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Paediatric Genital reconstructive surgery Specialist in Mukundapur

Paediatric Genital Reconstructive Surgery

Paediatric Genital reconstructive surgery Specialist in Mukundapur

Some children are born with problems that affect the genitourinary system, especially in the bladder and reproductive organs of both males and females. Several interventions can be done to address these conditions by modifying or repairing the affected structures. Paediatric Genital Reconstruction Surgery, at Manipal Hospitals is one such procedure to improve function and the overall quality of life for the child. Problems in the genitourinary system can occur due to congenital defects or trauma, and a comprehensive diagnosis is made to determine the feasibility of surgery by evaluating the severity of the condition, the general condition of the child, the timing, and the number of surgeries necessary, if any. 

Early reconstruction or intervention can help restore functionality, assisting children in leading a healthy life. At Manipal Hospitals, Mukundapur, Kolkata, specialists in the Department of Paediatric and Child Care ensure the treatment of several conditions and employ associated treatments by utilising cutting-edge techniques, enabling them to provide optimal outcomes for children.
 

FAQ's

Types of hypospadias include:

  • Balanic (glandular): When the meatus or urethral opening is in the head of the penis but not entirely at the tip, this condition is known as glandular hypospadias. It is the least severe kind of hypospadia.

  • Coronal: The most prevalent type of hypospadias is coronal hypospadias. It occurs when the penis head meets the shaft or when the meatus is somewhat below the head of the penis.

  • Middle shaft: Midway down the penis shaft is where midshaft hypospadias happens.

  • Peristaltic: Where the penis and scrotum connect is the site of penoscrotal hypospadias.

  • Perineal/Scrotal: The most severe types of hypospadias are perineal and scrotal hypospadias. The scrotum is where the urethra opens. 

Some conditions that are addressed with Paediatric Genital Reconstructive Surgery include:

  • Hypospadias is a type of congenital abnormality characterised by urethral meatus, i.e., the urethral opening, being located on the underside of the penis instead of at the tip.

  • Bladder Exstrophy is identified as improper formation of the bladder and abdominal wall, along with the urethra and genitals (clitoris in females and head of the penis in males), being split in half.

  • Androgen insensitivity syndrome is an inherited condition seen in males. In this condition, children are genetically male but have female genitals and do not produce male sex hormones, i.e., androgens.

  • Cloacal defects, a congenital defect seen in females, where the rectum, vagina, and urinary tract are joined as one common channel.

  • Trauma cases, such as female genital mutilation (FGM).

  • Hermaphroditism, where children can have both male and female reproduction organs or characteristics.

Hypospadias occurs frequently. About one out of every 150 to 300 male children experiences it. After undescended testicles, it is the second most frequent congenital disorder affecting male infants. Researchers believe there might be a connection between the growing prevalence of pesticides, pollutants, and certain chemicals and the rise in hypospadias cases. 
 

Specialists may employ several diagnostic procedures to determine the feasibility of Paediatric General Reconstruction Surgery, some of which include:

  • Physical examination, for cases like hypospadias and paediatric vulvoganitis.

  • Prenatal ultrasound, especially for bladder exstrophy cases where the condition can be diagnosed before birth.

  • Blood tests, where levels of hormones, changes in genes, or abnormalities in chromosomes (Karyotyping) can be done for differences in sex development.

  • Ultrasound of pelvis and abdomen for undescended tests, vagina, or uterus.

  • Contrast-dye X-ray studies.

In hypospadias, the meatus is situated on the underside of the penis instead of the tip, and symptoms include difficulty peeing, spray deviation, and even discomfort while urinating. 

Moreover, circumcision is discouraged since the foreskin may not be fully developed and may be utilised for surgical repair. The term "chordee," which refers to a downward curvature of the penis, and the undescended testicles are other common symptoms that require attention and management for the best possible treatment.
 

Paediatric Genital Reconstruction Surgery is of different types and is performed based on the condition addressed and the complexity of the disease. Preparation can also vary based on the type of procedure to treat the condition. However, general instructions include the following:

Fast for a particular period before the procedure. If the surgery involves the stomach or intestines, consume bowel preparation liquids to empty your bowel.
Discuss with our specialist if you need to shave the hair around the area where the surgery is performed.
Inform our specialist if your child is allergic to certain medications or allergies. Let them know of their current medications, including all prescription and non-prescription medications.

Leave all accessories or pieces of jewellery behind before your child’s procedure.


 

The exact causes of hypospadias are still unknown, although studies have suggested that genetics and chemical exposure have a bearing on this condition. Family history plays a role as it runs in the family, particularly if other members of your immediate family, like your father or brother, have been diagnosed with this condition. 

