may be difficult or impossible in severe cases.

Psychological problems about being ‘different’ to normal are common.

How common is hypospadias and what causes it?

About 1 in 300 boys are born with some degree of hypospadias. It seems to be getting more common. The reason why the penis does not develop properly is still not clear. The development of the penis while the baby is growing in the womb (uterus) is partly dependent on the male sex hormones such as testosterone.

What is the treatment for hypospadias?

If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, no treatment may be needed. However, in most cases an operation is required to correct the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, two operations may be necessary. The operation is usually done when the child is around 6-18 months old. The goals of treatment are:

For urine to be passed in a forward way.

For the penis to be straight when erect.

For the penis to look as normal as possible.

The position of the opening of the urethra is altered. Also, if chordee is present then this is corrected to allow the penis to straighten. The foreskin is usually used during the operation to make the new urethra so it is important that a circumcision is not done before the corrective surgery is performed.depanding on the surgery of hypospedias surgeryes

The success of the operation and the ‘normality’ that can be achieved depends on the severity of the hypospadias done in single as two stage

What happens after the operation?

Your son will be brought back to the ward to recover. He will be able to eat and drink after 3 hours He will have a dressing on his penis and a tube draining away the urine. The patients are usually kept for 2 days in the hosptial and then discharged. The dressing and tube need to stay in place for 10 days, then you will need to come back to the Hospital to have them removed.

What are the risks of hypospadias repair?

All surgery carries a small risk of bleeding during or after the operation.

For about one in ten boys, the original hole opens up again, so that your son passes urine through two holes. This can occur at any time after the operation. If this happens, your son will need the operation again. Occasionally, the new hole at the tip of the penis is too small, so your son will need another operation to make the hole larger. The drainage tube can irritate the inside of the bladder, which is painful. This is called ‘bladder spasm’. To reduce this, your son will be given ‘bladder spasm medicine’ as well as pain relief.

When you get home

Your son will go home with the catheter and dressing in place. Staff on the ward will give you full details of how to care for these at home.

You should encourage, to drink plenty of water/fluids.

Your child may need some pain relief when you get home.

You should not have a bath or shower until after the dressing comes off.

Putting your son in two nappies at a time can protect the area from accidental knocks.

Your son should not ride a bicycle or any sit-on toy until the area has healed.

Try to avoid getting the dressing dirty when nappy changing. If this happens, dab any faeces off with a damp cloth.

As there is a small risk of infection, your son will need to take antibiotics until he returns for his outpatient appointment.

Tags -hypospadias surgery in delhi, best pediatric surgeon in delhi, best pediatric urologist in delhi

For more information link - www.pedsurgerydelhi.com

[bestpediatricsurgeoninindia]

Dr Prashant Jain, best pediatric surgeon and pediatric urologist in delhi, india he is expertise in hypospadias surgery, hernia surgery for child, hydrocele surgery for child, hydronephrosis in child treatment, vesicoureteral reflux surgery child, hirschsprung disease treatment, absent anal opening treatment, Anorectal malformation and pelvi ureteric junction obstruction treatment.

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