Pediatric Surgery Procedure

13-year-old boy unable to voluntarily control his urination goes through a unique surgery and gets a fresh lease of life

Imagine the misery, a 13-year-old boy has to go through, if he is unable to control his urination in front of his friends, family and in a social gathering and helplessly wets his pants and smells pungent every time he has to urinate with the fear of getting mocked, bullied and laughed at. He was getting repeated urinary tract infections and constant suffering for which regular medications were required. That’s exactly what had happened with Bangalore - based Harsh (name changed), a teenager whose self-esteem got shattered and social life went haywire. The reason, a congenital disease that he was born with - Myelo Meningocele (MMC), a birth defect in which a developing baby's spinal cord fails to develop properly.

A newborn with Myelo Meningocele (MMC) is usually presented with swelling at the lower back and Harsh was no exception. He underwent surgery to remove the swelling containing nerves at the age of one year. According to Dr. Anil Kumar, Senior Consultant and HOD- Paediatric Surgery, Sakra World Hospital,  if the swelling is removed then over a period there is a risk that the nerves attached to this site start having a pulling effect and the child may start developing weakness in both legs and lose control over the bladder and bowel movements. 

The first 9 years after the removal of swelling was not that difficult for the child, but from the last year, he was not in a good position. He almost lost control over his urinary bladder and was not able to urinate properly. He kept on storing the urine in the bladder and suffered from a repeated urinary infection, urine leaking & swelling of the kidney and ureter which was threatening to damage his kidneys. Long-term urinary infection was not good for Harsh and also there was a risk of kidney damage and other health complications. 

Dr. Anil Kumar, best pediatric urology surgeon Bangalore says, “It was at this point of time when he was brought to us and our team of efficient doctors worked on his condition till we decided to conduct a unique procedure on him - Laparoscopic Appendicovesicostomy, a procedure where the appendix is used to connect the urinary bladder to the umbilicus (navel).”

How was the procedure conducted?

Dr. Anil Kumar performed surgery laparoscopically where keyholes were made on the patient’s body. He used the appendix and connected it to the patient’s bladder through the umbilicus. All Harsh has to do now is to go to the restroom at regular intervals, use the tube to empty the urine.

No big cut was made on the abdomen, hence, the cosmetic appearance is good. Also, post-operative recovery has been faster. Besides, the clinical outcome has been excellent. The child is no longer facing any difficulty in passing out urine and is able to empty his urinary bladder at frequent intervals. There is no risk of repeated urinary tract infection and no pressure effect on kidneys anymore, thereby no risk of damage to his kidneys., Harsh is healthy and fit.  

Post the surgery, Harsh is doing absolutely fine and has been able to come out of the long trauma that he was suffering from being able to safeguard his social image like any other teenager. He has begun with his regular schooling, attending classes and social functions, making new friends, and leading a normal life like never before. 

Sakra World Hospital is one of the best child hospital in Bangalore, offering state-of-the-art tertiary care in various pediatric specialities. The center has an outstanding team of pediatric surgeon in Bangalore covering all subspecialties in pediatrics to provide comprehensive management of problems of neonates and children.

Vesicoscopic Ureteric Reimplantation

Vesicoureteric reflux is the abnormal flow of urine from the bladder back up the ureters that connect the kidneys to the bladder. 
In normal conditions, urine flows from the kidneys through the ureters down to the bladder which is unidirectional.
This condition is usually diagnosed in children when they presented with urinary tract infection or ultrasound abdomen revealing dilated ureters. it increases the risk of urinary tract infections and if left untreated can lead to kidney damage.

Symptoms of Vesicoureteral reflux?

The signs and symptoms of vesicoureteral reflux include:

• A strong, persistent urge to urinate

• A burning sensation when urinating

• The need to pass urine frequently

• Cloudy urine

• Fever

• Pain in the side of the abdomen

Untreated vesicoureteral reflux in children can lead to bedwetting, constipation, high blood pressure, and protein in the urine.

How is vesicoureteral reflux treated?
 
The treatment of vesicoureteral reflux depend on the severity of the condition. Children with mild cases of vesicoureteral reflux don’t need any surgery or medication. 

For severe vesicoureteral reflux, treatment options include:

Medications: Medicines are given to keep the infection from moving into the kidneys and the children are monitored for as long as he or she is taking medicines.

