Imperforate Anus/Absent Anal Opening Treatment Delhi, India
Imperforate anus or absent anal opening, also called anorectal malformation, is a birth defect that happens during the development of baby in early in pregnancy, when the baby is still developing. In this defect, the baby’s anal opening (where stool exits) and the rectum (the last part of the large intestine), do not develop properly, preventing the child from to pass stool.

The condition affects one in 5,000 babies, and it is slightly more common in males than in females. In a baby with anorectal malformation, any of the following can happen:

The anal opening is too small or in the incorrect location
The anal opening is absent and the rectum enters other parts like urethra, the bladder, vestibule or vagina, which can lead to infections and bowel obstruction.
The anal opening may be absent and the rectum, reproductive system, and urologic system form a single common opening called a cloaca, where both urine and stool are passed.
At birth, doctors check the position and size of anal opening. New-borns pass their first stool within 48 hours of birth, so internal malformations are detected quickly. If an issue is found, we do a number of tests to better understand the problems and develop a long-term plan for the best outcome. This problem can be associated with other malformations. Various tests which are performed include:

X-rays of the abdomen to show how far the rectum reaches, and to see if there are any problems with the way the lower backbone has developed.
Abdominal ultrasound to find any problems in kidney.
Spinal ultrasound or MRI to look at the spine for a tethered spinal cord, which can cause neurological problems, such as incontinence and leg weakness as the child grows.
Echocardiogram to find heart defects.
These malformations will always require surgical repair by pediatric surgeon in single or multiple stage, but the exact procedure will depend on the type and severity of the defect, any associated health conditions, and the child’s overall health. Depending on the type and severity these babies may require a stoma formation (a temporary diversion of stools from abdominal wall).

Even though corrective surgery may restore some function, important nerves and muscles that tell your child when the rectum is full of stool and help keep the contents inside may be missing or damaged, so we start a bowel management program when they reach toilet-training to help them become clean.

What is an Undescended Testis?
An undescended testis is a defect that happens before birth when a testicle has still not moved to its correct position, which is the scrotum or the bag of skin hanging below the penis.
This condition usually affects one testicle, but, in a few cases, the condition may effect both testicles, thereby keeping them undescended.
An undescended testis is commonly seen in premature male child.
In most cases, Undescended testis gets recti�ed on its own, as the undescended testis moves to its appropriate position within the �rst few months of life.
However, if this condition is not corrected on its own till 6 months of age, then a surgery is required to move the testicle in to its correct position.

What are the signs or symptoms of an Undescended Testicle
If you cannot see or feel a testicle in the baby’s scrotum, then this may be due to an undescended testicle.
When the foetus is still developing, testicles are formed inside the abdomen.
In normal development of the foetus, the testicles descend from the abdomen, into the scrotum, through the tube-like passage, into the groin (inguinal canal).
The above process, happens in the last couple of months of normal foetal development. When this process is halted or delayed, it leads to the condition called Cryptochordism or Undescended Testicle.

When should you consult a doctor an undescended testicle ?
An undescended testicle gets identi�ed in the post birth examination of the baby boy.
If this happens, the baby boy will need to be examined regularly, and you should check with your doctor on the frequency of the baby boy’s examination.
It is often noticed, that if the testis has not moved to the scrotum within 6 months, chances are, the condition may not get recti�ed on its own.
Getting the baby boy treated for undescended testicle may lower the risk of complications in the future, like testicular cancer and infertility.
Some boys may have been born with normal testicles at birth, but the same might appear missing later. This may happen due to the following reasons:

Retractile Testicle – In this, the testicle moves back and forth, between the scrotum and groin. This may happen due to a muscle reflex in the scrotum, and may be easily guided into the scrotum with the hand, during the physical examination.
Ascending testicle – In this condition, the testicle moves back to the groin and cannot be guided back to the scrotum with the hand. This is also called acquired undescended testicle.
The corrective surgery is orchidopexy means fixing the testis in scrotum. The testis lying inside the abdomen needs laparoscopic orchidopexy.
It is best to speak to your paediatrician or doctor if you see any changes in your son’s genitals or are concerned about his developments.
To book an appointment with Dr. Prashant Jain, the best paediatric surgeon in Delhi, Call (+91) 8766350320.

