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Congenital Hydrocele - Cause & Treatment

1. What is a Congenital Hydrocele?
A Congenital Hydrocele is a swelling in the scrotum of a baby boy caused due to a collection of fluid around the testis.

2. What causes a Congenital Hydrocele?
The Hydrocele is due to a congenital defect (defect present before birth). Normally, when the baby boy is in the mother’s womb the testis develop in his abdomen. The testis then descend down through a path called the inguinal canal and reach the scrotum usually by the 7 th -8 th month of pregnancy. In case of Hydrocele, this path does not close off totally. There is a persistent connection/communication between the sac in the abdomen (tummy) and a sac around the testis in the scrotum. Thus fluid from the abdomen drains down and collects in the scrotum (communicating Hydrocele). Sometimes the connection gets sealed off but the fluid still persists in the scrotum (non-communicating Hydrocele).

3. How do I know if my baby has a Hydrocele and not a Hernia?
Your baby will have a swelling only in the scrotum and not in the groin. The swelling may be less in the morning and increase as the day progresses. There is no increase in size of swelling on crying, coughing or straining. However a thorough examination by a doctor is required. The doctor may
advise an ultrasound of the region to confirm the diagnosis.
4. Do all Hydroceles require surgery?
No. Majority of Hydroceles in babies less than 2 year of age are small in size and may regress with time. However a large Hydrocele or a hydrocele in an older child may require surgery. The doctor will evaluate your baby and then take the correct decision. You may be advised to wait and watch and
follow up after a few months if the doctor is hopeful that the condition will resolve on it’s own.
5. Do any medicines or alternative therapies work?
No. The Hydrocele usually resolves naturally on it’s own as the child grows up, as the connection between the abdomen and scrotum usually is very tiny and it closes off on it’s own followed by absorption of the fluid in the scrotum. However if it does not resolve then a surgery is necessary to
break the connection. No medicines or alternative therapies (like truss or scrotal support) work.
6. What is the surgery for Hydrocele?
The surgery for Hydrocele is the same as that for a congenital Inguinal Hernia – Herniotomy.

7. Will Hydrocele affect future fertility and child-bearing potential of my son?
In majority of the cases with Hydrocele, the testes are normal. Thus fertility is not affected.

Herniotomy - Addressing the FAQs for Parents

1. What is Herniotomy?

Herniotomy is the surgery performed for Inguinal Hernia and Hydrocele in children.

2. What preparation is required before the surgery?
The surgery is routinely performed as a day care procedure. You will need to keep your child nil by mouth (no water, food or breastmilk to be given) usually for 4 hours before the surgery. The child will be admitted on the day of the surgery itself and will be discharged 4-5 hours after the surgery. Make sure you feed the child as per the instructed time so he/she does not get too cranky before the surgery. Also try to keep their favourite toys/books /videos handy to keep them distracted when they are empty stomach.

3. What is done during the surgery?
The child will be given anesthesia to put him to sleep. A small incision/cut/hole will be taken in the groin crease and the connection/communication between the abdomen/tummy and the scrotum (labia in girls) will be closed off. The skin sutures will not be visible and they dissolve or fall off on their own. A waterproof dressing will be placed over the groin and the child will be woken up from anesthesia and shifted to the recovery room. The estimated time in the operating room should be approximate 20 to 25minutes.
4. What care needs to be taken immediately after surgery?
Your child will not be given anything to drink or eat for at least 2 hours after the surgery. Once he/she is fully awake and conscious and 2 hours have passed, few sips of water will be given. If the child is comfortable and does not vomit, then juices, milk, ice cream, soft diet (khichdi, dal-rice, sheera, upma) will be given.

Your child can walk and run about like before.

As far as possible, avoid using diapers for few days as we do not want the dressing to get soiled with stool or urine.

Make sure the elastic band of clothing does not put pressure on the dressing.
The dressing applied is waterproof so you can give a bath from the next day itself.
Once child accepts oral diet and passes urine, you will be discharged.
5. What precautions are to be taken at home after the surgery?
Your child can move and run about like before. No dietary restrictions are required. Daily bath is to be given. On the second day after surgery, the dressing is to be removed and an ointment is to be applied over the area twice a day for 3 days. The surgical wound is also to be cleaned properly at the time of bath. The stiches are not visible and they get absorbed on their own, so stitch removal is not required. In many boys, a swelling in the scrotum may persist for sometime. This should not be a cause of worry. It usually resolves on its own in 4-6 weeks’ time.
6. What are the complications/long term effects of Herniotomy?
In good hands, herniotomy has a negligible recurrence rate. It does not have any major influence on fertility or child bearing potential as well.

