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Nov09
D-backs Exchange Deadline programs
PHOENIX -- Just before opening their 4-recreation sequence with the Giants upon Thursday, the D-backs dealt outfielder Tim Locastro towards the Yankees within just change for Very little League specifically-hander Keegan Curtis.Even at the time their 5-3 acquire around the Giants at Chase Business, the D-backs locate them selves buried deep in just the Nationwide League West with a 23-60 history. It was specifically Arizona 3rd acquire within just its closing 27 video games and all 3 of these online games were being started out via Merrill Kelly, who authorized a few operates previously mentioned 7 innings with 7 strikeouts. Josh Reddick and Pavin Smith paced the offense as each individual homered off Giants newbie Johnny Cueto.Though there will virtually undoubtedly be further moves just before the July 30 Exchange Deadline, enthusiasts anticipating in the direction of perspective a carefully substitute D-backs staff members within just August are almost certainly in direction of be frustrated.I put on't check out any large transformation of our latest roster, reported assistant GM Amiel Sawdaye, who is taking care of the personnel working day-towards-working day functions even though GM Mike Hazen is upon a bodily go away of deficiency. "I have on't imagine we need a complete teardown. I can comprehend why followers need a entire teardown https://www.arizonapetsstore.com/Riley_Smith_Dog_Jersey-40 . I dress in't feel we need to have that. I consider coming into this calendar year we sure didn't be expecting this personnel in direction of visual appeal such as this, yet I moreover believe it's a great deal less difficult towards say, Oh, accurately rip it aside and rebuild. It's not that very simple toward do that. Generating trades is not an basic point toward do within just the league.That doesnt signify there wont be some alterations.There incorporate been rumors linking infielder Eduardo Escobar, who is within just the best calendar year of his deal, in the direction of the White Sox, still the D-backs are not merely moving toward offer you him absent.There much too been sound above Arizona becoming open up in the direction of working David Peralta, who would be a small more durable in direction of stream than Escobar as the outfielder is down below deal all through the 2022 time, manufacturing $7.5 million within the supreme yr of his package.Catcher Stephen Vogt is a no cost consultant at period finish as is outfielder Reddick, who consists of a lot of postseason encounter.However it not as basic as a workers boasting it desires in direction of exchange avid gamers."For each and every Arizona Diamondbacks vendor that is out there, there are other groups that are marketing that consist of superior avid gamers, as well, and a constrained selection of groups that purchase, Sawdaye stated. It's a current market, instantly? On your own've acquired towards consist of potential buyers and distributors https://www.arizonapetsstore.com/Custom_Dog_Jersey-12 . That's aspect of the problem at moments."Whilst it will come toward avid gamers that groups would nearly completely be fascinated inside, these as outfielder Ketel Marte or catcher Carson Kelly, either of whom are upon the hurt record, the D-backs imagine they are gamers who may be element of the main of a potential contending personnel.At the close of April, we observed Carson Kelly with a 1.000 OPS, and if we imagine inside that, it's not simple in the direction of locate a catcher towards switch Carson https://www.arizonapetsstore.com/Stone_Garrett_Dog_Jersey-104 , who we felt includes rather occur into his individual as a rather Fantastic defensive catcher and was likely, prior to he bought problems, upon his path in the direction of remaining an All-Star https://www.arizonapetsstore.com/Corbin_Carroll_Dog_Jersey-101 , Sawdaye reported.Kelly, who as well strike an RBI solitary in opposition to San Francisco, would surely focus groups as he consists of a rather economical employees preference for 2022 at $5.25 million, still all over again, he could possibly be unachievable for the D-backs towards aspect with presented that he is their highest regular newbie.It's additionally relevance holding inside of thoughts that the D-backs put on't consist of in the direction of do all their business enterprise ahead of the Exchange Deadline -- the offseason is frequently an less difficult season in direction of offer avid gamers quite than in just the warm of a time.On your own use't merely require in direction of press components during at the Deadline simply just towards press them all through considering the fact that it's the Deadline, Sawdaye explained. I do believe that there may be option dynamics at enjoy inside the offseason than there may perhaps be within just the upcoming 3 or 4 months."


