Paediatric Urology & Reconstruction
The Paediatric Urology division has remained at the forefront of urological care by performing extensive endourology and also reconstructive surgery, especially with children born with congenital defect in urinary system.
Common Urological Congenital Defects are Following
- UPJ obstruction
- Vesico ureteric reflux
- Hypospadias ( Urethral defect)
- Exstrophy (Bladder defect)
In many children, there is functional narrowing at ureteropelvic junction causing pain in flank region or progressive deterioration of kidney function. Often this is diagnosed early in life bur some times diagnosis may happen only in early adulyhhood.
Surgery for UPJ obstruction are
- Open Pyeloplasty:In children, the obstruction is relieved by excision of tight segment of UPJ and then restoring the continuity by ureteropelvic anastomosis over a stent. This is done by a small incision at subcostal region.
- Laparoscopic pyeloplasty:In relatively grown up children or adolescent the surgery can be done laparoscopicaly offering better cosmesis and less pain and hospital stay.
- Vesico ureteric reflux:Many children present as recurrent bout of urine infection in their early childhood. Often on evaluation, it is found because of reflux of urine in ureter and kidney due to incompetent valve at vesico ureteric junction(VUR).
Surgery for VUR
- Sting Procedure (DEFLUX):A silicon gel material is injected at ureteric meatus to partially obliterate the lumen so that reflux is prevented without causing obstruction to urine flow. The procedure can be done endoscopically thus patient can be discharged on next day and there is no operative scar.
- Ureteric reimplantation:Here, ureter is disconnected from bladder and reanastomosis is done with care to produce a tunnel so that reflux can be prevented. The procedure can be done either by opening the urinary bladder or extravesical.
- Hypospadias ( Urethral defect):In some children, the part of urethra is underdeveloped causing urethral opening at undersurface of penis. Often there is fibrosis at the site of undeveloped urethra causing curvature of penis (chordee).
- Chordee correction :The fibrosed segment is excised and tissue defect is replaced with adjacent tissue. This removes the curvature and penis become straight.
- Snodgross repair ( tube formation by local tissue):This technique is suitable for distal hypospadias. The local urethral plate is tabularized to form the neo urethra. The surgical repair is further reinforced by adjacent tissue.
- Tabularized flap repair: When the defect is big then a flap of prepuceal skin is prepared to make a tube (neourethra). Now, this tube is anastomosed with existing urethra to bridge the defect.
- Exstrophy bladder:In some children, the anterior bladder wall is deficient thus causing continuous leak of urine from lower abdomen. This need major repair of bladder and anterior abdominal wall. Most of the time bilateral iliac bones are also cut to facilitate anterior abdominal wall closure.
Common surgery for Hypospadias correction
Dr Amit K. Devra has special interest in pediatric urology. He has performed many pediatric urological surgeries with successful results, making him one of the most sought after pediatric urologist in Delhi NCR. He also believes in a unique child friendly approach which results in reduced anxiety and apprehension in children undergoing surgical procedure.
A Congenital Hernia is a scrotal collection of clear fluid in a thin walled sack that also contains the testicle. Less frequently, due to the common embryological background of male and female gonadal structures, female children or women may also experience a hydrocele. In this case, the sack and connection exist in the labia majora (the outermost and larger of the two labial structures). A hydrocele may involve either one side (unilateral) or both sides (bilateral) of the scrotum.
Causes, incidence, and risk factors of Congenital Hernia
Hydroceles are common in newborn infants. During normal development, the testicles descend down a tube from the abdomen into the scrotum. Hydroceles occur when this tube does not close. Fluid drains from the abdomen through the open tube. The fluid builds up in the scrotum, where it becomes trapped. This causes the scrotum to swell. Hydroceles normally go away a few months after birth, but they may worry new parents. Sometimes, a hydrocele may occur with an inguinal hernia. Hydroceles may also be caused by:
- Fluid or a blood blockage in the spermatic cord (this type of hydrocele is more common in older men)
- Inflammation or injury of the testicle or epididymis
Treatments for Congenital Hernia
Hydroceles are usually not dangerous. They are usually only treated when they cause discomfort or embarrassment. Hydroceles from an inguinal hernia should be fixed with surgery as quickly as possible. Hydroceles that do not go away on their own after a few months may need surgery. A surgical procedure called a hydrocelectomy is often performed to correct a hydrocele.