Early detection and treatment key to pediatric urological disorders

Laparoscopic Curative surgery can help cure the problem

There is no substitute for early detection in pediatric kidney disorders. This is true identify early and prevent long term dysfunction. The most important is VUR or vesico Ureteric reflux where he urine flows into the kidneys backwards. This occurs from birth in some children and later at 3-4 yrs of life. The most important symptom is development of fever without any obvious infection.

A simple urine test will identify the infection and the cause of the infection should ne ascertained and treated. They may also present with wetting their underpants or bedwetting. This is due to the bladder problem associated with the reflux. This left untreated will result in failure to grow properly, hypertension, and ultimately kidney failure needing transplantation.

This can be prevented by early diagnosis with urine test and an ultrasound of the abdomen. These children will need a surgical procedure called Ureteric Reimplantation to stop the reflux thus reducing the infections in the kidney. This can be done now laparoscopically.

There is also a procedure called injection of Deflux, which is a daycare procedure where an injection of Deflux is given at the place where the ureter inserts into the bladder thus reducing the reflux of urine.

This has no major side effects and is one of the safest procedures to be performed. So the primary symptoms are fever without cough and cold and failure to grow the primary diagnosis will be obtained by a urine test and ultrasound of the abdomen.

The second most important and correctable from of kidney dysfunction is Hydronephrosis due to obstruction of the urine tract just below the kidney. This is called PUJ OBSTRUCTION. This is mostly diagnosed in the fetal stage. Most of the time it affects one kidney and he child will not have any symptoms till late in life.

If it affects the both the kidneys the child will need immediate surgery for correction in about 50 per cent of the cases. The children who do not need surgery will be followed till the kidney becomes normal as some of them can become swollen and loose function if not monitored and intervened at the right time.

These surgeries can also be done laparoscopically by experienced surgeons so the recovery is fast there is less pain and also have a good cosmetic result. This is called laparoscopic pyeloplasty and it can be performed form the day of birth.

So these are the common problems which diagnosed early will prevent renal damage in children. With the availability of laparoscopic expertise the children will not need open surgery and will have a faster recovery and better cosmetic outcomes so that their future is bright and we have a healthy population.

Written by Sr Consultant - Urology, Gleneagles Global Hospitals

By Dr N Mallikarjuna Reddy