Risk factors of Undescended Testicles
Factors that might increase the chances of having an undescended testicle are:

Premature birth of the baby boy
Low birth weight of the infant
Complications associated with Undescended Testicles
Testicles need to be cooler than the normal body temperature, so they can develop and function normally. This environment is provided by the scrotum. In case of an incorrect placement of the testicle, following are the complications that may arise:

Testicular Cancer – develops in the cells of the testicles that produce immature sperms. Men with undescended testicles are at a higher risk of having testicular cancer. This risk increases if the testis is located in the abdomen instead of the groin, and when both testicles are affected. While the cause of cells developing into testicular cancer is still unknown, surgical correction may reduce the chances but does not eliminate the risk completely.
Fertility problems – Men with undescended testicles may develop low sperm count, poor quality sperm and reduced fertility the condition is ignored or left untreated for a long time.
Other complications associated with Undescended testicles are:
Testicular Torsion – This condition is painful as it cuts off the blood supply to the testicle. This happens when the spermatic chord, which contains blood vessels, nerves and the tube which carries semen, gets twisted. If left untreated, it may result in the loss of the testicle. Men with Undescended Testicles are ten time more prone to testicular torsion than the ones with normal testicles.
Inguinal Hernia – Happens when a part of the intestine pushes into the groin, if the opening between the abdomen and the inguinal canal is too loose.
Trauma – The testicle may be prone to damage from the pressure against the pubic bone, if it is located in the groin.
To know more or to book an appointment with Dr. Prashant Jain, the best paediatric surgeon in India, Call (+91) 8766350320.

Diagnosis of Undescended Testicle
Doctors may recommend the following types of surgery for the diagnosis and treatment in case of an undescended testicle.

Laparoscopy – Laparoscopy helps �nd out an intra-abdominal testicle. A small incision is made in the abdomen, post which, a small tube containing a camera is inserted.
In some cases, an additional surgery may be needed if the doctor cannot rectify the testicle’s
position during laparoscopy.
In case laparoscopy shows the absence of a testicle or a small remnant of the testicular tissue, then the same is removed.
Open surgery – This type of a surgery, requires a slightly bigger incision when testis is lying in groin.
Post the birth of a boy, if the doctor notices that the boy’s testicles are missing in the scrotum, he may do a few tests to see if the testicles are undescended or are absent.
If left untreated or undiagnosed, absence of testicles may cause serious medical problems post birth.
It is not recommended to go for an ultrasound or an MRI for the diagnosis of an Undescended Testicle.
Treatment of an Undescended Testicle
Treatment helps in moving the undescended testicle in to it’s appropriate position in the scrotum.
It is recommended that surgical intervention happens before 18 months of the child’s age. Earlier the treatment happens, better it may be, as treating the infant before one year, may reduce complications.
Following are the different treatment for Cryptochordism or Undescended Testicle:
Surgery
The process of the surgeon, moving the testicle back into the Scrotum and stitching it to place, is called Orchiopexy. Laparoscopy or surgery is used to carry out this process.
A number of factor’s, such as, the infant’s health or the level of the surgery’s complication, may determine how soon the surgery or correction of the undescended testicle can be carried out.
The surgery may be recommended when the child is between 6-12 months old. Early surgery reduces the risk of complications in the future.
The surgeon removes the tissue, in case he sees that the tissue has not developed properly or is an abnormal or a dead tissue.
The surgery also repairs an Inguinal Hernia that may occur due to the Undescended Testicle.
Post surgery, the testicles are regularly monitored to con�rm if it is staying in place and is developing properly. This is done through physical exams, Ultrasound examination of the scrotum and by testing of hormonal levels.

Other Treatments
Saline Testicular Prosthesis treatment, which gives the scrotum a normal appearance, may be considered, if one or both testicles are missing or did not survive post surgery.
An Endocrinologist or a hormone specialist may be referred if the child does not have even one testicle which is healthy.
Endocrinologist helps with future hormone treatments that are necessary to bring about puberty and physical maturity.
Results
Orchiopexy, mostly has a 100% success rate. Post surgery, the fertility for males with Undescended Testicle is nearly normal, however, for males with two Undescended Testicles, the chances are 65%.
While surgery might reduce the risk of testicular cancer, it still does not eliminate it.

Lifestyle changes and remedies at home for Undescended Testicles:
It is important to ensure that the testicles are developing normally, even after the child’s surgery. Being aware of the development of your son’s body and checking the position of his testicles regularly, helps him in the long run. This can be done while changing the diaper or while bathing him.
Talk to your son about the physical changes that are about to happen, when he reaches puberty.
Teach and encourage him to check his testicles regularly, as self-examination can help with the early detection of tumors.
How to cope with and support your son with Undescended Testicle Your son may be uneasy or sensitive about looking different, especially if he has to change his clothes in front of his friends or classmates, in a sports or in a school drama changing room. Guide him with the following tips, to help him deal with anxiety

