Paediatric Surgeon in Pune. Archives - Dr. Geeta Kekre

Is Testicular Torsion A Birth Defect?

Dr. Geeta Kekre — Sun, 28 Jan 2024 16:29:17 +0000

Testicular torsion is a medical condition involving twisting the spermatic cord, which supports the testicles. This twist can result in a compromised blood supply to the testicle, leading to severe pain and potential long-term damage. While testicular torsion is a well-known emergency, there is confusion regarding its origin, with some people wondering if it is a birth defect. In this blog post, we will explore the intricacies of testicular torsion, its causes, symptoms, and, most importantly, whether it can be classified as a birth defect

What is a Testicuar Torsion?

Testicular torsion is a medical emergency that occurs when the spermatic cord, which provides blood flow to the testicles, twists, leading to reduced blood flow and potential damage to the testicle. While it can occur at any age, including in children, it is crucial to understand the unique aspects of testicular torsion in pediatric cases.

Symptoms of Testicular Torsion

Testicular torsion in children is a medical emergency that demands immediate attention. Early recognition and understanding of the diagnostic process are essential for preserving testicular function. The following is a detailed overview:

Sudden and Severe Pain

Often, children who suffer from testicular torsion experience sudden and intense pain in the scrotum as a result of the condition.
In addition to pain in the lower abdomen or groin area, the pain may also radiate to the lower back.

Swelling and redness

The affected testicle might become swollen and appear larger compared to the other testicles.
There may be redness or discoloration of the scrotal skin as a result of the infection.

Abdominal pain and nausea

Children may complain of abdominal pain, which can accompany the scrotal pain.
Vomiting may also occur, reflecting the severity of the condition.

Change in Testicle Position

In some cases, parents may notice a change in the position of the testicle within the scrotum.
The affected testicle may appear higher than usual.

Reluctance to Move or Walk

Due to the pain, children with testicular torsion may be reluctant to move or walk.
The discomfort can be severe enough to limit physical activity.
Highlighting the sudden and intense pain experienced.
Discussing other symptoms such as swelling and discoloration.
The importance of seeking immediate medical attention.

Treatment Options for Testicular Torsion in Children

Testicular torsion in children is a surgical emergency that requires immediate intervention to restore blood flow to the affected testicle. The primary goal of treatment is to untwist the spermatic cord and secure the testicle to prevent future episodes. Here are the key treatment options:

Surgical Detorsion

The most common and urgent treatment for testicular torsion in children is surgical detorsion.
The procedure involves untwisting the spermatic cord to restore blood flow to the testicle.
This can often be achieved through a small incision in the scrotum.

Testicular Fixation

Following a successful detorsion, an orchiopexy may be performed to secure the testicle in its normal position within the scrotum.
This involves fixing the testicle to the inner lining of the scrotum to prevent future episodes of torsion.
Testicular fixation is typically recommended even if the testicle appears normal after detorsion to reduce the risk of recurrence.

Follow-up Care

After surgery, children will require careful monitoring and follow-up appointments with a healthcare provider.
Monitoring includes assessing the blood flow to the testicles and evaluating for any signs of complications.

Education and Prevention

Parents and caregivers should be educated about the importance of recognizing symptoms early and seeking prompt medical attention.
Pediatricians may discuss preventive measures with families, especially if there are anatomical factors or a family history that increases the child’s risk.

Birth Defects Defined

Birth defects, or congenital anomalies, are structural or functional abnormalities present at birth. These conditions can affect various parts of the body, ranging from mild to severe, and may impact the overall health, development, or functionality of the child. Birth defects can result from genetic factors, environmental exposures, or a combination of both.

Genetic Factors

Chromosomal Abnormalities

Alterations in the quantity or arrangement of chromosomes can lead to specific birth defects. For example, Down syndrome is characterized by an extra copy of chromosome 21.

Single-gene mutations

Some defects result from changes in a single gene. Single-gene mutations are responsible for the development of cystic fibrosis and sickle cell anemia.