Surgery: Vesicoureteral reflux surgery is done to repair the defect in the valve between the bladder and each affected ureter. An obstruction in the valve keeps it from closing and preventing urine from flowing backwards. 

Sakra World Hospital pediatric urologists examine each patient thoroughly and exam to fit each patient and family. Sakra World Hospital has a state-of-art pelvic floor rehabilitation program to help cure these conditions.

The surprising link between oral health and pregnancy

Can Oral Health Have an Effect on Pregnancy?

Recent research indicates a link between gum disease and childbirth complications. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

More studies are needed to confirm the exact correlation between gum disease during pregnancy and labor complications, but it appears that gum disease may trigger increased levels of biological compounds that induce labor. Data also suggests that when periodontal disease worsens during pregnancy, there's a higher risk of having a premature baby.

What Can I Do to Ensure I Have a Healthy Pregnancy?

Pregnancy and dental care are important for a healthy baby. Pregnant women and women who plan on getting pregnant should visit their dentist for a checkup and to treat any dental problems before conceiving.

Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce pregnancy dental problems.

What Oral Problems Might Develop During My Pregnancy?

Many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

Pregnancy gingivitis occurs due to increased levels of hormones that influence the way gums to react to the irritants in plaque.

Keeping your teeth clean, especially near the gum line, will help dramatically reduce or even prevent gingivitis during pregnancy. 

What Can I Expect When I Visit My Dentist During My Pregnancy?

First, be sure to let your dentist know you're pregnant when you schedule your appointment. It's best to schedule your dental visit during the fourth to sixth month of your pregnancy. Avoid seeing a dentist during the first three months of pregnancy, are thought to be of greatest importance in your child's development and the stress of a dental visit may be detrimental to the foetus.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless necessary. 

During the last trimester, prolonged sitting in a dental chair can become uncomfortable and a dental examination may be infeasible.

If you need to schedule an emergency visit, let the dentist know about your pregnancy before you arrive. Discuss any relevant medical history, stress factors, past miscarriages and medications you are taking as these can influence your dental care plan and outcomes.

Avoiding A Toothache During Pregnancy

It is recommended by dental specialists that women see a dentist before they plan a pregnancy. This way, the office can do a thorough checkup and cleaning, as well as treat any existing dental problems. Of course, you can also consult a dentist while pregnant.

When you experience a toothache or gum problems during pregnancy, see a dentist as soon as possible for treatment. Dental health issues can adversely affect your pregnancy and early intervention is important for both mother and child.

Avoiding Tooth Decay

Cavities are formed when the bacteria in your mouth use the sugars and carbohydrates present in food to produce acid, which dissolves the enamel on your teeth. 

Pregnant women are at increased risk for developing tooth decay due to a number of reasons: unhealthy food cravings, decrease in brushing and flossing and vomiting as a result of morning sickness can intensify the amount of acid in the oral cavity.

To prevent tooth decay, brush your teeth twice a day, using a soft brush and appropriate toothpaste. Keep sugary snacks to a minimum. Rinse your mouth with water when you aren't able to brush, and floss once a day. 

It's fairly common for an expecting mother to complain about bleeding gums when brushing or flossing. Hormonal changes that come along with pregnancy can cause inflammation, sometimes called pregnancy gingivitis. To keep this condition from developing into more serious gum disease, intensify your dental care routine by using an antibacterial mouthwash and seeing your dentist for more frequent cleanings.

Look Out for Gum Disease

Some pregnant women experience a raw-looking swelling of gum tissue called a "pregnancy tumor" grows between the teeth. These growths bleed easily and may be caused by excessive plaque. Consult a dentist if you suspect you have a pregnancy tumor, even though they are usually benign.

Another uncommon complication of pregnancy is loose teeth. This can develop due to hormones affecting the ligaments that hold the teeth in place.

Pregnancy dental care is an important part of your general health and the health of your baby. This is why, for a safe and healthy pregnancy, dentists and obstetricians encourage women to make their oral health a priority.

Oral hygiene maintenance during pregnancy

Unless it's a dental emergency, plan your dental visits throughout the entire pregnancy. Start by scheduling an appointment prior to becoming pregnant. That way, any necessary procedures can occur before you become pregnant. 