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Oct19
Efficacy of surgical techniques and factors affecting residual stone rate in the treatment of kidney stones
Original Research
Efficacy of surgical techniques and factors affecting residual stone rate in
the treatment of kidney stones
Dr. Anil Haripriya


1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to assess efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. Materials & Methods: 102 patients of kidney stones of both genders were divided
into 3 groups. Group I patients underwent open stone surgery, group II patients underwent percutaneous nephrolithotomy
(PNL) and group III underwent retrograde intrarenal surgery (RIRS). Surgical techniques complications were evaluated.
Results: In group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9 cm2
. The mean
operative time in group I was 84.2 minutes, in group II was 118.4 minutes and in group III was 78.6 minutes. There were 9
cases in group I, 7 in group II and group III was 5 cases. There were 7 cases of fever in group I, 4 in group II and 2 in group
III, infection 2 in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II.
The difference was significant (P< 0.05). Conclusion: PNL and RIRS have been seen as safe and effective methods as
compared to open method in case of kidney stones.
Key words: Percutaneous nephrolithotomy, Retrograde intrarenal surgery, Kidney stone.
Received: 13 September, 2020 Accepted: 18 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College,
Jabalpur (M.P.), India
This article may be cited as: Haripriya A, Baghel A. Efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. J Adv Med Dent Scie Res 2020;8(12):55-58.
INTRODUCTION
Urinary system stone disease is one of most
frequently encountered diseases in the urology
practice. The stones are frequently observed in the
renal localization, and most of them require
intervention.1 Kidney stone disease, also known as
urolithiasis or renal calculi contributes to one of the
most common health problems in the daily lives of
men and women. It occurs when a solid piece of
material (stone) forms in the urinary tract.2
Approximately 12% of men and 6% of women in the
USA and 10 to 15% of people in Europe and North
America are affected by it. Calcium oxalate (CaOx) is
found to one component of the most common kidney
stones. It has been proposed that the most likely stone
formation mechanism for people with idiopathic
CaOx stones is caused by CaOx overgrowth in renal
papillary Randall’s plaque.
3
Preventive measures such
as dietary therapy and therapeutic treatments such as
drugs and surgical techniques have been verified to be

effective in the treatment of renal calculi. Dietary
modification is a safe and economical preventive
measure for dietary therapy, and in some cases, drugs
are important to reduce the risk of stone formation.
Unfortunately, since the 1980s, there have been no
new drugs developed for the prevention of renal
calculi after the introduction of potassium citrate.4
Some of these methods include percutaneous
nephrolithotomy (PCNL), extracorporeal shockwave
lithotripsy (SWL), retrograde intrarenal surgery
(RIRS), etc. Extracorporeal shock wave lithotripsy
(ESWL) into clinical practice after 1980s, a new era
had begun in the treatment of urinary system stone
disease. In recent years, percutaneous
nephrolithotomy (PNL) has taken increasingly greater
part in the treatment of stone disease with success
rates nearing to 80 percent.5 The present study was
conducted to assess efficacy of surgical techniques
and factors affecting residual stone rate in the
treatment of kidney stones.
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Treatment of kidney stones.

56

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
MATERIALS & METHODS
The present study was conducted among 102 patients
who underwent surgical treatment of kidney stones of
both genders in the department of general surgery in a
medical college hospital. All were informed regarding
about the study and their consent was obtained.
Data such as name, age, gender etc. was recorded.
Patients were divided into 3 groups. Group I patients
underwent open stone surgery, group II patients
underwent percutaneous nephrolithotomy (PNL) and

group III underwent retrograde intrarenal surgery
(RIRS).
Endoscopic stone surgery was performed for stone
fragmentation in all patients using pneumatic
lithotriptor or Holmium: YAG laser. Surgical
techniques complications were evaluated. Stones
equal or larger than 4 mm were considered as residual
stones. The dimensions of the stones were calculated
and measured in cm2

. Results thus obtained were
subjected to statistical analysis. P value less than 0.05
was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II Group III
Methods Open stone surgery PNL RIRS
M:F 34 34 34