Environmental Factors

Maternal Exposures

It’s important to know that exposure to certain substances during pregnancy, like drugs, alcohol, tobacco, or infections, can put the baby at risk of developing birth defects. For instance, if a pregnant woman is exposed to thalidomide, it can lead to limb abnormalities in the baby. So it’s crucial to stay away from such harmful substances during pregnancy to ensure the baby’s healthy development.

Nutritional Deficiencies

Not getting enough nutrients, especially in the early stages of pregnancy, can lead to birth defects. When there is a lack of folic acid, for instance, it has been linked to neural tube defects.

Conclusion:

In conclusion, while testicular torsion is a serious medical condition affecting the testicles, it does not fit the criteria of a birth defect. The origins of testicular torsion are primarily related to anatomical features and genetic factors rather than developmental anomalies during birth. Understanding the distinction between birth defects and conditions like testicular torsion is crucial for accurate information dissemination and can contribute to better awareness and prevention strategies for this emergency medical condition.

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How Serious is Hernia in A Child?

Dr. Geeta Kekre — Mon, 11 Dec 2023 05:37:00 +0000

Understanding the Severity of Hernias in Children

Hernias in kids can worry parents. In this guide, we explore pediatric hernias, what parents should keep in mind, and make it easy to understand.

Types of Pediatric Hernias

Inguinal Hernias

One common problem that children can have is called an inguinal hernia. This is when a part of their intestine pushes through a weak spot in the wall of their belly, near their groin area. Sometimes, she can be seen right after they are born, but other times it may develop later. It is important to get it checked out by a doctor right away to prevent any problems.

Umbilical Hernias

Umbilical hernias are lumps that can be seen near the belly button in babies. They are quite common and usually disappear on their own by the time the baby is 2 years old. However, if the lump doesn’t go away, it’s important to talk to a doctor. Regular check-ups with a healthcare professional are necessary to ensure the baby’s health.

Recognizing Symptoms

Vigilance in Observation

Early detection of hernias in children is paramount. Parents should remain vigilant for signs such as a noticeable bulge, discomfort, or changes in bowel movements. Prompt consultation with a pediatrician ensures timely diagnosis and appropriate action.

Assessing the Severity – When Urgency Matters

When you are trying to decide how serious a hernia is in a child, you need to think about things like how big it is, what symptoms the child is having, and how likely it is to cause problems. If the hernia is big, or if it’s causing pain or blocking the bowels, you should get help right away. Taking care of it quickly can stop things from getting worse and help the child feel better faster.

Treatment Options – Surgical Operation

Sometimes, when children have a hernia, doctors suggest getting surgery to fix it. The surgery is usually a quick and easy procedure that doesn’t require staying in the hospital overnight. Skilled doctors use special techniques to fix the hernia, which helps the child feel better faster.

Recovery and Aftercare

Parent’s Guidance Through the Process

After the surgery, parents play a very important role in their child’s recovery. They need to follow the instructions given by the doctor to take care of their child, keep an eye out for any unusual symptoms, and make sure to attend follow-up appointments. Usually, children can resume normal activities within a few days after the surgery, and the risk of the hernia coming back is lower.

Preventing Complications

Addressing a hernia in a child promptly is crucial to prevent potential complications and ensure their well-being. This will help to prevent any complications and ensure that the child can continue growing and developing normally. Acting quickly can make a big difference in the long run.

Conclusion

it’s important to take a proactive and informed approach when dealing with hernias in children. Recognizing the symptoms, understanding the urgency of treatment, and following up with post-surgical care are all crucial in ensuring a positive outcome. By equipping themselves with this knowledge, parents can better navigate the challenges of pediatric hernias and ensure the well-being of their children.