Inguinal Hernia and Hydrocele in Children

These problems are seen as swelling in the lower part of the abdomen or scrotum. If the swelling remains constant in size it is usually due to accumulation of fluid around the testis, known as hydrocele. However if the swelling increases in size on crying, coughing, straining at the time of defecation or lifting weight and reduces on remaining calm, then it is known as inguinal hernia. In hernia, intestines descend from the abdomen to inguinal canal and reduce on remaining calm.

There is a possibility of spontaneous resolution of fluid by the age of 2 years, hence we can safely wait till two years of age in hydrocele child. However, in case of hernia, the intestines can get trapped at any time, hence should be operated as soon as the condition is diagnosed(even in the newborn period).

Surgery in both these cases is similar and daycare surgery. In both these conditions, the passage through which fluid/intestines descend down is closed.

Undescended Testis (UDT):

Undescended testis or cryptorchidism is a condition in which testis doesn’t drop and /or can not be brought into the scrotum with external manipulation. Before the male child is born, testes of the unborn baby are situated inside the tummy. They slowly move down into the scrotum through a small passage called inguinal canal during 7th month of pregnancy. Scrotal sac is cooler than the rest of the body temperature, which is ideal for the function of testis.

UDT occurs in 3% of newborn males and up to 21% of premature newborns. Most of the testis come down to the scrotum by 6 months of age. UDT can be found in belly, inguinal canal or perineal region. In 10-15% of the cases UDT is seen on both sides, while in 6% of cases, father also had the history of UDT.

UDT which is located at an abnormal is exposed to higher temperatures hence spermatogenesis is hampered. Abnormally located testis is more likely to get traumatized during day to day activity. Testicular torsion is also more common in UDT in which there is twist and reduction of blood supply which leads to eventual loss of the testis. UDT are having higher chances of cancer than normal.

UDT should be operated as soon as possible after 6 months of age. Orchidopexy is done as a daycare surgery. Laparoscopic orchiopexy is performed when testis can not be felt on clinical examination or can not be located sonographically.

It is very important to differentiate between retractile testis from UDT as former doesn’t require surgical correction.

हाईपोस्पोडीयास क्या हैं?

हाईपोस्पोडीयास (Hypospadias) एक प्रकार की पुरुषों की गुप्तांग (Genitals) की जन्मजात खामी हैं । सामान्यत: लड़को के पेशाब का छेद लिंग की चोच पर खुलता हैं, इस में छेद लिंग के नीचे की भाग में खुलता है और चमडी उपर के भाग में बड़ी होती है । कई बच्चों में लिंग नीचे की तरफ मुड़ी हुई होती है, जिसको ‘कोर्डी' (Chordee) कहते हैं।

• हाईस्पोरपाडीयास कितने प्रकार के हो सकते हैं ? हाईस्पोस्पाडीयास दिए गए <image> प्रकार के होते हैं।

जितना पेशाब का छेद पिछे की तरफ रहता है, इतनी इन्द्री ज्यादा मुडी हुई होती है।

यह तकलीफ बच्चो के जन्म होने के बाद बच्चो के डॉ. या माता-पिता द्वारा देखने में आता हैं।

यह हर ३०० पुरुष बच्चो में १ बच्चे में देखने को मिलता हैं।

• हाईस्पोरपाडीयास के साथ दूसरी कौन सी बिमारी हो सकती हैं ?

हाईस्पोस्पाडीयास के साथ जन्मजात गोटी नीचे न उतरना और सारणगाठ (हर्निया) भी हो सकती हैं।

• यह ऑपरेशन क्यो जरुरी हैं ? बालक के लिए सामान्य लिंग इसलिए जरुरी हैं।

(१) बालक बड़े होकर सीधी धार से पेशाब कर सके।

(२) बालक दूसरे बच्चे को देखकर अपने आप को कम ना समझे और उसपर मानसिक प्रभाव ना पड़े।

(३) विवाह के बाद संतान होने में तकलीफ ना पडे।

ऑपरेशन का मुख्य हेतु पेशाब का छिद्र लिंग की चोच पर लाने का होता है जिससे पेशाब सीधी धार से कर सके । इस ऑपरेशन में हुड की चमड़ी का प्रयोग करते है। इसलिए ऑपरेशन के बाद सुन्नत (Circumcision) किया हुआ दिखता हैं।

• क्या ये ऑपरेशन मे जोरिवम हैं ?