Table I shows that group I patients underwent open stone surgery, group II patients underwent PNL, and group
III underwent RIRS. Each group had 34 patients.
Table II Assessment of parameters

Parameters Group I Group II Group III P value
Stone burden (cm2

) 3.2 2.5 1.9 0.01
Operative time (mins) 84.2 118.4 78.6 0.001
Length of hospital stay 3.2 3.0 1.4 0.05
Cases with residual stone 9 7 5 0.02
Table II shows that in group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative timein group I was 84.2 minutes, in group II was 118.4 minutes and in group III was
78.6 minutes. There were 9 cases in group I, 7 in group II and group III was 5 cases. The difference was
significant (P< 0.05).
Table III Assessment of complications in groups

Complications Group I Group II Group III P value
Fever 7 4 2 0.02
Infection 2 0 3 0.05
Urine leakage 0 0 5 0.05
Persistent pain 6 1 0 0.001

Table III, graph I shows that there were 7 cases of fever in group I, 4 in group II and 2 in group III, infection 2
in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II. The
difference was significant (P< 0.05).
Graph I: Assessment of complications in groups

0
1
2
3
4
5
6
7

Fever Infection Urine leakage Persistent pain
7

2

0

6

4

0 0

1

2

3

5

0

Group I
Group II
Group III

Haripriya A et al. Treatment of kidney stones.

57

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
Currently, a diverse range of non-invasive, minimally
invasive and invasive methods have been reported as
treatment approaches for renal calculi. Recent studies
have reported that flexible ureterorenoscopy
(URS)/holmium laser lithotripsy can be an alternative

treatment for patients with renal calculi. The micro-
percutaneous nephrolithotomy (microperc) is a

recently described technique in which percutaneous
renal access and lithotripsy are performed in a single
step. Microperc has been found to be safe and
effective in removing small renal calculi in the adult
and pediatric populations with a high stone-free rate
and lower complication rate.6 Despite all the new
approaches, shock wave lithotripsy (SWL) remains
the first line treatment modality that is widely used for
renal, ureteral and intermediate-size renal calculi. Its
success rates from contemporary series vary from 60
to 90%. However, during an SWL procedure,
physicians should consider the association between
SWL-related pain and patients’ positioning, which
may negatively affect the SWL success rate as well as
its potential complications. PCNL can be divided into
two types: minimally invasive percutaneous
nephrolithotomy (mini-PCNL) and standard
percutaneous nephrolithotomy (standard PCNL).7
Mini-PCNL has a higher efficacy and better safety in
the management of small renal calculi, while standard
PCNL is still regarded as the conventional technique
for the treatment of large renal stones in the upper
urinary tract. However, in the recent years, there has
been a shift in trend to favor a mini-PCNL approach
in order to reduce the morbidities.8The present study
was conducted to assess efficacy of surgical
techniques and factors affecting residual stone rate in
the treatment of kidney stones.
In present study, group I patients underwent open
stone surgery, group II patients underwent PNL, and
group III underwent RIRS. Each group had 34
patients. Ayedemir et al9

included records of 109
cases of kidney stones. Patients were divided into
three groups in terms of surgical treatment; open stone
surgery, percutaneous nephrolithotomy (PNL) and
retrograde intrarenal surgery (RIRS). Patients’ history,
physical examination, biochemical and radiological
images and operative and postoperative data were
recorded.The patients had undergone PNL (n=74;
67.9%), RIRS (n=22;20.2%), and open renal surgery
(n=13; 11.9%). The mean and median ages of the
patients were 46±9, 41 (21–75) and, 42 (23–67) years,
respectively. The mean stone burden was 2.6±0.7 cm2
in the PNL, 1.4±0.1 cm2 in the RIRS, and 3.1±0.9
cm2 in the open surgery groups. The mean operative
times were 126±24 min in the PNL group, 72±12 min
in the RIRS group and 82±22 min in the open surgery
group. The duration of hospitalisation was 3.1±0.2
days, 1.2±0.3 days and 3.4±1.1 days respectively.
While the RIRS group did not need blood transfusion,
in the PNL group blood transfusions were given in the
PNL (n=18), and open surgery (n=2) groups. Residual