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Hypospadias: What You Need To Know

Dr. Geeta Kekre — Wed, 21 Dec 2022 13:05:58 +0000

Introduction

Hypospadias is one of the most common birth defects, affecting 1 in 200 boys. In this condition, the urethra (which is the tube through which urine leaves the body) opens on the underside of the penis instead of at its tip. Very often there is also a curvature or a downward bend of the penis which becomes more pronounced when the penis is erect. This curvature is called chordee. Sometimes, the penis appears to be rotated to one side resulting in what is called torsion. Torsion and chordee can occur without hypospadias too.

Why does hypospadias occur?

We’re not sure why hypospadias happens. When the fetus develops inside the mother, the genitals form under the influence of hormones. It has been postulated that inadequate hormonal action during this time results in hypospadias. However, the vast majority of boys with hypospadias have normal hormones. There are also hypotheses about various substances in the environment increasing the risk of hypospadias in the fetus, but again, the evidence is not clear. Boys who have a brother or a father affected by hypospadias are more likely to have the condition although such familial cases account for less than 10% of all cases. As far as we know, there are no foods that if consumed during pregnancy would lead to hypospadias in the baby.

How is hypospadias diagnosed?

Most often, hypospadias is diagnosed at birth or shortly after, simply by physical examination. No tests are required to identify hypospadias. We classify hypospadias depending on where the urethra opens along the penis. When it opens closer to the tip, we call it distal hypospadias. When it opens closer to the scrotum, we call it proximal hypospadias. Mid-penile hypospadias is the type in which the urethra opens somewhere along the middle of the penile shaft. Sometimes, the urethra may open at the scrotum or on the perineum. The foreskin in hypospadias has a distinct hooded appearance too.

What are the symptoms of hypospadias?

An altered appearance of the penis is the most obvious symptom. The urinary stream can also be seen emerging from a site other than the tip of the penis. Distal hypospadias may be noticed when the child is a little older. In boys with curvature, the urinary stream is deflected, making it difficult for older boys to use the toilet. If the urethral opening is very narrow, the stream may be very thin or splayed. When the urethra opens at the perineum or very close to the scrotum, the child may have to squat or sit to pass urine.

However, hypospadias in itself does not lead to infections, kidney problems, or growth failure in a child. A child with hypospadias is otherwise healthy.

How is hypospadias treated?

Reconstructive surgery is required to correct hypospadias. There are many different types of surgeries to correct hypospadias, and no particular method has been found to be superior to the others. Depending on the type of hypospadias, the reconstruction may require a single surgery or two surgeries. The choice of surgery to be performed depends on the anatomy of the hypospadias. Most of the time, a tube is left in the newly constructed urethra for a few days to allow it to heal. The urine is allowed to drain through this tube. Pain medications are given to ease any discomfort. Thorough local hygiene is paramount to ensuring that the surgical wound heals well. The goals of surgery for hypospadias are:

To restore the normal appearance of the penis
To straighten any curvature of the penis
To create a urethra that opens at the tip of the penis
To ensure a normal stream of urine

What are the potential complications of hypospadias surgery?

Fistula formation and recurrent curvature are the two main reasons why a hypospadias repair could potentially need reoperation. While fistula formation will become apparent within a few days after surgery, recurrent curvature becomes obvious only when the boy grows, sometimes becoming apparent only at puberty.

A fistula is a tiny opening in the new urethra which occurs when the wound does not heal well. Urine may dribble through this opening, along with a good stream from the new surgically created opening at the tip of the penis. While a tiny fistula may close on its own, a larger one needs the surgeon to repair it.

At what age must repair be performed?

It is recommended to complete all stages of reconstruction between 6 and 18 months of age.

Can I circumcise my baby if he has hypospadias?

If your child has hypospadias, it is recommended not to circumcise him as the foreskin can be used in reconstructive surgery. Reconstructive surgery can be performed in such a way as to give a circumcised appearance.

If my baby has hypospadias, does it mean that he has other problems too?