- प्रत्येक छोटे अथवा बड़े ऑपरेशन की तरह इसमें भी जोखिम रहता है पर ज्यादातर बालको में बिना किसी तकलीफ के ऑपरेशन अच्छे से हो जाता है।

- १० में से १ बच्चे को ऑपरेशन के बाद पेशाब पहले की जगह से हो सकता है क्योकि लिंग के उपर की चमडी नाजुक होती है। इसके लिए दूसरा छोटा ऑपरेशन जरुरी हो सकता हैं ।

- ऑपरेशन के बाद पेशाब की धार पतली हो सकती है जिसके लिए थोडे समय के बाद पेशाब के मार्ग को बड़ा करने की जरुरत (Dilatation) पड़ सकती है।

- प्रत्येक ऑपरेशन की तरह इसमें भी चेप लग सकता हैं

• ऑपरेशन के अलावा दूसरा कोई विकल्प है ?

नही, ऑपरेशन के अलावा कोई दूसरा इलाज नहीं है।

• ये ऑपरेशन कब करने में आता है ?

- आमतौर पर १ वर्ष के बाद ऑपरेशन होते है, परंतु बालक को अगर जन्मजात बड़ी बिमारी हो तो ऑपरेशन करने में देर हो सकती हैं।

- अगर बालक कि इन्द्रिय बहुत छोटी हो अथवा इसके साथ गोली की बिमारी हो तो ऑपरेशन से पहले बालक के इन्द्रिय बड़ी करने की ईन्जेक्शन देनी होती हैं।

• ऑपरेशन पहले और बाद में क्या करना होता हैं ?

- ऑपरेशन पहले बालक को ४-६ घण्टे भूखा रखना पड़ता हैं, ऑपरेशन के दिन बालक को अच्छे से नेहलाना जरुरी हैं।

- ऑपरेशन के लिए बेहोशी की दवा दी जाती हैं और ऑपरेशन के बाद तुरन्त दर्द ना हो उसके लिए कमर में और लिंग के पास इन्जेक्शन देते हैं।

- ऑपरेशन के बाद पेशाब की जगह १०-१२ दिन तक नली रखनी होगी, इस दौरान पेशाब के इन्द्रिय शिथिल रखने और कबजी ना हो उसके लिए दवा चालु रखते हैं।

- कभी पेशाब की नली ज्यादा दिन तक रखनी पड़ सकती हैं (१४-१६ दिन) जिसके लिए डॉ. आपको समझायेगें।

- ऑपरेशन के बाद बालक को सामान्य २-३ दिन में छुट्टी दे दिया जाएगा।

• हॉस्पिटल से छुट्टी मिलने के बाद बालक के लिए क्या ध्यान रखना होता हैं ?

- जब तक पेशाब की नली शरीर में हो तब तक बालक साधारण हलन-चलन कर सकते हैं परन्तु बालक के खेलने, कुदने, दौडने से परहेज रखना हैं।

- पेशाब की नली के आजुबाजु में से पेशाब न निकले इसके लिए जरुरी हैं कि बालक संडास करते समय जोर ना लगायें । इसके लिए बालक को कब्ज नहीं होना चाहिए। नली बंद या पेशाब अटके नहीं उसके लिए रोज ज्यादा से ज्यादा पानी पिलाये।

- ऑपरेशन की जगह दर्द हो सकता है उसके लिए दवाई दी गई है। दवा से आराम ना मिले तो डॉ. को तुरन्त बतायें।

- यदि बालक को ज्यादा दर्द हो और दवा से आराम ना मिले तो डॉ. को तुरन्त बताये।

- ऑपरेशन के बाद ड्रेसींग या पेशाब के साथ खून दिखना सामान्य है, परन्तु खून बंद ना हो तो डॉ. को तुरन्त बताये।

- नली में पेशाब आना बंद अथवा नली निकल जाने पर भी डॉ. को तुरन्त सुचित करे।

- ऑपरेशन के बाद बालक को ढीला कपड़ा पहनावे जिससे बालंक को तकलीफ ना हो और ड्रेसीग गिला ना हो उसका ध्यान दे।

- छुट्टी के समय डॉ. आपको नली निकालने की तारीख दे उस तारीख पर जरुर आये।

• ड्रेसींग निकालने के बाद क्या देखभाल करे ?

- ड्रेसीग निकालने के बाद इन्द्रिय पर लालास और सुजन होती है, जो समय के साथ चली जाती है।

- इन्द्रिय पर दिखने वाले टांके अपने आप गल जाएगे उसको तोड़ने की जरुरत नहीं है।

- घर में बालक के ऑपरेशन की जगह खून साफ अथवा टांका तोड़ने की कोशिश ना करे, नही तो चेप अथवा फिस्च्युला हो सकता हैं।

- रोज बताये गये जगह पर सुबह-शाम मलहम लगायें।

- ऑपरेशन के बाद डॉ.को समय से बताना जरुरी हैं।

Kidney Stones in Children:

What are Kidney Stones?