stones were detected in the PNL (n=22), open surgery
(n=2), and RIRS (n=5) groups.
We found that in group I mean stone burden was 3.2
cm2
, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative time in group I was 84.2
minutes, in group II was 118.4 minutes and in group
III was 78.6 minutes. There were 9 cases in group I, 7
in group II and group III was 5 cases. Stone-free rate
in percutaneous nephrolithotomy can vary dependent
on the stone location, and size, as reported in the
literature, it increases up to 90 percent. In the AUA
guideline, this rate has been given as 78 percent. In
our study, in 74 patients, a 70.3% stone-free rate has
been detected. Size, location, composition of the
stone, anatomy of the affected kidney, and experience
of the surgeon are effective on success, and
complications of PNL.10
We found that there were 7 cases of fever in group I, 4
in group II and 2 in group III, infection 2 in group I
and 3 in group III, urine leakage 5 in group III and
persistent pain 6 in group I and 1 in group II.
Lingeman et al11reported 88–91% success rates for
stones with a diameter of 1–3 cm, mean success rate
decreased to 75% in stones larger than 3 cm in
diameter. Still Clayman et al12reported success rates
as 89.2, and 97–100% for stone with a stone burden of
>2, and <2 cm2

, respectively.
CONCLUSION
Authors found that PNL and RIRS have been seen as
safe and effective methods as compared to open
method in case of kidney stones.
REFERENCES
1. Karatag T, Buldu I, Inan R, Istanbulluoglu MO: Is
MicropercutaneousNephrolithotomy Technique Really
Efficacicous for the Treatment of Moderate Size Renal
Calculi? Yes. UrolInt 2015;95:9-14.
2. Kim BS: Recent advancement or less invasive treatment
of percutaneous nephrolithotomy. Korean J Urol
2015;56:614-623.
3. Hyams ES, Munver R, Bird VG, Uberoi J, Shah O:
Flexible ureterorenoscopy and holmium laser lithotripsy
for the management of renal stone burdens that measure
2 to 3 cm: a multi-institutional experience. J Endourol
2010;24:1583-1588.
4. Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S,
Vyas J, Jagtap J, Desai M: Current role of microperc in
the management of small renal calculi. Indian J Urol
2013;29:214-218.
5. Knoll T, Buchholz N, Wendt-Nordahl G: Extracorporeal
shockwave lithotripsy vs. percutaneous nephrolithotomy
vs. flexible ureterorenoscopy for lower-pole stones.
Arab J Urol 2012;10:336-341.
6. Capitanini A, Rosso L, Giannecchini L, Meniconi O,
Cupisti A: Sepsis complicated by brain abscess
following ESWL of a caliceal kidney stone: a case
report. IntBraz J Urol 2016;42:1033-1036.
7. Kim JK, Ha SB, Jeon CH, Oh JJ, Cho SY, Oh SJ, Kim

HH, Jeong CW: Clinical Nomograms to Predict Stone-
Free Rates after Shock-Wave Lithotripsy: Development

and Internal-Validation. PLoS One 2016;11:e0149333.

Haripriya A et al. Treatment of kidney stones.

58

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
8. Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han
DH: Relationship Between Patient Position and Pain
Severity During Shock Wave Lithotripsy for Renal
Stones With the MODULITH SLX-F2 Lithotripter: A
Matched Case-Control Study. Korean J Urol
2013;54:531-535.
9. Aydemir H, Budak S, Kumsar Ş, Köse O, Sağlam HS,
Adsan Ö. Efficacy of surgical techniques and factors
affecting residual stone rate in the treatment of kidney
stones. Turkish journal of urology. 2014 Sep;40(3):144.
10. Wong C, Leveillee RJ. Single upper-pole percutaneous
access for treatment of > or = 5-cm complex branched

staghorn calculi: is shockwave lithotripsy necessary? J
Endourol. 2002;16:477–81.
11. Lingeman JE, Coury TA, Newman DM, Kahnoski RJ,
Mertz JH, Mosbaugh PG, et al. Comparison of results
and morbidity of percutaneous nephrostolithotomy and
extracorporeal shock wave lithotripsy. J Urol.
1987;138:485–90.
12. Clayman RV, Mcdougall EM, Nakada SY. Endourology
of the upper urinary tract: percutaneous renal and
ureteral procedures. In: Wals PC, Retik AB, Vaughan
EJ, Wein AJ, editors. Campbell’s urology. Philadelphia:
WB Saunders; 1998; 2789–874.