In most cases, hypospadias occurs as an isolated defect and all the other organs in the body, including the reproductive organs, are absolutely normal. Infrequently, hypospadias may be a part of a cluster of anomalies, called a syndrome (e.g. WAGR syndrome, Denys-Drash syndrome). In about 10% of cases, hypospadias is associated with undescended testes. If one or both testes are undescended, then there is a possibility of a disorder of sexual differentiation. This possibility is highest when the hypospadias is proximal and both testes are undescended. Such children need to be investigated before any reconstructive surgery is performed. Tests to identify or rule out a disorder of sexual differentiation are also advisable in cases where the penis is abnormally small for the age of the child or the scrotum is bifid and the urethra opens at the perineum or between the two halves of the scrotum. It is important that any such disorder is correctly identified before embarking on reconstructive surgery.

Can my child have a normal adult life after hypospadias surgery?

After successful hypospadias repair, sexual and reproductive functions in adulthood is normal in the absence of any other abnormality.

Dr. Geeta Kekre is a well-known Paediatric Surgeon in Pune. Along with her team, she has successfully treated many children with hypospadias. If you or someone you know is seeking treatment for hypospadias, please visit our center for further assistance.

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My Unborn Baby Has Swollen Kidneys

Dr. Geeta Kekre — Wed, 16 Nov 2022 07:25:37 +0000

With advancing technology, ultrasound machines allow doctors to see your unborn baby’s organs more clearly. Often times, babies are found to have enlarged kidneys while still in the uterus- your doctor may use the term “hydronephrosis”, i.e, “antenatal hydronephrosis” or “foetal hydronephrosis.”

Hydronephrosis essentially means that there’s urine backed up in your baby’s kidneys. It may be unilateral, meaning that the kidney on only one side is affected, or bilateral, meaning that both kidneys are affected. The causes for hydronephrosis in the unborn child are numerous, and the treatments vary based on the cause.

The urinary tract

The urinary tract consists of the kidneys, the ureters, the urinary bladder and the urethra. The primary function of the kidneys is to manufacture urine by filtering out solutes and waste products from the blood. The urine from each kidney is transported to the bladder by a fine muscular tube called the ureter. The urinary bladder stores urine and then throws it out via the urethra.

When your doctor assesses your baby’s urinary tract, some of the things he/she looks for are the following

Are both kidneys are present?
Are both kidneys are positioned normally?
Is there any enlargement of one or both kidneys? (Is there any hydronephrosis ?)
Are the ureters dilated?
Are there any cysts in the kidneys?
Can the bladder be seen to fill and empty?
Is there an abnormality in any other structure or organ?
Is there enough fluid around the baby?

What if a problem is detected in my baby’s urinary tract? Who can treat my baby?

The most common problem detected in the urinary tract of an unborn baby is hydronephrosis. The condition of the rest of the urinary tract affords a clue to the cause of hydronephrosis.

In India, paediatric surgeons and paediatric nephrologists are trained to treat conditions of the kidneys in children. During pregnancy, your doctor may ask you to follow up more closely with frequent ultrasounds. The ultrasound findings will offer your doctor some clues about how severely the bay has been affected. Once the baby is born, further investigations are usually needed to determine the course of action. Typically, these investigations include an ultrasound, a special xray called a voiding cystourethrogram ( VCUG; also commonly called a micturating cystourethrogram or MCU) and sometimes, renal scintigraphy studies. Depending on the findings of these tests, treatment varies from immediate surgery to simple observation. Oftentimes, low dose antibiotics are recommended to prevent urinary tract infection in the baby. In all cases, strict follow up and close monitoring of the urinary system is required.

What should I do, now that I know I’m carrying a baby with hydronephrosis?

Relax. Remember that your baby is growing, and so is its renal system. As of today, ante natal therapies have not been proven to be helpful in changing long term outcomes for hydronephrosis. Familiarise yourself with the team that is going to care for your baby once it arrives. Have a detailed discussion about the team’s plan for the baby. Be prepared to stay in the hospital for a few days after you deliver. Talk to your doctors about all your concerns for yourself and for your baby. Care for yourself as your gynaecologist has advised, and keep a positive attitude.

