Dr. Prashant Jain Provides the Treatment for Vesicoureteral Reflux Surgery Child in Delhi
Posted by on Tuesday, 12th July 2022
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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Hypospadias Surgery in Delhi by Best Pediatric Surgeon in Delhi - Dr. Prashant Jain
Posted by on Tuesday, 5th July 2022
Hypospadias Surgery In Delhi
What is hypospadias?
Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In boys with hypospadias, the urethra forms abnormally during 8-14 weeks of pregnancy. The abnormal opening can be anywhere, from just below the end of the penis to the scrotum. Depending on the site of the opening they are classified as distal (minor type)and proximal (major type).
Types of Hypospadias:
The types of hypospadias a boys has depends on location of the opening of the urethra:
Subcoronal: The opening of the urethra is located somewhere near the head of the penis.
Midshaft: The opening of the urethra is located along the shaft of the penis.
Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.
Understanding the normal penis and urethra
The normal urethra is a tube through which that urine flows out of the bladder. It passes through the penis. The opening of the urethra (meatus) is normally at the end of the penis, partly covered by the foreskin.
What is the penis like in hypospadias?
The main problem is that the urethra opens on the underside of the penis instead of at the end of the penis. The opening can be anywhere from just below the normal position (mild) to as far back as the base of the scrotum (severe).
Hypospadias may also include the following:
A hooded appearance of the foreskin. This is because the foreskin does not develop on the underside of the penis.
Tightening of the tissues on the underside of the penis (called ‘chordee’). This pulls the penis down and it cannot fully straighten. This is commanly seen in severe hypospedias
What problems can hypospadias cause?
Problems are likely to occur if hypospadias is left untreated. The further back the opening of the urethra is, the more severe the problems are likely to be.
Passing urine is different to normal. A baby in nappies will have no problem. However, when older, the urine stream may not be able to be directed forward into a urinal. When going to the toilet the urine is likely to ‘spray’ backwards. Sitting on a toilet may be needed to pass urine without mess.
Chordee causes bending of the penis. This is more noticeable when the penis is erect. Sexual intercourse may be difficult or impossible in severe cases.
Psychological problems about being ‘different’ to normal are common.
How common is hypospadias and what causes it?
About 1 in 300 boys are born with some degree of hypospadias. It seems to be getting more common. The reason why the penis does not develop properly is still not clear. The development of the penis while the baby is growing in the womb (uterus) is partly dependent on the male sex hormones such as testosterone.
What is the treatment for hypospadias?
If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, no treatment may be needed. However, in most cases an operation is required to correct the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, two operations may be necessary. The operation is usually done when the child is around 6-18 months old. The goals of treatment are:
For urine to be passed in a forward way.
For the penis to be straight when erect.
For the penis to look as normal as possible.
The position of the opening of the urethra is altered. Also, if chordee is present then this is corrected to allow the penis to straighten. The foreskin is usually used during the operation to make the new urethra so it is important that a circumcision is not done before the corrective surgery is performed.depanding on the surgery of hypospedias surgeryes
The success of the operation and the ‘normality’ that can be achieved depends on the severity of the hypospadias done in single as two stage
What happens after the operation?
Your son will be brought back to the ward to recover. He will be able to eat and drink after 3 hours He will have a dressing on his penis and a tube draining away the urine. The patients are usually kept for 2 days in the hosptial and then discharged. The dressing and tube need to stay in place for 10 days, then you will need to come back to the Hospital to have them removed.
What are the risks of hypospadias repair?
All surgery carries a small risk of bleeding during or after the operation.
For about one in ten boys, the original hole opens up again, so that your son passes urine through two holes. This can occur at any time after the operation. If this happens, your son will need the operation again. Occasionally, the new hole at the tip of the penis is too small, so your son will need another operation to make the hole larger. The drainage tube can irritate the inside of the bladder, which is painful. This is called ‘bladder spasm’. To reduce this, your son will be given ‘bladder spasm medicine’ as well as pain relief.
When you get home
Your son will go home with the catheter and dressing in place. Staff on the ward will give you full details of how to care for these at home.
You should encourage, to drink plenty of water/fluids.
Your child may need some pain relief when you get home.
You should not have a bath or shower until after the dressing comes off.
Putting your son in two nappies at a time can protect the area from accidental knocks.
Your son should not ride a bicycle or any sit-on toy until the area has healed.
Try to avoid getting the dressing dirty when nappy changing. If this happens, dab any faeces off with a damp cloth.
As there is a small risk of infection, your son will need to take antibiotics until he returns for his outpatient appointment.
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Best Pediatric Surgeon, Pediatric Laparoscopic Surgeon And Best Pediatric Urologist In Delhi, India - Dr. Prashant Jain
Posted by on Tuesday, 5th July 2022
Dr. Prashant Jain - Best Pediatric Surgeon in Delhi
Director and Sr Consultant Pediatric Surgery and Pediatric Urology
Dr. Prashant Jain is a young and dynamic pediatric surgeon and pediatric urologist in Delhi, India. He has been trained in premier institutes, King Edward Memorial Hospital (KEM), Mumbai and Kalawati Saran children’s hospital, New Delhi. He has been a meritorious student throughout his medical career and was gold medalist in his training in pediatric surgery and pediatric urology. He has special expertise and vast experience in pediatric urology and pediatric minimal invasive surgery. He was fortunate to get opportunity to work in Great Ormond Street, London. He has been performing reconstructive surgeries for congenital anomalies with great skills and excellent results. He has successfully treated many previously failed cases of urological anomalies like hypospadias, bladder exstrophy etc. Over the years he has devised his own innovative techniques in several surgical procedures which have won him accolades. He has presented his innovations in various conferences and workshops for which he has received critical acclaim. He has multiple publications in pediatric surgery and pediatric urology in various national and international journals.
Presently he heads the department of pediatric surgery Dr BL Kapur Memorial Hospital, New Delhi. The department of pediatric urology and pediatric surgery in Dr BL Kapur Super speciality hospital, performs all pediatric reconstructive surgeries for complex congenital anomalies and pediatric laparoscopies.
Recently, he had privilege of heading a team of 40 super specialists doctors involved in the surgical separation of conjoined twins (pygopagus) from Nigeria, which involved major and complex genito-urinary reconstructive work. This rare and exclusive work got acknowledged worldwide.
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