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Oct19
A comparative study of laparoscopic appendectomy versus open appendectomy for the treatment of acute appendicitis
Original Research
A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis
Dr. Anil Haripriya



1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to compare open versus laparoscopic appendectomy in acute appendicitis.
Materials & Methods: 68 cases of acute appendicitis were divided into 2 groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open appendectomy. Results: Symptoms were nausea/vomiting seen 28 in
group I and 26 in group II, abdominal pain 32 in group I and 33 in group II and fever in 25 in group I and 21 in group II. The
difference was non- significant (P> 0.05). Oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group
II, average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I and 4
days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant (P< 0.05).
Conclusion: Laparoscopic appendectomy is effective method of acute appendicitis as compared to open appendectomy.
Key words: Acute appendicitis, Laparoscopic appendectomy, Oral feed
Received: 11 September, 2020 Accepted: 16 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur
(M.P.), India
This article may be cited as: Haripriya A, Baghel A. A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis. J Adv Med Dent Scie Res 2020;8(12):42-45.
INTRODUCTION
Acute appendicitis is the most common emergent
abdominal condition requiring surgical intervention.
Appendicitis is inflammation of the appendix.
1
Symptoms commonly include right lower abdominal
pain, nausea, vomiting, and decreased appetite.
However, approximately 40% of people do not have
these typical symptoms. Severe complications of a
ruptured appendix include widespread, painful
inflammation of the inner lining of the abdominal wall
and sepsis.
2
Appendicitis is the most common cause of the acute
abdomen in the United States, with an estimated
lifetime risk between 5 and 20%. In fact, appendectomy
is the most common non-elective operation performed
by general surgeons. Although it has been over 115
years since Reginald Heber Fitz first demonstrated the

natural history and pathophysiology of appendicitis and
advocated early appendectomy in his landmark article,
appendicitis continues to present challenges for the
surgeon today.3
Appendectomy is the most commonly performed
operation in the world, 6% of all the surgical procedures
and is done as emergency procedure wherever possible,
the only exception is formation of appendicular mass or
abscess. In these cases, interval appendectomy is
performed as elective procedure.4
Laparoscopic appendectomy gives a better evaluation of
the peritoneal cavity than that obtained by open
approach and also facilitates other differential
diagnosis. Advantages of laparoscopic approach include
less operative time, less postoperative pain, reduced
analgesia, less surgery associated complications, shorter
hospital stay, faster recovery, reduced wound infection

Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

43

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
and minimal scarring.5 The present study was
conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
MATERIALS & METHODS
The present study was conducted in the department of
general surgery in a medical college hospital. It
comprised of 68 cases of acute appendicitis. Patients
were informed regarding the study and written consent
was taken.

Patient information such as name, age, gender etc. was
recorded. Patients were diagnosed on the basis of
physical examination, laboratory tests and ultrasound
examination (USG). Patients were divided into 2
groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open
appendectomy. Patients were monitored for pulse rate,
blood pressure, temperature, respiratory rate, bowel
sounds and urinary output. Patients were put on follow
up at 1 week, 2 weeks and 4 weeks after surgery. P
value less than 0.05 was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II
Number Laparoscopy appendectomy Open appendectomy
Number 34 34

Table I shows that group I patients were subjected to laparoscopy appendectomy and group II patients subjected to
open appendectomy.
Table II Assessment of symptoms

Symptoms Group I Group II P value
Nausea/vomiting 28 26 0.97
Abdominal pain 32 33 0.94
Fever 25 21 0.91

Table II shows that symptoms were nausea/vomiting seen 28 in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and 21 in group II. The difference was non- significant (P>
0.05).
Table III Assessment of parameters

Parameters Group I Group II P value
Oral feed started postoperatively 5.9 2.6 0.01
Average hospital stay 5.6 4.2 0.05
Wound abscess 3 4 0.05
Wound infection 2 8 0.01