Practice him to come up with a response if he is asked or teased about his condition
Let your son know that he is healthy, even if one or both the testicles are missing, and that there are two testicles in the scrotum
Teach your son to use the right words when he is talking about testicles or scrotum
To make the condition less noticeable, let your son wear loose-�tted swimming trunks or boxer shorts, so he is comfortable while changing clothes in front of others
Be watchful or aware of any behavioural changes, like not enjoying the sports or activities he he earlier used to
Speak to him about testicular prosthesis and discuss if it is a good option for him
What to ask your doctor if your son has undescended testicles
An undescended testicle is a birth defect, and is identi�ed in the post birth examination. This condition is monitored through regular examination of your infant. Here are a few questions that you can ask your family doctor or your paediatrician:

What are the different tests that my son will need to undergo?
Which option would you recommend as a treatment?
Can you recommend a specialist, to whom i can show my son’s condition.
to build my knowledge about my son’s condition, can you recommend a few websites or give me some brochures that i can read at home
How frequent should my son’s appointments be?
To monitor any changes in the undescended testicle, how can i examine the scrotum at home?

Hernia and Hydrocele
How to differentiate between Inguinal hernia and hydrocele?
Inguinal hernia is usually a reducible swelling with cry/cough impulse while a hydrocele is a tense cystic, clinically irreducible swelling without any impulse. Transillumination test is not reliable as can be present in both the cases.

Why hydrocele is irreducible swelling?
The pathogenesis of both hernia and hydrocele is same that is persistence of processus vaginalis.

The neck of hydrocele is very narrow and so even if you try to compress the swelling, the fluid from processus vaginalis will not go into the abdominal cavity. The parents will give a characteristic history of swelling being less during morning and then gradually starts increasing in size. While the opening of hernia sac is large enough to allow the free reduction of contents.

For how long one can safely wait in hydrocele?
The hydrocele which are constant in size through out the day time are usually scrotal type hydrocele and are seen in newborns. They are called as non- communicating hydroceles. It is this type of non -communicating hydrocele which tends to resolve spontaneously.

The hydrocele in which parents gives the history of increase and decrease in the size of swelling are called as communicating hydrocele and will require surgery.

The condition can be safely observed till 18mths to 2 years of age as it is harmless. But one should be sure that they are not associated with hernia.

When one should advice for hernia surgery?
Inguinal hernias never go away without surgery. This is a condition in which surgery is advised to be done as early as possible as the risk of hernia getting incarcerated is as high as 30 to 40%. If not tackled in time it can lead to major complications of gut and testis necrosis. Also emergency anesthesia may further increase the risk for the child.

How safe is inguinal hernia surgery in newborns and infants?
Like any other surgery anesthesia have its own risks. As the risk of hernia incarceration is very high especially in newborns, waiting for hernia repair is not a good option once a diagnosis of hernia is made.

The commonest problem of hernia surgery in newborns is postoperative apnea. To minimise this it is usual practice to perform surgery once the child is more than 49 wks of gestational age or weighing more than 2.2 kg. After surgery these patients needs to be monitored in hospital for 24 hrs for risk of postoperative apnea.

What is the surgical procedure done for hernia and hydrocoel?
The surgery in both the conditions is same that is the ligation of patent processus vaginalis called as “HERNIOTOMY�.

Are there any indications for performing bilateral repair in case of a unilateral inguinal hernia?
The risk of hernia manifesting on the contralateral side after unilateral repair is just 10 %. Although the patent processus vaginalis may be present in higher number of cases but it may not manifest as hernia later on. So as per present recommendations bilateral hernia repair is not routinely done in cases of a unilateral inguinal hernia.

Hypospadias Surgery In Delhi

What is hypospadias?
Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In boys with hypospadias, the urethra forms abnormally during 8-14 weeks of pregnancy. The abnormal opening can be anywhere, from just below the end of the penis to the scrotum. Depending on the site of the opening they are classified as distal (minor type)and proximal (major type).

Types of Hypospadias:
The types of hypospadias a boys has depends on location of the opening of the urethra:

Subcoronal: The opening of the urethra is located somewhere near the head of the penis.
Midshaft: The opening of the urethra is located along the shaft of the penis.
Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.
Understanding the normal penis and urethra
The normal urethra is a tube through which that urine flows out of the bladder. It passes through the penis. The opening of the urethra (meatus) is normally at the end of the penis, partly covered by the foreskin.

What is the penis like in hypospadias?
The main problem is that the urethra opens on the underside of the penis instead of at the end of the penis. The opening can be anywhere from just below the normal position (mild) to as far back as the base of the scrotum (severe).

