Undescended testes in children: Management

An undescended testes condition also known as “cryptorchidism” or “empty scrotum” is the most common genital pathology encountered in paediatrics. An undescended testis (UDT) is normally a congenital condition in which one (unilateral) or both of a baby's testicles (bilateral) have not moved into the scrotal sac. About 1-2 percent of male infants are affected worldwide. In about 20 percent of affected boys, an undescended testis  will descend on its own within the child’s first six months of life. The outlook for children with a UDT is very good and your child just requires prompt treatment and plenty of reassurance.

 

What causes undescended testes?

Before a baby boy is born, the testes in a male foetus are formed inside the abdomen. The Trans-abdominal descent of the testes involves the differential growth of vertebrae and the pelvis as the testes move down the groin through the inguinal canal and into the scrotum during the third trimester, usually happens in the ninth month of pregnancy. This descent is facilitated by the growth of a foetal ligament  the gubernaculum - which connects the testis  to the bottom of the scrotum. A normal hypothalamic-pituitary-gonadal (HPG) axis is an important requirement for testicular descent. 

A baby with UDT will have one or both  of their testes located in the path of the descent in the  groin or abdomen instead of the scrotum.

The two types of UDT:

Congenital undescended testes

In babies born early, the testes may not have had time to move down into the scrotum by the time the baby is born.

The conversion of testosterone to dihydrotestosterone (DHT) is essential for the continued migration of testes and Intra-abdominal pressure also plays a role in testicular descent. The conditions associated with decreased pressure, such as cloacal exstrophy a birth defect where abdominal organs are exposed, Prune belly syndrome  and gastroschisis  where the abdominal contents protrude through the separation in the abdominal wall, are associated with an increased risk of undescended testes.

Babies born with Klinefelter’s syndrome, spina bifida or Down syndrome are more likely to have undescended testes.

Retractile testes (hypermobile testes) - the muscle attached to the testes (cremasteric muscle) pulls the testes up and that causes them to move back into inguinal canal from the scrotum to the groin. If the testes can be moved back down to the scrotal sac and stay there, then no further treatment is required. However, this condition need to be observed over a period of time.

 

What are possible complications of UDT in children?

Undescended testes can cause a range of health problems later in life:

Infertility: This is the most common complication of UDT when both testes don’t descend. Fixing the problem between six and 12 months of age can improve fertility later in life.

The Risk for testicular cancer: This risk of testicular cancer increases greatly by age 30 - 40.  The risk is up to ten times greater than in the general male  population.

Inguinal hernia: Undescended testes can widen and weaken the inguinal canal allowing the development of inguinal hernia.

Testicular torsion: This is a painful twisting of the testes on its spermatic cord that can cut off blood supply to the testes. The testicle may become damaged beyond repair without prompt medical attention and have to be removed.

Emotional stress: UDT increases poor self-image and psychological vulnerability.

Treatment:

There are two options for treatment of undescended testes:

Hormone injections: Hormones that stimulate testosterone production is used to make the child’s testicle to descend. According to recent research studies, this treatment method has only about a 10 percent success rate. It’s not as effective as surgery as the testicles may reascend, i.e., move back out of the scrotum.

Hormone injections work best if the testes are already very close to the scrotum. Some testicles may descend only part of the way or temporarily, when a child is treated with hormones. But this may still be beneficial, because the testes may descend to a position that is easier to treat with surgery.

Surgical treatment: If his testicle hasn’t descended before age 1year then testes may need  to be surgically brought down in to the scrotum. This surgery is called Orchidopexy. The surgery is usually done as a short stay procedure and recovery typically takes about one week. The surgeon will make a small incision in his groin to allow his testicle to descend to a proper position. The spermatic cord that connects testis to the scrotum is released and lengthened and gently brought to the bottom of the scrotum and fixed with out any tension to the chord.  Successful surgical placement of the testes in the scrotum requires sufficient mobilisation of the testes and spermatic vessels, fixation of the testes in a dependent portion of the scrotum and ligation of the associated hernia sac.