Table III, graph I shows that oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I
and 4 days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant
(P< 0.05).
Graph I Assessment of parameters

0
1
2
3
4
5
6
7
8

Oral feed started
postoperatively

Average hospital
stay

Wound abscess Wound infection

5.9 5.6

3

2

2.6

4.2 4

8

Group I
Group II

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

44

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
The diagnosis of acute appendicitis is often difficult,
and challenging. The most common cause of surgical
abdomen is appendicitis affecting all the age groups.6
The maximum incidence is documented to be about 7-
10 % of the general population in the second and third
decades of life.7 Appendectomy is the operation which
is most commonly performed by the general surgeons.
The Laparoscopic appendectomy was first performed
by Semm K, German Gynaecologist.8

It has gained
acceptance with the technological advances of the past
two to three decades as a diagnostic and treatment
method for acute appendicitis. From that time, this
procedure has been used widely. In spite of its wide
acceptance, there remains a continuing debate in the
literature related to the most appropriate way of
removing the inflamed appendix.9 The present study
was conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
In present study, group I patients were subjected to
laparoscopy appendectomy and group II patients
subjected to open appendectomy. Burra et al10 in their
study a total 140 patients admitted with clinical
diagnosis of acute or recurrent appendicitis. They were
divided into two groups: open appendectomy (OA)
group with 70 patients in each) and laparoscopic
appendectomy (LA) group (70 patients in each). OA
was performed through standard Mc Burney incision. A
standard 3-port technique was used in this study for the
laparoscopic procedure. It is found that laparoscopic
appendectomy is as safe and effective as the open
procedure. The pain score was reduced in laparoscopic
which is 3.4±1.8 and in open 4.2±1.4. This difference
was found to be statistically significant at p value of
0.05. The duration of analgesics was also reduced in
laparoscopic with mean value of 4.81±3.6 and
10.32±4.2 and this difference was found to be
statistically significant at p value of 0.05.
We found that symptoms were nausea/vomiting seen 28
in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and
21 in group II. Gupta et al11 compared and evaluated the
open and laparoscopic method of appendectomy in
acute appendicitis. The subjects undergoing
appendectomy were evaluated for age, sex, episode
number, duration of pain before presentation in
hospital, operative time, conversion rate, wound
infection, post-operative intra-abdominal abscess
formation, and stay in hospital. It was found that
average operative time in open surgery was 67.5
minutes and 104 minutes in laparoscopic surgery, with
a conversion to open in about 20% of the cases. Oral
feeding in the open group was around the 5th day while
it was around 2nd day in the laparoscopic group.
Average hospital stay was also low in the laparoscopic
group, being only around 5 days in laparoscopic group

and around 8 days in the open group. Overall
complications were also low in the laparoscopic surgery
group.
We observed that oral feed started postoperatively at
mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2
days in group II. Wound abscess was seen in 3 days in
group I and 4 days in group II and wound infection 2
days in group I and 8 days in group II.
Another study by Garg CP12 which studied a total of
110 patients, 61 of whom underwent open
appendectomy and the rest 49 underwent laparoscopic
appendectomy. Operative time was noted to be higher
in laparoscopic surgery, also it was noted that
laparoscopic surgery was associated with less analgesic
use, shorter hospital stay.
The shortcoming of the study is small sample size.
CONCLUSION
Authors found that laparoscopic appendectomy is safer
and effective method for patients of acute appendicitis
as compared to open appendectomy.
REFERENCES
1. Chiarugi M, Buccianti P, Celona G, Decanini L,
Martino MC, Goletti O et al. Laparoscopic compared
with open appendectomy for acute appendicitis: A
prospective study. Eur J Surg 1996; 162(2): 385–390.
2. Garbutt JM, Soper NJ, Shannon W, Botero A,
Littenberg B. Meta-analysis of randomized controlled
trials comparing laparoscopic and open appendectomy.
Surg Laparosc Endosc. 1999; 9(4):17-26.
3. Akshatha Manjunath, Aparajita Mookherjee.
Laparoscopic versus open appendectomy: An analysis
of the surgical outcomes and cost efficiency in a tertiary
care medical college hospital. International Journal of
Contemporary Medical Research 2016; 3(6):1696-
1700.
4. Di Saverio S. Emergency laparoscopy: a new emerging
discipline for treating abdominal emergencies
attempting to minimize costs and invasiveness and
maximize outcomes and patients’ comfort. J Trauma
Acute Care Surg. 2014; 77(1):338–50.
5. Hansen JB, Smithers MB, Schache D, Wall DR, Miller
BJ, Menzies BL. Laparoscopic versus open
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6. Klingler A, Henle KP, Beller S, Rechner J, Zerz A,
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7. Kurtz RJ, Heimann TM. Comparison of open and
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Jul26
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.