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Why does my child wet?

Dr. Geeta Kekre — Mon, 07 Nov 2022 04:53:47 +0000

Daytime and nighttime wetting are among the more frequent problems that we see in school-aged children. While some children find it hard to toilet train in the first place, others may have leaks and accidents months or years after they have successfully toilet trained. We understand that daytime wetting is stressful for the parent, but it is far more stressful and embarrassing for the child. Children don’t want to wet- it’s just that they can’t stay dry. Unless addressed, daytime and nighttime wetting can have lasting psychological and behavioural impacts on the child.

A child may be wetting for a number of reasons. If your child was born with a condition such as an anorectal malformation, a urologic anomaly or a spinal dysraphism, achieving continence may be a challenge for him or her. Therapy may include surgical procedures that help achieve “social continence”, which means the child can achieve a level of dryness that allows him/her to participate in regular activities with other children at school and outside.

However, the vast majority of children who wet have no anatomic abnormality. It is important to understand that bladder control in a child is different from bladder control in an adult. When children toilet train, their pelvic muscles learn to relax and contract in a coordinated manner. During this phase, children can develop holding behaviours which either prevent them from emptying their bladders completely or prevent them from going before it is too late. Incomplete emptying of the bladder can lead to urinary tract infections (UTIs) that further compound the problem.

Children who have urine leaks are also usually constipated. The pelvic floor nerves and muscles that control urine are closely related to those that control stool. Hence, a child who holds urine also likely holds stool. It is important to pay attention to the posture of the child while passing urine or stool. The child must be seated comfortably on the toilet seat to enable the pelvic floor muscles to relax. It is advisable to use a footstool to support the child’s feet while seated on the toilet so that the torso is relaxed and the hips and knees are parallel to each other. A child-sized toilet seat is also highly recommended to ensure that the child’s pelvis is relaxed. Even little boys may benefit from sitting on the toilet to urinate in the early part of toilet training. When seated on the toilet, the child’s knees must be kept apart. Pants must be pulled down all the way to the ankles. To pass urine, the child must be at the toilet for at least 30 seconds to a minute. It may be necessary to engage the child with a book or a conversation so that he/she sits on the toilet for adequate time. Many Indian households have an Indian-style toilet. A small child will not be able to squat on the pan. These children may develop a habit of passing stool and (in girls) urine in the standing position which can lead to constipation and wetting. In that case, it is advisable to use a “potty” until the child is tall enough to squat on the pan.

Attention to your child’s diet and fluid intake is also necessary. Many school-age children learn to avoid drinking water so as to avoid going to the toilet, especially while at school. This compounds the problem in more ways than one. A decreased fluid intake predisposes to urinary tract infection (UTI) which causes the bladder to become irritable. Poor fluid intake also leads to the formation of hard stool resulting in constipation. The presence of a loaded bowel in the pelvis further makes it difficult for your child to effectively empty his or her bladder with adequate control. Avoidance of all foods that can constipate the child- which includes refined flour in bakery products and high sugar content foods- is necessary.

Your paediatrician and paediatric surgeon will need to have a detailed conversation with you and also run a few tests to decide what the cause of wetting in your child is. Most certainly, they will be looking for evidence of a UTI and an anatomic anomaly that could cause incontinence. They would ask you to observe details of your child’s voiding habits, including how frequently he/she voids, how frequently he/she wets, and whether you can identify anything that might be precipitating accidents. They may also have to perform invasive tests such as a VCUG or a urodynamic study. Further therapy will be determined by their findings. in many cases, simple behavioural changes and timed voiding can relieve children of the problem. Do not restrict your child’s fluid intake unless your doctor asks you to do so.