Hypospadias may also include the following:

A hooded appearance of the foreskin. This is because the foreskin does not develop on the underside of the penis.
Tightening of the tissues on the underside of the penis (called ‘chordee’). This pulls the penis down and it cannot fully straighten. This is commanly seen in severe hypospedias

What problems can hypospadias cause?
Problems are likely to occur if hypospadias is left untreated. The further back the opening of the urethra is, the more severe the problems are likely to be.

Passing urine is different to normal. A baby in nappies will have no problem. However, when older, the urine stream may not be able to be directed forward into a urinal. When going to the toilet the urine is likely to ‘spray’ backwards. Sitting on a toilet may be needed to pass urine without mess.
Chordee causes bending of the penis. This is more noticeable when the penis is erect. Sexual intercourse may be difficult or impossible in severe cases.
Psychological problems about being ‘different’ to normal are common.

How common is hypospadias and what causes it?
About 1 in 300 boys are born with some degree of hypospadias. It seems to be getting more common. The reason why the penis does not develop properly is still not clear. The development of the penis while the baby is growing in the womb (uterus) is partly dependent on the male sex hormones such as testosterone.

What is the treatment for hypospadias?
If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, no treatment may be needed. However, in most cases an operation is required to correct the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, two operations may be necessary. The operation is usually done when the child is around 6-18 months old. The goals of treatment are:

For urine to be passed in a forward way.
For the penis to be straight when erect.
For the penis to look as normal as possible.
The position of the opening of the urethra is altered. Also, if chordee is present then this is corrected to allow the penis to straighten. The foreskin is usually used during the operation to make the new urethra so it is important that a circumcision is not done before the corrective surgery is performed.depanding on the surgery of hypospedias surgeryes

The success of the operation and the ‘normality’ that can be achieved depends on the severity of the hypospadias done in single as two stage

What happens after the operation?
Your son will be brought back to the ward to recover. He will be able to eat and drink after 3 hours He will have a dressing on his penis and a tube draining away the urine. The patients are usually kept for 2 days in the hosptial and then discharged. The dressing and tube need to stay in place for 10 days, then you will need to come back to the Hospital to have them removed.

What are the risks of hypospadias repair?
All surgery carries a small risk of bleeding during or after the operation.

For about one in ten boys, the original hole opens up again, so that your son passes urine through two holes. This can occur at any time after the operation. If this happens, your son will need the operation again. Occasionally, the new hole at the tip of the penis is too small, so your son will need another operation to make the hole larger. The drainage tube can irritate the inside of the bladder, which is painful. This is called ‘bladder spasm’. To reduce this, your son will be given ‘bladder spasm medicine’ as well as pain relief.

When you get home
Your son will go home with the catheter and dressing in place. Staff on the ward will give you full details of how to care for these at home.

You should encourage, to drink plenty of water/fluids.
Your child may need some pain relief when you get home.
You should not have a bath or shower until after the dressing comes off.
Putting your son in two nappies at a time can protect the area from accidental knocks.
Your son should not ride a bicycle or any sit-on toy until the area has healed.
Try to avoid getting the dressing dirty when nappy changing. If this happens, dab any faeces off with a damp cloth.
As there is a small risk of infection, your son will need to take antibiotics until he returns for his outpatient appointment.

Calcaneal spur (Heel spur) is a painful condition in which there will be severe pain in the heel. There is a bony outgrowth in the calcanial bone (Heel bone) due to continuous stress in the region. The pain in this disease will be more severe when waking up in the morning or walking after period of rest.


In siddha system of medicine the calvaneal spur is referred as Kuthikaal Vatham.

TREATMENT

The main aim of the treatment is to reduce the level of injury in the concerned area and thereby maximum possible pain relief, for that internal medicines, external applications and exercise are must.

INTERNAL MEDICINES

The following siddha medicines can be used with an advice of a siddha physician.
Singi Chunnam
Chitramutti madakku thylam
Ayakantha chenduram
Ayaveera chenduram
Arumugha Chenduram
Chandamarutha Chenduram
Athirshta Rasayanam.

EXTERNAL MEDICINES

Chitramutti Madakku Thyalam
Sivappu Kukkil Thylam
Mayana Thyalam

Special Medicines for Calcaneal spur (To be prepared by self)

1. Euphorbia tirucalli (Thirikkalli) is fried with castor oil and add crushed leaves of Clerodendrum phlomodis(Thazhuthalai), Vitex negundo(Nochi) to it and applied to the affected foot as a medicated bandage. (Agasthyar vaidyam 292,293/ External therapies of siddha medicine (P.9))



2. Calatropis giganta (Erikku) leaves are cleaned and placed over a hot Brick and step over it until get sufficient heat. Do it daily twice after applying suitable oils to the affected part.



EXERCISE

The aim of exercise is to strengthen calf and lower leg muscles there by reduce the stress in the calcaneal bone.