Paediatric Treatments
ANTENATAL HYDRONEPHROSIS
Hydronephrosis is the term used to say that the urine filled part of the kidney is appearing prominent. Antenatal means it was noted before birth. Antenatal Hydronephrosis is not a disease by itself but a pointer to look closer to see if anything is wrong.
The majority when followed up after birth turn out to be normal. Even then, some appear to improve and then come back again.The state of the kidney meat, the state of the ureter, bladder wall thickness and the appearance of the opposite kidney tell us which ones need to be taken seriously. In around 3%, some abnormality is found that requires further evaluation.
If you wish to have a paediatric urologist’s opinion on your baby’s antenatal hydronephrosis and the tests needed after birth, you can click the button, upload the reports and photos of the scans and write or record your questions.
PUV are two valve like folds that block the urethra in boys. The severe resistance to passage of urine, damages the bladder and affects the developing kidneys to produce kidney failure. It is suspected in boys when both kidneys show hydronephrosis. In the most severe form, the waste accumulates and the baby can become very ill even if the urine is drained. Those who have enough kidney reserve can be rescued and the block cleared. After that, they still need a plan of management to protect kidney reserve from the damage of infection and high bladder pressure. A MCU (micturating cystourethrogram also called voiding cystourethrogram or VCUG) is done to confirm or rule out posterior urethral valve. If suspicion still exists, then cystoscopy is used to see the urethra with a telescope and if suitable divide the valve.
If your son is suspected or has been treated for PUV, and you wish to have a paediatric urologist’s assessment, click the button, attach photos of reports, then write or record your question.
UNDESCENDED TESTIS
Testis that has not reached the bottom of the scrotum by 3 months of age (4months age in preterm) will not come down after that. Previously it was customary to wait upto 1 year of age. But now, as we know that the maturation gets affected, the testis is to be brought down surgically between 6 months and 1 year of age. Those with hernia should have earlier surgery.
If the testis is not felt outside, Ultrasound or MRI even if done is not accurate enough to make any difference to management. If it is felt outside, then the testis is brought down by a daystay operation. If it is not felt, then laparoscopy is used to look for it and if present, used to bring it down. Sometimes this will need to be done in two stages to get the best result.
If you wish to consult on Undesceded Testis, click the button and write or record your question.
Ultrasound examination and MCU (micturating cystourethrogram, also called Voiding Cystourethrogram) are the two imaging investigations done to pick up conditions that can indicate a future risk for kidney damage. Based on the risk assessment further investigations that may be needed include cystoscopy, nuclear scans (DMSA, DTPA, in some centres EC and MAG3 are preferred).
In boys under 1 year of age, circumcision reduces the chance of urine infection. In paediatric urology practice, circumcision is advised in boys under one and half years of age if they have vesicoureteric reflux or some other condition that predisposes them to urine infection.
If you need an opinion or arrange an MCU or discuss the value of circumcision, click the button, attach reports and either type or record your questions.
MCU (VCUG) WITHOUT TEARS
A Micturating Cystourethrogram is used to show the bladder, urethra and the presence or absence of vesicoureteric reflux. For doing MCU, a dye that can be seen on Xray is put into the bladder using a catheter and its passage watched live on a TV screen. In paediatric urology centres, the paediatric urologist themselves do it to find the answer quickly and gently; a parent usually can be with the child for this 5 to 10 minute
If you wish to know more about having MCU done without fear or pain, click the button – please upload photos of lab reports and doctor’s advice on why the test is needed, then text or record your questions.
DTPA diuretic renal scan is used to measure the severity of obstruction in hydronephrosis. DMSA scan shows the functioning meat of the kidney. It is used to assess if the kidney has been damaged after an infection in children with vesicoureteric reflux (VUR) and to identify a missing on non-functioning kidney. It is safe because the picture is created from electrons sent out by the isotope, it is more useful than IVP in children.
Care Co-ordinators are there to help you with dates, times and with vein cannulation required for the tests in the Centres adjoining the Clinic. For getting either done in one of the centres, click the button and upload photos of reports, doctor’s advice and then text or record your request and expect to receive a reply next working day.
MULTICYSTIC KIDNEY
These are instances when many empty spaces are seen within the kidney. The most common type also is the least harmful the “Multicystic Dysplastic Kidney”(MCDK), where one kidney is fully destroyed and replaced with cysts. Since some growths in the newborn kidney also look like this, they all need to be reassessed at birth; a few need removal.
The only remaining kidney can sometimes have a block in its ureter and have hydronephrosis. If so, a CT Urogram and if proved, early surgery may be needed.
If your baby is suspected to have MCDK, do click and upload the reports and text or record your question for an online consultation.
A single kidney if normal, is enough to have a full normal life. Most often it follows disappearance of a multicystic dysplastic kidney. Sometimes the missing kidney can be found by DMSA scan to be present and functional in an abnormal location. Children in whom one kidney did not form at all may have a smaller bladder and or genital abnormalities needing treatment.