Kidney Stones are also known as Renal Calculi or Nephrolithiasis. They typically occur in Adults, but can affect Children as well and can occur even in Babies.

What Causes Kidney Stones to form?

1) Low Urine Volume: When a child does not drink enough fluids, urine to become concentrated and dark in color. Increasing fluid intake will dilute the urine and decrease the chance of stone formation.

2) High Sodium Diet

3) Medications: Some medications may cause low Urinary Citrate. Urinary Citrate, a natural substance in the urine, protects against kidney stone formation. These include Furosemide (Lasix), Acetazolamide (Diamox), and high doses of Vitamin C.

4) Medical Conditions that can cause Kidney Stones: Metabolic abnormality predisposing to kidney stones. Hypercalciuria means the urine has a very high level of calcium.

- High salt in the diet can cause hypercalciuria.

- Some medications can cause hypercalciuria.

- Hypercalciuria is the most common genetic cause of kidney stones. Hypocitraturia means there are low levels of citrate in the urine.

- When Citrate is low in the urine, calcium and uric acid kidney stones can form.

Hyperoxaluria is where the Liver makes too much Oxalate leading to kidney stones made from Oxalate.

Cystinuria is an inherited genetic disorder where there is too much of the amino acid cysteine in the urine that can lead to cysteine stones.

Other: Hyperparathyroidism can cause too much calcium to be pulled from bones leading to high calcium in blood and urine.

5) Bowel or Gastrointestinal conditions

- In conditions that cause Chronic Diarrhoea, such as Crohn’s disease or Ulcerative Colitis, kidney stones are more likely to form due to the excessive fluid loss.

- Some Gastrointestinal diseases or surgeries, such as Gastric bypass surgery or inflammatory bowel disease, can cause the intestines to absorb more oxalate from foods and form Calcium Oxalate stones.

What is difference between stone in Adults and Children?

Stones are less common in children than in adults. Most children who develop kidney stones have an underlying condition that increases their risk of stones. Metabolic abnormality is seen in 70 - 90% of children with the stone disease.

When should we visit to Doctor? The most common symptoms of Kidney Stones include:

o Pain in the Belly or Back

o Blood in the Urine (Hematuria) or Cloudy Urine

o Nausea or Vomiting, Fever

o Needing to rush to the bathroom to Urinate

However, some children, particularly young children, do not have any symptoms, and the Kidney Stone is found when an imaging test (like an X-ray or ultrasound) is done for another reason.

Risk Factors for Kidney Stones

Factors that place a child at increased risk for developing kidney stones are:

- Defects in the Urinary tract

- Family history of Stones

- Decreased water intake or long periods of Dehydration

- Repeated Urinary Tract Infection

- Diet high in Sodium and/or Protein

- Obesity, Decreased activity level

- Use of certain Medications

How are Kidney Stones Diagnosed by Doctor?

- Medical History

- Physical Examination

- Renal Ultrasound: Most common Radiologic test used to diagnose a urinary tract stone. This is a painless test using sound waves to take pictures of the kidneys, ureters and bladder. The images created may show the location of the stone(s).

- CT Scan

- Kidney, Ureter, Bladder (KUB) X-ray

The doctor may also order a 24-hour urine collection that a special lab will evaluate to see what kind of stones your body is making.

How are Kidney Stones treated?

Mode of Treatment - Medical Management and /or Surgery, depends on the size, what it is made of, and whether they are causing symptoms or blocking the urinary tract.

Small stones are likely pass on their own without treatment, but will often require pain control and encouragement to drink a lot of extra fluids to help the stone pass.

Stones larger than 9 or 10 millimeters (about half an inch) or ones that block the urine flow may require surgery or hospitalization.

Treatments to eliminate the stone — One or more treatments can be used to eliminate a kidney stone. Shock Wave Lithotripsy is the first-line treatment in most cases.

- Shock Wave Lithotripsy: This treatment is first choice for kidney stones in many children. Lithotripsy is done by directing a high-energy shock wave toward the stone to break into fragments and passage. The procedure takes about 20-30 minutes. Some children, although not all, are given Anaesthesia to prevent movement during the treatment. The success of Lithotripsy depends, in part, on the size of the stone; larger stones are more difficult to break up and sometimes need more than one treatment. It can take three months after lithotripsy for all of the stone fragments to pass.

- Percutaneous Nephrolithotomy: Large stones or stones that do not break up with Lithotripsy will require a minimally invasive surgical procedure to remove the stone. During the procedure, small instruments are passed through the skin (percutaneously) into the kidney to remove the stone. The child is given Anaesthesia for the procedure to prevent pain.

