Pediatrics

CONTACT US / MAKE AN APPOINTMENT

This clinic offers diagnosis. treatment, surgery, etc. for persons from 0 to 16 years

PEDIATRICS AND PEDIATRIC SURGERY

A snap before surgery Just after birth the pediatrician receives the babies
Dr. Nurullo the pediatric surgeon carrying a baby Mother. child and doctor pose for a photograph

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX


Our polyclinic is about health, vaccination, nutritional education and maturation of children aged 0-14. Diagnosis and treatment are performed during the development of the disease. All required measures are taken since childbirth. Depending on the severity of the disease our patients can either visit outpatient clinic or stay in our hospital. In the necessity of urgent medical intervention we are able to provide you with an ambulance, required technical equipment and personnel.

After childbirth nurses take care of mothers and their new-born babies twenty-four hours a day and pediatricians perform routine examinations until the day of discharge. Because our clinic has “Baby-friendly hospital” certificate, mothers here are also provided with breastfeeding training.

Diagnosis and treatment are performed in our children’s health and diseases outpatients’ clinic, which includes pediatric surgery, pediatric cardiology and sub branches of pediatric psychology.

  • Children’s asthma and allergic diseases,
  • Infectious pediatric diseases,
  • Healthy child follow up,
  • Measures to preserve children’s health,
  • Preliminary diagnosis and treatment of children’s diseases,
  • Evaluation and monitoring of children’s maturation and development,
  • Evaluation and monitoring of social and psychological development,
  • Carrying out vaccination programs,
  • Childhood monitoring
  • Nutrition education and proper nutrition recommendations,
  • Family education, carrying out general pediatric practices.

 Pediatric Surgery department

Children are not adults in miniature form. For this reason, their psychology, physiology, metabolism and treatment priorities may vary in comparison to adults. Therefore, surgical diseases of children should be considered typical of their age, similar to their internal diseases.

In pediatric surgery, surgical diseases of children (age range; 0-16 years) are diagnosed, treated and followed-up. Also, albeit limited, pre-natal (fetal) surgical interventions are dealt with.

Surgical procedure covers a small portion of the treatment process in children. The outcomes of the surgery affect a very long period of life, and accordingly, both functional and cosmetic outcomes of the procedure are taken into consideration. Sometimes, a minor surgical procedure such as circumcision or suturing an incision can cause lifelong trauma if enough attention is not paid.

A substantial part of pediatric surgery does not require hospitalization, and they can be discharged on the day of surgery (outpatient surgery – day surgery).

Therapeutic and diagnostic units of pediatric surgery department are as follows:

Neonatal surgery:

  • Antral web, pyloric stenosis,
  • Colonic atresia and anal atresia
  • Cmphalocele and gastroschisis
  • Neonatal intra-abdominal cysts (duplication cysts, mesenteric and omental cysts)

Inguinal and scrotal diseases

  • Undescended testis, ectopic testis
  • Inguinal hernia
  • Hydrocele
  • Inguinal cyst (cord cyst)
  • Testicular torsion
  • Testicular trauma
  • Circumcision

Urinary tract diseases

  • Prenatal diagnosis of renal abnormalities: renal cysts, structural abnormalities, kidney enlargement
  • Ureteral obstruction (stricture at origin of ureter on kidney or orifice of ureter on urinar bladder),
  • Urinary leakage from bladder to kidneys (vesicoureteral reflux),
  • Urethral valves
  • Hypospadias
  • Epispadias
  • Urinary stone (kidney, bladder or urinary)
  • Cystic kidney diseases
  • Nocturnal and/or day-time urinary incontinence (enuresis)

Liver, gallbadder and spleen disorders

  • Liver and spleen cysts: simple cysts, hydatid cyst.
  • Gallstones
  • Splenomegaly (due to blood diseases).

Accidents and injuries

  • Trauma (motor vehicle accidents, falls and blows)
  • Burns: liquid, surface or flame burns on the body
  • Diagnosis, treatment and follow-up of burns of the esophagus, stomach, duodenum, small intestine due to ingestion of acidic or basic substance
  • Esophagus, stomach or bowel obstruction due to ingestion of foreign bodies

Constipation

  • Habit- or diet-induced constipation
  • Constipation due to bowel disease (Hirschsprung’s disease)

Circumcision

The efficacy of circumcision is reducing the risks of sexual transmission of HIV, herpes viruses, HPV, treponemapallidum, chlamydia, hemophilusducrey and Neisseria gonorrhoeae

Neonatal circumcisions (and circumcision in early childhood) are irreparable interventions in the physical integrity. The risk of complications is dependent on the education of the circumciser (ritual, medical), analgesia and hygiene. Circumcisions should be performed under optimal surgical and hygienic conditions.

Acute abdomen

The term “acute abdomen” refers particular complaints such as abdominal pain, nausea, vomiting, abdominal swelling, or inability to defecate that may require surgical procedure. Most patients are diagnosed with acute appendicitis. Other cases are:

  • Perforation of GI tract
  • Meckel’s diverticulitis (small intestine),
  • Invagination (invagination of intestines)
  • Perforation or torsion of ovarian cyst,
  • Intestinal adhesions

What is umbilical hernia?
Umbilical hernia is an abnormal bulge that can be seen or felt at the umbilicus (belly button). This hernia develops when a portion of the lining of the abdomen, part of the intestine, and / or fluid from the abdomen, comes through the muscle of the abdominal wall.