Dr. Mahendra Jain, Bangalore is one of the best urology specialists in India, having practiced the medical specialization for so many years. Dr. Jain performs around 700 surgeries a year. He is specialized in Endourology, Uro-oncology, Reconstructive urology, LASER Surgery for prostate, renal transplant, undescended testis orchiopexy Bangalore, Flexible uretereoscopy with Laser for RIRS and Penile prosthesis for impotency.

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Are you suffering from Frequent Urination?

Frequent urination is passing of urine often than usual. Usually day frequency of more 8 times is taken as abnormal. Increased Frequency of urination is either because of increased production of urine or increased voiding of same quantity of urine.

 

Causes of frequent urination:

• Increased consumption of liquids
• Urinary tract infection
• Anxiety
• Enlarged Prostate
• Over active bladder
• Some neurological conditions
• Tumor in the pelvic area
• Weakened pelvic floor muscles
• Interstitial cystitis
• Kidney or bladder stones
• Cancer in the bladder
• A sexually transmitted disease like Chlamydia
• Colon diverticulitis
• Diabetes
• Medications
• Psychological

 

 Frequent urination remedies

• Avoid consuming alcohol, caffeine which has a diuretic effect
• Drink only adequate quantity of fluid.
• Minimize late night fluid intake to avoid nocturia
• Avoid stressful activities 
• Try to lose weight, if you are overweight
• Keep bowels regualr
• Quit smoking as it could irritate the urinary bladder

 

Frequent Urination Treatment

The treatment for frequent urination, is treatment of the cause.  Various types of treatment are available for frequent urination.

1. Treatment of the under lying cause like stones , infection, Diabetes, neurological conditions, prostate and tumors.
2. Identify medications like diuretics and stop them will reduce the frequency.
3. Medications: Off late there are many effective medications available for the treatment of the over active bladder. They are Darifinacin, Solifinacin and  Mirbegron. They reduce the frequency of contraction of the bladder muscle. They slow inaction but very effective in majority of patients.

Pelvic floor muscle exercise: This exercise would help to strengthen the pelvic floor muscles that help in urine control. It is otherwise called as Kegel exercises and it is effective for stress incontinence, frequent urination.

Electrical stimulation: In order to strengthen pelvic floor muscle electrodes are temporarily inserted into vagina or rectum and stimulated. 

Botox

In OAB treatment when all the other options have failed to give effective and satisfactory results BOTOX injections in to the bladder is very effective. This is a day care procedure done under anesthesia in Operation Theater. Injections need to be repeated every year if needed.

 

Best Urology Specialist in India

Dr. Mahendra Jain an eminent Urologist in Bangalore who has been treating all kinds of urological problems especially frequent urination, enlarge prostate successfully.

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Mail us: mahijain@yahoo.com
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Say bye to Kidney Stones via PCNL technique

Fluctuating pain in the abdomen? Difficulty in passing urine? Chills? Nausea or vomiting,  Pink red or brown urine?
If your answer’s a yes, you are likely to have “kidney stones”.

Kidney stones are crystals of minerals in the kidneys developed from long-term crystallization of waste materials in the urine excreted by kidneys.

Urine is a complex solution of many minerals, proteins and water. Some naturally present substances in urine like Citrate prevents crystallization and formation of stones. When these substances are less in urine, or concentration of solutes is more and associated with less water content, minerals crystallize and grow in to stones. Moreover, high levels of substances like calcium and oxalates encourage its formation.

Why treat it?

Kidney stones as such can be painful. When these stones block the urinary tract urine accumulates and causes back pressure on the kidney causes severe pain  - a condition known as Renal Colic. Left untreated for long stones causes infection and or damage to kidneys function. Larger stones in the kidney left untreated for many years can cause complete loss of function and  can cause cancer.