The first trimester isn't ideal for dental treatments as the fetus is in the initial stages of development. Instead, schedule non-emergency visits for the second trimester or early in the third trimester.

There a few experiences in a woman's life as special as being pregnant. Seeing a dentist while pregnant is often overlooked but it is important that you don't forget to maintain good oral health. That includes teeth cleaning while pregnant. 

Brush at least twice each day with good toothpaste and don't forget to floss, as it complements brushing by removing food particles that stick in places a brush can't reach. Taking care of your mouth ahead of time will allow you to focus on the joyful arrival of your child.

Docs extricate LED bulb from toddler

Infants and babies have their own new ways of exploring everything in the small world around them. Everything is new to them and so is to the new parents. Especially in case of first time parents, everything that the child encounters and experiences for the first time, the parents have their own moments of learning, with lots of surprises, both good and bad. In this whole process of exploring and learning, the dangers that children are prone to are sometimes completely unimaginable for parents. Therefore, it is very essential to understand the potential risks that your child might be exposed to, while doing simple activities like playing, crawling, walking, and even eating.

Foreign body ingestion is one such risk that the parents need to consider at all points of time. Especially for children above the age of 6 months, i.e when they start sitting and crawling and have the ability to move around and  the tendency to approach or pick up almost any object in their reach. Almost every child has the risk of foreign body ingestion in the form of objects like – coins, pins, screws, buttons, batteries, and any kind of toy and toy parts. Although children may also sometimes aspirate food particles but the risks are comparatively lower, unless it is hard food particles like nuts that a baby is unable to chew. The foreign body can enter into the food passage or into the breathing passage, the latter resulting in serious breathing problems.

Recently a 15 month old baby was admitted to the ED of Sakra World hospital when the child accidentally ingested a small LED light, which was actually a part of one of his toys. Certainly the child must have broken that part of the toy while playing and would have put it into his mouth out of curiosity. Now the likelihood of such a thing is purely out of a new parents’ imagination but it seems parents need to become extra cautious nowadays. The incident happened outside Bangalore and the parents had to rush the child driving 3 hours to Bangalore.

The child was admitted immediately to the emergency and an X- Ray was done to identify the foreign body and its location in the breathing passage. A team of doctors including – pediatric surgeons (Dr.Ramachandra.C and Dr.Anilkumar P.L), Anesthesiologist (Dr.Hirachand Mutagi) at Sakra World Hospital got together and discussed the case to decide upon an appropriate line of treatment keeping in mind the best interest of the baby. It is very essential to take the right decision at the right time in such situations and since it is a complicated procedure considering the type of foreign body and its location. Every step needs to be performed carefully to avoid damage to the vocal cords (voice box) and trachea (main breathing passage) further leading to possible blockage of the breathing passage and temporary/permanent disabilities in speaking.

A carefully coordinated challenging anesthesia was induced for completing a successful bronchoscopy to safely retrieve the foreign body from the breathing passage ensuring it did not slip further into lungs nor caused any damage to the breathing passage.  A healthy playful child was discharged and the parents were well informed about future precautions and for ensuring a safe environment for the child to play and explore his surroundings.

Dr. Anil Kumar, Consultant – Pediatric Surgery, Sakra World Hospital – “Foreign body ingestion is a very common and a life threatening condition that infants and babies are highly prone to. The line of treatment and surgeries in such situations are also very complicated as the child often has to be put under general anesthesia and the surgery itself is complicated. Also such surgeries are considered very technique sensitive as the anesthesia is given through the trachea which is also the main site for surgery - Bronchoscopy.   I advise all parents to be very careful especially when they feed the baby with nuts / fruits with seeds. It is always preferable to feed these things under vision and also supervise the child while playing. Parents should seek immediate medical attention whenever child chokes or has continuous cough post feeding.”

Mr. Hari Kirishna Naidu – father of the baby said – “The whole situation came as a complete shock and was like living a nightmare for me and my family.  And I believe that the prompt decisions like taking an X-ray as the first step and deciding on an appropriate line of treatment taken by Dr. Anil Kumar and his team at Sakra World Hospital have played a big role in saving our child. I would also like to advise all parents to be extra careful and never to leave your kids unattended and also make sure that you buy only age appropriate toys for your kids.”

*representative image only and does not represent the actual patient