If you wish us to evaluate your child for a single or missing kidney, click the button, upload the reports and pictures so far and text or record your question.
VAGINAL / VULVAL / LABIAL SYNECHIAE / SYNEKIAE
It is the sticking together of the labia minora in girls from 1 to 8 years of age. Parents may suddenly notice that the vaginal and urinary openings are not to be seen. It opens up by itself much before puberty. Some have discomfort while passing urine or it might come to light after a urine infection.
It is usually easy to separate the stuck surfaces during the outpatient examination itself. Older girls who are concerned about privacy, have it done under light anaesthesia in theatre. Recurrences are treated with female hormone application or can be left alone.
Click the button if your child needs treatment for vulval synechiae.
Hypospadias is the condition where the urethral opening is on the under surface of the penis. When the opening is close to the head of the penis, surgery can make it look like a circumcised penis. When the penis is bent over very far, it is usually done in two stages with a gap of around 6 months. This means that the urine stream will still be directed downwards after the first operation.
However, in the most severe type called penoscrotal hypospadias, sometimes parents are unhappy that even after the first operation, the boy has to sit down and pass urine; they want to know if it is possible to get a forward flow of urine by the first stage operation itself.
If you wish to consult about single stage repair of severe hypospadias, click the button.
BEDWETTING, URINARY INCONTINENCE
Bedwetting is common in those under six years of age. When it becomes a social problem, a checklist tells us whether any investigation is required. If there is a no abnormality, medicine is available for use as and when needed.
Sometimes the wetting of undergarments goes on night and day unrelated to sleep.
Click the button if you are concerned about wetting for your child.
Children who have had surgery for swellings of the midline back have the potential to slowly develop unrecognised kidney damage,. A paediatric urology assessment at birth and every 6 months till 6 years of age is advisable to prevent them growing into renal failure. This is all the more imperative if the children have a poor urinary stream, have had urinary infections and if cannot hold urine for long.
Click here for a consultation if your child needs a paediatric urological assessment or have not had one after myelomeningocele repair.
KEYHOLE SURGERY FOR DUPLEIX KIDNEYS
Dupleix means double. Dupleix kidneys have double ureters opening one below the other. They have a higher chance of obstruction and reflux, presenting with urinary infection. Rarely, the location may be so extreme that it may open outside the bladder and urine keeps leaking. The traditional choices have been to remove that abnormal part of the kidney or to detach and re-implant the ureters back into the bladder, both reasonably major surgeries. While the removal of the abnormal part of the kidney can be achieved by keyhole surgery, there is one more option, if one of the ureters open normally into the bladder; the abnormal ureter can be reconnected to this normal one by a much smaller operation.
For a consultation about dupleix kidney please click the button.
Pelviureteric Junction (PUJ) Obstruction is one of the causes of severe hydronephrosis. When surgery is required to resolve the blockage of PUJ obstruction that caused the hydronephrosis, open or keyhole surgery are equally successful. Laparoscopic (keyhole) surgery is advisable when it is important to reduce the size or noticeability of the scar and is generally preferable in children over 2 years of age. Open surgery with placement of DJ stent however is the least invasive for babies and also for older children whose kidneys are hugely dilated.
If you wish to consult about surgery for hydronephrosis in your child, click the button
INJECTION TREATMENT FOR VUR
VUR can also be treated by injection of a material into the wall of the ureter from within the bladder at endoscopy (cystoscopy). Two techniques are called STING or HIT. There is no wound, pain or tube or hospital stay, but it has a lesser success rate than surgery, and reflux can recur over time. It is a reasonable choice when there is reflux of grade 2,3 or 4 of only one side and there is no structural problem of the bladder.
If you wish to consult about treating your child with STING or HIT method for VUR, click the button.
Instead of cutting and stitching the foreskin, a ring is placed in the space inside the foreskin and a string tied tightly. This slowly cuts and the skin fuses, and the ring with the excess skin falls off in 8 to 10 days. A numbing cream is applied to the base of the penis and a numbing injection is given to make the separation of the skin painless. The process is quick, not requiring stitching, parents stay with the baby, the baby is ready to go home in between 1 to 2 hours and so it appears to be less traumatic than the steps involved in general anaesthesia of blood test, Covid test for baby and mother, separation from parents and spending nearly a day in hospital. This technique is not suitable for some boys.
If you wish to consult regarding circumcision by this technique click the button.
URODYNAMICS – A STUDY OF BLADDER PRESSURE ON FILLING
The bladder of children who have had posterior urethral valve at times continue to generate high pressure. High back pressure can worsen the kidney function over time and result in kidney failure. Some of the conditions with leaking of urine can also have high bladder pressure and result in urine infections and kidney failure over a few years. One such situation occurs in children who have had meningomyelocele and lipomeningocele – swellings over the back at birth.
If you have been advised about Urodynamics for your child, click the button and Paediatric Urology clinics can help you get it done in the centres attached to it.
