Dr Khan is a specialist in Paediatric Surgery/Urology, He has double fellowship of the Royal College of Surgeons in Ireland and a Fellow of the European Board of Paediatric Surgery. He has over 26 years’ experience of Paediatric Surgery/Urology. He is committed to the provision and further development of a high quality Paediatric Urology service. His research work has been published in leading International medical journals such as The Journal of Pediatric Surgery (2015: vol. 3, pp541-544) and The Journal of Pediatric Urology (2013: vol. 9, pp78-81).
Tight foreskin called phimosis is either normal with no sign of scarring, or diseased due to a scarring such as balanitis xerotica obliterans. Options of treatment such as medication, circumcision, preputioplasty, frenuloplasty will be proposed after patient history and physical examination. The retraction of a too narrow foreskin (paraphimosis) behind the glans penis must be regarded as an emergency situation. Paraphimosis may constrict the shaft and lead to swelling. Infection of foreskin (balanitis) may require medication to treat. Circumcision might be recommended in these conditions. Buried penis or hidden penis may require repair in future. Circumcision is not recommended in severe form of buried penis.
Hypospadias is the condition in which the hole (meatal opening) through which a child passes urine is not at the tip of the penis as it should be. Hypospadias occurs during development before birth and affects approximately 1 in 300 live births. Circumcision should not be done before the repair. Hypospadias can be corrected by surgery. There are many different operations for hypospadias that can be discussed after physical examination and reviewing the child’s medical history. An operation is performed to give the penis a more normal appearance and also to allow the boy to pass urine normally.
Bed wetting (nocturnal enuresis)
Bedwetting (nocturnal enuresis) is a common childhood problem in the UK which can create huge stress and embarrassment for children and their families. It has been estimated 5-10% of boys at the age of 7 might suffer from this. It might be the result of many factors. The child’s history is the main source for diagnosis. Simple treatment measures should be considered before using a bed betting alarm nappy or medication.
Urinary Tract Infection
A urinary tract infection is the most common bacterial infection for boys under 2 years old in the urinary tract (water works). Infants might show symptoms of irritability, poor feeding, fever, tiredness, vomiting, tummy ache and smelly nappies. Older children might show symptoms of fever, vomiting, abdominal pain, increased frequency of passing urine, back pain, pain when weeing, vomiting and smelly or bloody urine. A sample of your child’s urine will need to be collected to look for signs of infection and dehydration. Infection should be treated with antibiotics after discussion with your medical practitioner (GP). Children who have had a urinary tract infection should have an ultrasound scan. Other tests and investigations might be needed. Circumcision may be required in boys to minimise the infection.
Undescended (absent) Testis
During pregnancy, the testes start developing inside the abdomen. Usually about two months before birth the testes move down (descend) into the scrotum. However in some boys this does not happen. This leads to undescended testes being detected in the baby. An operation called an orchidopexy might be required to place and fix the testes in the scrotum if they are still undescended by the time the baby is approximately one year of age. Occasionally testes which have descended at birth ascend as the boy grows and undescended testes are diagnosed at an older age. Boys can have one testis that is undescended or sometimes both. Some cases might require keyhole surgery (laparoscopy).
Painful scrotum is an emergency, most commonly caused by torsion of the testis or cyst of testis, or infections. Other causes of scrotal pain are trauma, varicocele, scrotal haematoma, obstructed hernia, appendicitis or systemic disease (e.g. Henoch-Schönlein purpura). Diagnosis is usually clinical but some tests might be required for confirmation. Testicular torsion is an urgent condition, which requires prompt surgical treatment.
Kidney and bladder problems
Urine is formed in the kidneys and collects in the pelvis of the kidney. The urine then drains from the kidney to the bladder through a tube called the ureter. From the bladder urine is passed through another tube called the urethra. Hydronephrosis is a swelling in the pelvis of the kidneys. The two main causes of swelling are an obstruction (blockage) to the flow of urine or vesico-ureteric reflux where urine leaks (flows back) into the ureters from the bladder as urine is being passed through the urethra. If both kidneys are affected, there is more chance of an operation being needed, typically on the urethera. This condition is called posterior urethral valves. If the bladder does not work properly, a child may develop the condition called a neurogenic bladder which can be managed with medication, catheterisation and/or operation. Urinary infection is common in children with the neurogenic bladder. Circumcision prevents urinary tract infection in these cases.
A hydrocele appears as swollen scrotum. It is a fluid filled pouch which lies alongside the testes within the scrotum. A hydrocele can occur on only one side or on both sides. The hydrocele is not painful. The amount of swelling observed can change over a period of days or on different days. In many cases, during the first year of life the hydrocele resolves itself without any treatment being required. If the hydrocele does not resolve on its own, an operation is required. The operation to correct the hydrocele is called ‘ligation of the Patent Processus Vaginalis’ and is carried out under general anaesthesia.
An inguinal hernia appears as a lump or bulge in the groin, especially when part of the intestine gets into the sac. Children need to have an operation as there is a risk that a piece of bowel can become trapped in the inguinal hernia (strangulated hernia). The operation to correct the inguinal hernia is called an ‘inguinal herniotomy’ and is performed under general anaesthesia. Complications from this operation are rare, but might include infection and recurrence.