Hypospadias is frequently observed together with other congenital anomalies and newborn disorders. It normally arises early in pregnancy, between nine and twelve weeks, when significant phases in penile development begin at eight weeks of pregnancy.
 

Before the procedure, our specialists will discuss with you and your child, using age-appropriate language, the type of anaesthesia that will be administered, the events of the procedure, and the expected outcomes. In a general scenario, your child may receive an intravenous (IV) tube to administer any medicines, blood, or fluids. Moreover, a catheter may be placed on your child’s bladder to drain fluids during the procedure. 
 

Several maternal variables are putatively linked to infant hypospadias risk. These include advanced maternal age, especially being over 35 during pregnancy, and obesity in mothers, defined as a body mass index (BMI) of more than thirty. Increased risk is also linked to fertility therapies, particularly those that involve progesterone supplementation and the use of other hormones either before or during pregnancy. 

Furthermore, there is evidence linking mother smoking during pregnancy and exposure to chemicals or pesticides to a higher risk of hypospadias in offspring. To reduce the incidence of this congenital defect, it is essential to comprehend these maternal effects, put preventive measures in place, and optimise prenatal care.
 

Some Genital Reconstruction procedures performed by specialists for paediatric patients include:

  • Hypospadias Repair: In this procedure, an incision is made on the skin of the penis to expose the urethra, followed by creating a new opening at the tip of the penis. The urethra is then attached to the new opening, and the incision is closed. 

  • Bladder Exstrophy Reconstruction Surgery: The procedure involves closing the bladder and abdominal wall. In some cases, it may also include fixing hip bones and genital abnormalities. The surgery may require multiple interventions, with regular and close follow-up and lengthy hospital stays.

  • Cloacal Anomaly Reconstruction Surgery: The procedure involves performing a Colostomy after birth. Specialists may perform additional surgery, which includes Vesicostomy, which entails creating an opening between the abdominal wall and the bladder. When the child is older, specialists can create an anus and separate the vagina or urethral bladder, although this can depend on the severity of the condition and the general condition of the patient.

  • MACE: Also known as Malone Antegrade Continence​ Enema, the procedure is addressed for children with constipation. A channel is created from the appendix or intestine to the colon, followed by placing the catheter into the skin, where the hole delivers enema directly to the colon, facilitating effective bowel movement. 

Since hypospadias is characterised by the placement of the meatus and concomitant genital abnormalities, diagnosis is usually simple. Identification is further aided by the inadequate creation of the foreskin, which frequently resembles a "hood" on the bottom of the penis, and the existence of a downward curve or bend. 

The diagnosis is easier to make in extreme cases where the scrotum appears divided and the penis is noticeably tiny. During standard physical examinations of newborns, healthcare personnel typically identify hypospadias shortly after delivery. However, in certain cases, the condition may not be apparent until \an attempt at circumcision is made, in which case the treatment is stopped upon diagnosis. Early detection makes it easier to refer patients to experts for additional assessment and care.
 

Common complications that may arise while your child undergoes any Paediatric Genital Reconstruction Surgery include:

Damage to the genitals
Infection or pain
Fatigue
Vaginal discharge
Bleeding
Constipation

Our specialists will inform you about possible complications based on your child’s case. 
 

Paediatric Genital Reconstruction Surgery is usually done between the ages of 6 and 12 months to treat the problem and enhance long-term results. To ensure safety and facilitate postoperative care, it is typically carried out as an outpatient treatment under general anaesthesia. Depending on the severity, more than one stage can be required.

To create a suitable urinary route, the procedure entails straightening the penis, reconstructing the urethra, and sculpting the remaining skin, frequently in conjunction with circumcision. A temporary Foley catheter may be placed in certain situations to promote healing; this catheter will be taken out one to two weeks after surgery during a follow-up visit.
 

You will be given personalised follow-up care for your child based on the type of Reconstruction Surgery performed. In most cases, you will have to attend regular follow-ups and routine check-ups to evaluate your child’s progress and to examine any new manifestation of side effects. If your child experiences any abnormal events after the procedure, such as vaginal discharge or bloody urine, you should seek medical attention. 

There are several ways for mothers to reduce their baby's risk of hypospadias during pregnancy. Pregnant women can reduce their risk by not smoking or drinking alcohol, keeping their weight stable during pregnancy, and making sure they are getting enough folic acid, 400 to 800 micrograms per day, on average. 

Frequent prenatal visits with medical professionals are also essential for tracking foetal growth and quickly resolving any possible issues, which improves both the mother's and the foetus's general health.
 

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