- Ureteroscopy: Ureteroscopy is a procedure that can be done if the stone is in the middle and lower portion of the Ureter. The Doctor passes a small instrument with camera through the urethra and bladder, into the Ureter. The stone can be removed or broken up into smaller pieces that can pass more easily.

KIDNEY STONE PREVENTION

Children who develop a kidney stone have a significant chance of developing stones in the future between 30 and 65 percent.

- Blood and Urine Tests: After a child has had a Kidney Stone, blood and urine tests are performed to identify factors that can increase the risk of future stones.

Testing is not done until the child is at home, walking and playing normally, eating a normal diet, and has finished any treatment for Urinary Tract Infection (UTI).

Urine Metabolic profile after collecting urine for 24 hours to check amount of Calcium, Oxalate, Citrate and Uric Acid in urine.

- Stone Testing: If the child passes a stone or stone fragment, save it in a clean container. A lab can analyze the stone to determine the type, which can guide treatment. Based on what the stone is made of, one or more treatments might help to reduce the risk of future stones.

- Drink More Fluids: Drinking more fluids can help to decrease the risk of forming all types of kidney stones. The goal is to increase the amount of urine that flows through the kidneys and ureters and to lower the concentration of substances that promote stone formation.

હાઈપોસ્પાડીઆસ શું છે?

હાઈપોસ્પાડીઆસ શું છે?
હાઈપોસ્પાડીઆસ (Hypospadias) એ એક પ્રકારની પુરુષોના જનનાંગોની (ઈન્દ્રિય શિખ / Genitals) જન્મજાત ખામી છે. સામાન્ય રીતે, છોકરાઓમાં પેશાબનું છિદ્ર (Urethral meatus) લિંગની ટોચ પર ખુલે છે. આ ખામીમાં છિદ્ર લિંગની નીચેના ભાગમાં ખુલે છે. તેની સાથે લિંગની ચામડી ઉપરના ભાગમાં વધેલી હોય છે. જેને હુડ (Prepucial nood) કહેવાય છે. ઘણીવાર આ કારણોસર
કોઈ બાળકોમાં લિંગ નીચેની તરફ વળેલુ હોય છે, જેને કોર્ડ (Chordee) કહેવાય છે.

હાઈપોસ્પાડીઆસ ક્યા ક્યા પ્રકારના હોઈ શકે?
હાઈપોસ્પાડીઆસ નીચેના પ્રકારના હોઈ શકે:

હાઈપોસ્પાડીઆસ સાથે બીજી કોઈ બિમારી હોઈ શકે?
હા, જન્મજાત રીતે ગોળીઓનું નીચે ન ઉતરવું (undescended Testes) અને સારણગાંઠ (inguinalhernia) સાથે જોવા મળી શકે.

આ ઓપરેશન શા માટે જરૂરી છે?
બાળકનું લિંગ નોર્મલહોવું તે મુખ્યત્વે આ કારણોસર જરૂરી છે
(૧) બાળક ઊભુ રહી અને સીધી ધારથી પેશાબ કરી શકે.
(૨) બાળકને બીજા બાળકોની સરખામણીમાં ઉતરતા દરજ્જાનું ના લાગે અને બાળકના માનસિકવિકાસને અસર ના થાય.
(૩) લગ્નપછી સંબંધ બાંધવામાં અને સંતાન થવામાં તકલીફ ન પડે.

ઓપરેશનના મુખ્ય હેતુ પેશાબના છિદ્ર નેલિંગની ટોચ પર ખુલે તે માટે હોય છે. જેથી બાળક ઉભુ રહીને સીધી ધારથી પેશાબ કરી શકે. આ માટે લિંગની ઉપરના હુડની ચામડી નો ઉપયોગ કરવામાં આવે છે એટલે ઓપરેશન પછી બાળકને સુન્નત (ખતના/circumcision) કર્યું હોય તેવો દેખાવ થાય છે.

શું આ ઓપરેશન જોખમી છે?
-દરેક નાના અથવા મોટા ઓપરેશન ની જેમ આમાં પણ આડઅસરો/જોખમો રહેલા છે, જોકે મોટા ભાગના બાળકોમાં વિના જોખમે ઓપરેશન સારી રીતે પાર પાડી શકાતું હોય છે.
-આશરે ૧૦ માથી ૧ બાળક ને ઓપરેશન પછી પેશાબ પહેલાની જગ્યાએથી થઈ શકે છે (Fistula/Leak) કારણકે લિંગની ઉપરની ચામડી અત્યંત નાજુક હોય છે.
-આ માટે બીજા નાના ઓપરેશનની જરૂર પડી શકે છે
-ઓપરેશન પછી પેશાબનો માર્ગ અથવા છિદ્ર - સાંકડુ થઈ જવાથી (Stricturelstenoses) પેશાબ ની ધાર પાતળી થઈ શકે છે. જેના માટે થોડા સમય સુધીમાર્ગ પહોળો કરવાની સારવાર કરવી પડી શકે છે (dilatation)
-દરેક ઓપરેશનની જેમ આમાપણ ચેપ (infection) લાગવાની શક્યતા રહે છે.