What is stone extraction?

PCNL (Percutaneous NephroLithotomy) or stone extraction is an innovative technique for the removal of large stones   or a large number of small stones in the kidney. The technique is carried out through a small incision in the skin. Under X ray guide Kidney is punctured on a safe spot  through the skin in the flank.  Track is developed and a tube is inserted from the skin in to the kidney. Under vision stones are broken down and pieces are removed.

Why PCNL?

• Only a minute scar
• Quick recovery
• Less postoperative pain
• Short hospital stay

 

What is tubeless PCNL?

A tubeless PCNL as the name suggests requires no tube postoperatively. In this, a hemostatic plug is employed to seal the tract. The advantages include minimized leakage and low pain hence a faster recovery.

Procedure:

Kidney stones  cause much less harm when its diagnosed and treated early. Smaller stones are treated conservatively. Small stone5 mm or less pass along on urination. These are manageable at home and with medications. Stones larger than 6-7 mm generally don’t come out with medications. Stones are diagnosed by Ultrasound scan , XRay of the kidney and urine bladder. CT scan can diagnose stones more accurately than x ray or ultra sound scan.

Surgery is obvious to treat larger stones and stones which are not cleared by medications. Generally stones in the kidney l cm and above merits a PCNL. PCNL surgeries is done  under general anaesthesia. The term “Percutaneous” means through the skin and “Nephrolithotomy” refers to “taking those stones out”. A small puncture wound up to 1 cm is made at the back to carry out a keyhole surgery wherein a nephroscope is passed through. Voila! The stone is identified. Laser energy is employed to annihilate these stones. It is a safe procedure.

Dr. Mahendra Jain, the best urology doctor in Bangalore offers the best available kidney stone treatment in Bangalore with advanced technologies. Dr. Mahendra Jain is an eminent and an extremely experienced Urologist and Andrologist residing in Bangalore, India.

The bottom line:

Preventive methods are merely a way to reduce the impact. However, there is no guarantee that these will prove to be 100% effective. In Order to prevent kidney stones measures like increase water intake, restrict food like red meat, tomato, spinach, brinjal, airated drinks, chocolate and tea. Consumption of calcium-rich and fewer sodium foods should be taken into account.

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Pediatric Care For Urology Issues

Many children face urinary issues. Most of the times, they are considered trivial and ignored. For example, many parents think that conditions like bedwetting are just bad habits and they will cease when the children grow older. It can be true in many cases but not always. So, instead of waiting for the situation to get serious, the child should be taken to a urologist for counselling and treatment if required.. Timely treatment is the key to recovery for any sorts of diseases. Parents ought to know more about various urology conditions in children. Here is a brief study of the most commonly seen urology issues in children.

Common Urology issues

Infection: Urinary tract infection though common in adult population, is less frequent in children. It is comparatively more in female children than male. Cry while voiding urine, fever are common symptoms. “ All urinary tract infection in children needs closer look and should be  investigated  for the cause of it.

Phimosis: Phimosis is “tight foreskin’ is  normal  in children till the age of 1 year.  The foreskin can’t be pulled back from  the tip of the penis. Pain, Ballooning of the foreskin, difficulty urinating, swelling of the tip of the penis are the main symptoms. Left untreated, leads to urinary tract infection.

Congenital Hernia/ Hydrocele: Hydroceles are common in newborn infants. Painless swelling in scrotum incrses while crying and reducing while resting is the main symptoms of Hydrocele or hernia

Torsion testis: This is an emergency.The condition when a testicle rotates on its own, twisting the spermatic cord that brings blood to the scrotum is Torsion Testis. The reduced blood flow causes sudden and often severe pain and swelling. The symptom is Excruciating one-sided testicular pain, with sudden swelling. If treatment is delayed, testis will get strangulated and then it has to be removed.