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Jul26
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.


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Jul19
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?


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Jul19
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.


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Jul18
Fractional Laser Resurfacing Treatment Done by Dr. Megha Modi
Fractional Laser Resurfacing

What is fractional resurfacing?
Fractional resurfacing is an advanced technology in which only a small fraction of the skin receives the laser light. The laser delivers a series of high precision microbeams that create narrow, deep columns of tissue penetration well below the epidermis (skin surface) and into the dermis, while preserving the surrounding healthy tissue from damage. This “fractional” treatment allows the skin to heal much faster than if the entire area were treated at once, using the body’s natural healing process to create new, healthy skin cells.

What conditions does fractional resurfacing treat?
Fractional resurfacing is very effective on fine lines and wrinkles (including around the eyes), age or sun spots, acne scars, surgical scars and sun damage.

What is the recovery time?
The healthy cells in unlasered areas promote rapid healing of the entire treatment area, resulting in faster recovery time and minimal side effects. The result is softer, smoother and healthier skin without a prolonged healing period.


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Jul12
Hernia Surgery for Child in Delhi, Hydrocele Surgery for Child in Delhi - Pedsurgerydelhi
Hernia and Hydrocele
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.

Why hydrocele is irreducible swelling?
The pathogenesis of both hernia and hydrocele is same that is persistence of processus vaginalis.

The neck of hydrocele is very narrow and so even if you try to compress the swelling, the fluid from processus vaginalis will not go into the abdominal cavity. The parents will give a characteristic history of swelling being less during morning and then gradually starts increasing in size. While the opening of hernia sac is large enough to allow the free reduction of contents.

For how long one can safely wait in hydrocele?
The hydrocele which are constant in size through out the day time are usually scrotal type hydrocele and are seen in newborns. They are called as non- communicating hydroceles. It is this type of non -communicating hydrocele which tends to resolve spontaneously.

The hydrocele in which parents gives the history of increase and decrease in the size of swelling are called as communicating hydrocele and will require surgery.

The condition can be safely observed till 18mths to 2 years of age as it is harmless. But one should be sure that they are not associated with hernia.

When one should advice for hernia surgery?
Inguinal hernias never go away without surgery. This is a condition in which surgery is advised to be done as early as possible as the risk of hernia getting incarcerated is as high as 30 to 40%. If not tackled in time it can lead to major complications of gut and testis necrosis. Also emergency anesthesia may further increase the risk for the child.

How safe is inguinal hernia surgery in newborns and infants?
Like any other surgery anesthesia have its own risks. As the risk of hernia incarceration is very high especially in newborns, waiting for hernia repair is not a good option once a diagnosis of hernia is made.

The commonest problem of hernia surgery in newborns is postoperative apnea. To minimise this it is usual practice to perform surgery once the child is more than 49 wks of gestational age or weighing more than 2.2 kg. After surgery these patients needs to be monitored in hospital for 24 hrs for risk of postoperative apnea.

What is the surgical procedure done for hernia and hydrocoel?
The surgery in both the conditions is same that is the ligation of patent processus vaginalis called as “HERNIOTOMY”.

Are there any indications for performing bilateral repair in case of a unilateral inguinal hernia?
The risk of hernia manifesting on the contralateral side after unilateral repair is just 10 %. Although the patent processus vaginalis may be present in higher number of cases but it may not manifest as hernia later on. So as per present recommendations bilateral hernia repair is not routinely done in cases of a unilateral inguinal hernia.


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Jul12
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.


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