ઓપરેશન સિવાય બીજો કોઈ વિકલ્પ હોઈ શકે?
ના, ઓપરેશન સિવાય બીજી કોઈ વૈકલ્પિક સારવાર નથી.

આ ઓપરેશન ક્યારે કરવામાં આવે છે?
-સામાન્ય રીતે ૧ વર્ષ પછી કરવામાં આવે છે. જો બાળકને સાથે કોઈ બીજી ગંભીર જન્મજાત ખામી હોય તો ઓપરેશન કરવામાં મોડુ થઈ શકે છે.
-ક્યારેક જો બાળકની ઈન્દ્રિય ખૂબ નાની હોય અને / અથવા સાથે ગોળીની પણ તકલીફ હોય, તો ઓપરેશન પહેલા બાળકને ઈન્દ્રિય લાંબી કરવામાં હોર્મોન્સની સારવાર (InjectionTestosterone) કરવી પડી શકે છે.

ઓપરેશન પહેલાં અને પછી શું કરવામાં આવે છે?
-ઓપરેશન પહેલા ૪-૬ કલાક બાળકને ભૂખ્યું રાખવામાં આવે છે. ઓપરેશનના દિવસે બાળકને બરાબર નવડાવવું જરૂરી છે.
-ઓપરેશન માટે શીશી સુંઘાડીને બેભાન કરવામાં આવે છે અને ઓપરેશન પછી તરત દુઃખાવો ના થાય તે માટે કમરમાં (caudal Block) અથવા લિંગની ફરતે (Penile Block) ઈજેકશન આપવામાં આવે છે.
-ઓપરેશન પછી પેશાબના માર્ગમાં ૧૦-૧૨ દિવસ સુધી નળી રાખવામાં આવે છે. તે દરમ્યાન પેશાબની ઈન્દ્રિયને શિથિલ રાખવા માટે અને કબજિયાત ન થાય તે માટે દવા આપવામાં આવે છે.
-ક્યારેકપેશાબની નળી લાંબો સમય રાખવી પડે શકે છે (૧૪-૧૬ દિવસો) જેના માટે ડોકટર તમને જે-તે સમયે સમજાવશે.
-ઓપરેશન પછી બાળકને સામાન્યરીતે ૨-૩દિવસમાં રજા આપવામાં આવે છે.

હોસ્પિટલમાંથી રજા મળ્યા પછી મારા બાળકની ઘરે કઈ રીતે કાળજી રાખવી?
-જ્યાં સુધી પેશાબની નળી શરીરમાં હોય ત્યાં સુધી બાળક સામાન્ય હલનચલન કરી શકે છે પરંતુ રમવા-દોડવાથી પરેજી રાખવી જોઈએ.
-પેશાબની નળીની આજુબાજુમાંથી પેશાબનનીકળે તે માટે બાળક સંડાસ માટે જોર ન કરે તે જરૂરી છે. આ માટે બાળકને કબજિયાત ન થવી જોઈએ. નળી બંધ ન થાય અને પેશાબ અટકે નહિ તે માટે બાળકને વધુ પ્રમાણમાં પાણી આપવું જોઈએ.
-ઓપરેશનની જગ્યાએ દુઃખાવો થઈ શકે છે જેના માટે દુઃખાવાની દવા આપવામાં આવે છે.
-જો બાળકને વધુદુઃખાવો થાય અને દવાથી ઓછો ન થાય તો તાત્કાલિકડોકટરને બતાવવું જોઈએ.
-ઓપરેશન પછી ડ્રેસિંગમાં લોહી આવવું અથવા લોહી મિશ્રિત પેશાબ આવવો તે સામાન્ય હોય છે પરંતુ જો લોહી બંધ જ ન થાય તો તાત્કાલિક ડોકટરને બતાવવું જોઈએ.
-નળીમાં પેશાબ આવતો બંધ થઈ જાય અથવાળી નીકળી જાય, તોપણ તાત્કાલિક ડોકટરને બતાવવું જોઈએ.
-ઓપરેશન પછી બાળકને ઢીલા કપડાં પહેરાવવા જોઈએ જેથી બાળકને તકલીફ ના થાય. ડ્રેસિંગ પલળે નહિ તેની કાળજી રાખવી જરૂરી છે.
- રજા સમયે ડોકટર તમને પેશાબની નળી કઢાવવા માટેની તારીખ આપશે - આ તારીખે અચુક આવવું.