Un-descended testis: An un-descended testicle (testis) is more common in boys who are born prematurely. Testes stops short of reaching the scrotum, thus found in the groin commonly. Often mothers, while bathing the child, notice empty scrotum. They need surgical fixation of the testis.

Hypospadias: Hypospadias is a congenital condition. This condition is caused when the opening of the urethra is seen under the penis rather than at the tip. This might be associated with bent penis. This needs surgical correction.

UPJ Obstruction:  Ureteropelvic junction (UPJ) is located where the pelvis of the kidney meets the ureter. UPJ obstruction occurs when that part is blocked. This leads to ballooning of the kidney and slow reduction in the function of the kidney. This may lead to  Kidney infection, Blood in urine, Poor growth in infants, Urinary tract infection.

PU valves: Posterior urethral valves are extra flaps of tissue that are in the tube that carries urine out of the urine bladder. This another congenital condition where the urine outlet is obstructed. This is best treated by early intervention.

VU reflux: Vesicoureteral reflux is the abnormal flow of urine from the bladder to the upper urinary tract. Recurrent urinary tract infection Frequent and urgent urination, Foul smelling or cloudy urine, Backache, Burning or pain while urinating are the main symptoms. this is common in female child.

When your child develops a urology issue, you need to take him/her to the doctor as soon as possible to avoid further complications. Do visit Dr. Mahendra Jain, pediatric urologist bangalore for expert care and treatment.

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No more panic about Urinary bladder cancer

The Urinary bladder is a hollow and flexible pouch located in the pelvic area. It carries and releases the urine through the urethra. When the bladder cells start to grow out of control urinary bladder cancer occurs.

Urinary bladder cancer symptoms

• Frequent urination
• Changes in the urine color
• Feeling burning sensation while urinating
• Feel to urinate though the bladder is not full
• Poor urination
• Pain in the abdomen
• Blood in the urine
  

  

  
  

Urinary Bladder Cancer treatment:

It purely depends on the stage of cancer, the severity of the symptom and overall health condition of the patient.

Stage 0-1 treatment

• Removing tumor from the bladder with surgical intervention without removing the entire bladder
• Administering immunotherapy or chemotherapy directly to the bladder

Stage II &III treatment

• Removing the whole bladder and adjoining lymph nodes
• Removing a part of the bladder and giving radiation and chemotherapy
• Applying chemotherapy for tumor shrinkage before the surgery
• Administering both chemo and radiotherapy in patients who cannot undergo surgery

Patients who suffer from Stage IV cancer will not be recommended for surgery. In such cases, chemotherapy is administered.

Chemotherapy:

For stage 0-1 patients (early stage), chemotherapy is given directly to the bladder with the help of a Foley catheter for delivering the medicine. For the patients with Stage 2-3, chemotherapy is administered before or after surgery in order to prevent tumor relapse. Stage 4 patients are provided with intravenous chemotherapy medication. The most common side effects of chemotherapy treatment are bladder wall irritation and painful urination.

Urinary Bladder Cancer surgery

Transurethral resection of the bladder (TURB): 

This method is used to diagnose and remove the cancerous tissues from the bladder. Under general anesthesia or epidural injection, the surgery is performed. During the TURB surgery, a cystoscope is introduced into the bladder through the urethra, using a resectoscope tumor is removed for biopsy purpose and the remaining cancer cells are burnt. As the cancer relapse is expected after surgery, repeated TURB is required sometimes.

Radical Cystectomy: 

Most of the Stage II-III patients are performed with bladder removal and sometimes a part is removed. After the surgery, radiation and chemotherapy are advised to avoid relapse.

Continent urinary reservoir: 

Using an intestinal piece, a pouch is created to collect the urine. The patient needs to insert a tube into the opening of the skin to drain the urine from the pouch.

Dr. Mahendra Jain is an iconic Urologist in Bangalore who has been treating all kinds of urinary problems from UTI to tumor in an effective way.

mail us @ urologistbangalore@gmail.com
visit us : www.best-urologist-doctor.com