Night-time wetting usually resolves later than daytime incontinence. Isolated nighttime wetting (nocturnal enuresis) in the absence of daytime wetting can be a manifestation of underlying emotional issues in the child, although it is not always so. Teasing by siblings and peers can worsen the problem. Nocturnal enuresis can be treated with behavioural modification and pharmacologic therapy. Use of bed-wetting alarms, voiding at bedtime and limiting fluid intake two hours before bedtime are some common interventions that have proven useful. Patience while dealing with the child is paramount, but the results of therapy are good.

If your child is wetting, do not hesitate to seek help. Timely intervention by your doctor will not only help resolve the issue but will avert any long-term impact of the incontinence.

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Intussusception in the Child

Dr. Geeta Kekre — Fri, 11 Feb 2022 11:24:36 +0000

Introduction

Intussusception is a common condition in childhood wherein one segment of the intestine telescopes into the other. It is most common in the first two years of life but it can affect all pediatric ages. It is a surgical emergency in children, and with timely intervention, the outcomes of treatment can be excellent.

Intussusception most commonly occurs as a consequence of a viral infection. In older children, a diverticulum of the intestine is often the instigating factor. Other lesions such as polyps or masses are the underlying cause in a minority of childhood cases. Such lesions are called pathological lead points. They are usually picked up during investigation for the intussusception and their presence or absence determines further therapy.

When one loop of bowel telescopes into the other, the bowel wall begins to swell, leading to blockage of the bowel lumen. Gradually, the blood vessels supplying the bowel wall get compressed. The bowel wall becomes weak in some areas making it susceptible to rupture. Complete occlusion of the blood supply can lead to bowel gangrene. Timely intervention is necessary to avoid these complications.

The most common symptom of Intussusception is crampy abdominal pain with or without vomiting. Between episodes of pain, the baby may appear surprisingly well. Many children have had symptoms of a viral infection or diarrhea in a preceding couple of days. During an episode of pain, the child typically draws his/her legs over the abdomen while crying. Another classic symptom is the passage of blood and mucus in stool, described as “red currant jelly stool”. Along with these symptoms, your doctor’s findings on examination of the child will lead to the suspicion of Intussusception. The diagnosis is confirmed by a radiological investigation, which is usually ultrasonography.

Treatment:

The therapy offered by your paediatric surgeon will depend on a number of clinical and anatomical factors. Generally, the surgeon would follow one of two approaches a) enema reduction and b) surgery.

1. Enema Reduction:

In recent years, this non-invasive therapy for Intussusception has become the first line of treatment in many cases. In this therapy, a paediatric surgeon uses radiological guidance to reduce the Intussusception ( which means to free the bowel) by instilling fluid rectally. The use of ultrasound to guide the procedure is popular because it is free of radiation risk.

In general, it is difficult to do the procedure after 48 hours of the onset of symptoms. Whether or not enema reduction can be attempted depends on the surgeon’s clinical judgement. Even in the best of hands, there remains a small but real risk of bowel perforation during enema reduction. Therefore, your surgeon will always have the child ready for surgery before attempting an enema reduction. This is because enema reduction can fail, or can be complicated by a rent in the intestine. In that case, the child needs to be operated on immediately, to minimise damage.

2. Surgery:

this was the classic treatment for Intussusception, before the advent of enema reduction techniques. Even today, a paediatric surgeon will decide to proceed straight to surgery, especially if the symptoms have been present for more than two days, the child’s bowel seems obstructed, the anatomy of the intussusception is not amenable to enema reduction, or the surgeon suspects that there may be a mass or lesion causing the intussusception and which needs to be removed.

The surgery may be limited to simple manual reduction of the intussusception or may require more extensive procedures such as the removal of a part of the bowel. If any bowel has been removed, it will be sent to a histopathologist for examination. This is to detect any underlying illness that will require more extensive therapy.

Intussusception can recur after therapy and the surgeon will continue to remain vigilant after an enema reduction or surgery. The risk of recurrence is 4-10% after enema reduction and 3-5% after surgery. That is to say that more than 90% of children will not have a repeat episode. There is nothing that can really be done to prevent an intussusception. Attention to food hygiene is all that can be recommended.

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