ડ્રેસિંગ કાયા પછી શું કાળજી રાખવી પડે?
-ડ્રેસિંગ કાઢ્યા પછી ઈન્દ્રિયપર લાલાશ અને સોજો રહે છે, જે સમય સાથે જતો રહે છે.
-ઈન્દ્રિય પર દેખાતાં ટાંકા જાતે ઓગળી જાય છે અને તેને તોડવાની જરૂર પડતી નથી.
-ઘા પરથી લોહીના ડાઘા કાઢવાની અથવા જાતે ટાંકા કાઢવાની કોશિશ કરવી જોઈએ નહિ. આવું કરવાથી બાળકને ચેપ (Infection) અથવા ફિમ્યુલા (Fistula) થઈ શકે છે.
નિયમિત રીતે ટાંકાપર આપેલો મલમ સવાર-સાંજ લગાડવો.
-ઓપરેશન પછી ડોક્ટરને નિયત સમયાંતરે બતાવવું અત્યંત જરૂરી છે.

Hydrostatic Reduction of Intussusception in Children: A Lifesaving Procedure

What is intussusception?

Intussusception is a condition in which one segment of intestine slides inside another, like a telescope, causing an intestinal blockage and colicky abdominal pain. It usually occurs at the junction of the small and large intestines. If not diagnosed early, it can cause swelling of the intestine with a compromise to its blood supply that can lead to irreversible intestinal injury and gangrene. Intussusception usually affects infants and toddlers, typically between the ages of 3 months and 3 years. It is considered a medical emergency due to its potential to cause serious complications, such as bowel obstruction, reduced blood flow to the intestines, and even tissue death/gangrene.

What causes intussusception and how common is it?

The exact cause of intussusception is unknown. Intestinal Infection by a virus (preceding diarrhoea or cough/cold) is thought to produce swelling of the lining of the intestine, which then slips into the intestine below. This happens most often during the weaning period. Some children are born with a polyp or diverticulum, which can also lead to Intussusception. The common age range is 3-36 months, but may appear at any age especially if it is due to a polyp etc. It is seen in approximately one in 1,200 children, and more often in boys.

What are the symptoms?

Excessive crying (due to severe and crampy abdominal pain) when the infant often folds and draws up legs towards his chest. This can last for few minutes alternating with periods of no pain. Rectal bleeding (red jelly-like stools), sometimes mixed with mucus may begin suddenly which is very alarming and worrisome for parents. Vomiting is usually present. Vomiting can be dark green after some time. Abdominal distension may be present in some patients.

Why Hydrostatic Reduction?

Hydrostatic reduction is a non-surgical procedure used to treat intussusception. It involves using a contrast solution, usually contrast/dye or air, to gently push the telescoped portion of the intestine back into its normal position. This procedure is usually preferred over surgery because it is less invasive and carries a lower risk of complications. However, not all cases of intussusception are suitable for hydrostatic reduction. The decision depends on the child's condition, the duration of symptoms and doctor’s discretion.

The Procedure:

The hydrostatic reduction procedure takes place under the supervision of medical professionals, usually in a radiology suite. Here's a step-by-step breakdown:

Diagnosis: The first step is diagnosing intussusception, often through an ultrasound or an X-ray. These imaging techniques help confirm the presence of the condition and its severity.

Preparation: Before the procedure, the child might receive intravenous fluids to correct any dehydration. A nasogastric tube (tube through the nose that goes to the stomach to drain its contents) may be placed to prevent vomiting. Sedation or anaesthesia might also be administered to keep the child comfortable and still during the procedure.

Contrast Solution Injection: a catheter is placed inside the rectum. A contrast solution, either water soluble dye or air, is gently inserted into the rectum. This solution helps outline the intestine on imaging, making it easier for medical professionals to see the intussusception.

Imaging Guidance: Under real-time X-ray or ultrasound guidance, the medical team slowly introduces the contrast solution. As the solution enters the intestines, it pushes the telescoped segment back into place. Throughout the procedure, the medical team carefully monitors the child and the progress of the reduction. Once the telescoped portion is successfully reduced (as confirmed by imaging), the contrast solution is carefully removed, and the child is observed for any adverse reactions. After few hours, a repeat ultrasound is done to confirm the reduction of the intussusception. After that, regular feeds are gradually reintroduced, and the child's recovery is monitored.

Benefits of Hydrostatic Reduction: Hydrostatic reduction offers several advantages over surgical intervention:

Less Invasive: Since the procedure doesn't involve an incision, the risk of surgical complications is minimized.
Quick Recovery: Children who undergo successful hydrostatic reduction tend to recover more swiftly than those who undergo surgery.
Avoiding Anesthesia Risks: While sedation or anesthesia may be used during the procedure, it's generally safer than undergoing full surgical anesthesia.
High Success Rate: When performed under the right conditions, hydrostatic reduction has a high success rate in resolving intussusception.

Risks:

In case hydrostatic reduction fails, surgery will be required for reduction of intussusception.
There is 6-10% chance of recurrence of intussusception, especially in the first 2 weeks after the procedure, till the swelling in the intestinal lining subsides completely.

What is the long term outcome in such patients?

In the long term, intussusception patients usually do well without any deleterious effects on health and wellbeing of the child.

Undescended Testes

1. What is undescended testes?

This is a condition in which testicle is not able to reach up to bottom of the scrotum one or both side after birth. Normally testicle on each side reaches up to bottom of the scrotum after birth in term baby

2. What is the cause of undescended testes?

During pregnancy both testes form in the boy abdomen and slowly it moves down to reach scrotum as

shown in the figure. Due to unknown reason, sometimes testes is not able to reach in the scrotum that causes undescended testes.

Other causes are-

- Genetic predisposition

- Hormonal imbalances

- Premature birth

- Low birth weight

3. Why should we be concerned about undescended testes?

Temperature of abdomen is 4 degree higher than scrotum. so, testicle is exposed to higher temperature when it is undescended due to closeness to abdomen so exposed to higher temperature. Because of this, testicle may get shrink in size and slowly over the time period may be non-functional.

4. Risks of Untreated Undescended Testes

- Infertility: Higher risk of infertility in adult life.

- Testicular Cancer: Increased risk if not treated.

- Inguinal Hernia: Potential for hernia formation.

-testicular torsion: which can cause permanent damage of testes

What is the treatment of the this?

We observe this condition till 6 months of age. Because ,sometimes testicle can reach up to the bottom of the scrotum in this time period on its own. Beyond this time, descend of the testicle is unlikely and also testicle starts getting damaged. After this time period surgery is performed.

1. What type of surgery is needed?

Surgery is performed depending on the position of the testicle. if testicle is outside the abdomen and above the scrotum then surgery is being done by open method if testicle is inside the abdomen, then it is done by laparoscopic method. Again, if testicle is very high up there may be need of two surgeries.

2.How long we need to stay for surgery?

This is the day care surgery in which child will be discharged on the same day after surgery. It will take around 45 minutes to 60 minutes in surgery. And child should be empty stomach for 4hrs before surgery

3. Is there any risk during surgery?

There is no life risk in this surgery. Surgery is being done under caudal anesthesia with sedation in which surgical site area and adjacent area is made numb. Child will be awake just after the surgery.

4. How long my child will be empty stomach?

We have to keep child empty stomach 4hrs before surgery and after surgery child can be fed after 2 hrs.

5. What are the complications?

Bleeding and infection may occur after orchidopexy, as for any operation but chances are very less. There is a very small risk of damage to the blood vessels to the testis and to the vas. The testis may not grow normally after the operation, either due to poor testis development, or due to operative damage to the blood vessels.

The testis may fail to reach the scrotum in the first operation, and move up (‘reascend’) with growth. In these cases, a second operation may be needed.

1. What are the outcomes from surgery?

When the undescended testis is initially in the groin, 95% can be successfully placed in the scrotum. When the testis is initially in the abdomen, 85-90% can be successfully placed in the scrotum. Men who have had surgery for one undescended testis (with a normally descended testis on the other side) have near normal paternity (~90%). In contrast, men who have had surgery for undescended testes on both sides have reduced fertility. Surgery for undescended testis does not remove the risk of tumour in the testis, but does make early diagnosis and thus successful treatment possible.

2. What is the follow-up?

Your child will need review of their wound and their testis size and position. An appointment will be made 7 days after surgery. Further appointments are made at 6 months and puberty to again check testis size and position; and to discuss testicular self-examination in the future.

-જેમ પેશાબનું છિદ્ર પાછળની તરફ (વૃષણ કોથળી તરફ) હોય,-તેમ Hypospacias ની સાથે ઈન્દ્રિયનો વળાંક વધુ તીવ્રહોવાની શક્યતા છે.

-આ તકલીફ બાળકોમાં જન્મ થયા પછી બાળકોના ડોકટરઅથવા માતાપિતા દ્વારા નોંધવામાં આવે છે.

-દર ૩૦૦ પુરુષ બાળકોએ ૧ બાળકમાં આ તકલીફ જોવામળે છે.