Umbilical hernias are common, occurring in 10 percent to 20 percent of all children. They are, however, more common in Africans.

What causes an umbilical hernia?

As the baby grows after birth, this opening in the abdominal muscles closes. Sometimes, however, these muscles do not meet and grow together completely, and a small opening remains. This opening is called an umbilical hernia.

What are the symptoms?

Umbilical hernias appear as a bulge or swelling in the belly button area. The swelling may become more noticeable when the baby cries, and may become smaller or disappear when the baby is quiet. If a physician gently pushes on the bulge when a child is lying down and calm, it will usually get smaller or go back into the abdomen

Sometimes the intestines get trapped within the umbilical hernia. This is referred to as an incarcerated hernia. When this occurs, the child usually has severe pain and the bulge may be firm and red. Urgent medical evaluation to exclude an incarcerated hernia is required in order to prevent possible damage                                        to the intestines. It is uncommon for this to occur.

How is it treated?

Many umbilical hernias close spontaneously by ages 3 to 4. If closure does not occur by this time, surgical repair is usually advised. In younger children, if there is an episode of incarceration or if the hernia is very large, surgical repair may be recommended.

Umbilical hernias can vary in size. They are rarely bigger than about 1 in. (2.5 cm) across. Most children don’t feel pain from the hernia.

Talk to your doctor if your child is vomiting, has pain, or has a swollen belly.

Umbilical hernia is a common condition among infants and children. In the great majority of cases, the natural history is one of eventual closure without treatment. If spontaneous closure does not occur until the age of 3-4 years, operative correction is recommended.

Undescended testicles (UT)

These are common childhood condition where the testicles do not move into the scrotum by the time the baby is born.It is estimated that about one in every 25 boys are born with UT.It is not known exactly why some boys are born with undescended testicles and others are not, although having a low birth weight, being born prematurely (before the 37th week of pregnancy) and having a family history of undescended testicles have all been identified as risk factors.

Diagnosing undescended testicles
UT usually have no symptoms other than not being able to feel the testicles in the scrotum. Your child will not normally experience any pain.The majority of undescended testicles are palpable. If testicle are unpalpable – cannot be felt because they are higher up in the groin or abdomen

Undescended testicles are often diagnosed during a physical examination soon after a baby is born.

How undescended testicles are treated

If the testicle(s) do not descend treatment is usually recommended. This is because boys with undescended testicles may have fertilityproblems in later life and an increased risk of developing testicularcancer, although this risk is still very small.

Surgery is usually carried out before your child is two years old. If the condition is treated at an early age, the boy’s fertility should be unaffected.

As a baby boy grows inside his mother’s womb, his testicles typically form inside his abdomen and move down (descend) into the scrotum shortly before birth. But in some cases, that move or descent doesn’t occur, and the baby is born with a condition known as undescended testicles (or cryptorchidism).

Cryptorchidism is the most common genital abnormality in boys, affecting approximately 30% of baby boys born prematurely and about 4% born at term.

About half of the number of babies with undescended testicles, the undescended testicles move down or descend on their own by the sixth month after birth. If descent doesn’t happen by then, it’s important to get treatment because testicles that remain undescended may be damaged, which could affect fertility later or lead to other medical problems.
Diagnosis
Doctors usually diagnose cryptorchidism during a physical exam at birth or at a checkup shortly after. In 7 of 10 boys with an undescended testicle (or “testis”), it can be located or “palpated” on examination by the pediatric specialist.

In 3 of 10 boys, the testicle may not be in a location where it can be located or palpated, and may appear to be missing. In some of these cases, the testicle could be inside the abdomen. In some boys with a “non-palpable” testicle, however, the testicle may not be present because it was lost while the baby was inside the womb.

In some boys, the testicles (or “testes”) may appear to be outside of the scrotum from time to time, which can raise the concern of an undescended testicle. Some of these boys may have the condition known as retractile testes. This is a normal condition in which the testes reside in the scrotum but on occasion temporarily retract or pull back up into the groin.

There is no need to treat a retractile testicle, since it is a normal condition, but it might require examination by a pediatric specialist to distinguish it from an undescended testicle.
Treatment
If a baby’s testicle has not descended on its own within the first 6 months of life, the boy should undergo evaluation by a pediatric specialist and treatment if the condition is confirmed. This usually involves surgically repositioning the testicle into the scrotum.

Treatment is necessary for several reasons:

  • The higher temperature of the body may inhibit the normal development of the testicle, which could impair normal production of sperm in the undescended testicle in the future, which could lead to infertility.
  • The undescended testicle is at a greater risk to form a tumor than the normally descended testicle.
  • The undescended testicle may be more vulnerable to injury or testicular torsion.
  • An asymmetrical or empty scrotum may cause a boy to worry or feel embarrassed.
  • Sometimes boys with undescended testicles develop inguinal hernias

If surgery is done, it’s likely to be an orchiopexy, in which a small cut is made in the groin and the testicle is brought down into the scrotum where it is fixed (or pexed) in place. Doctors typically do this on an outpatient basis, and most boys recover fully within a week.

Most doctors believe that boys who’ve had a single undescended testicle will have normal fertility potential and testicular function as adults, while those who’ve had two undescended testicles might be more likely to have diminished fertility as adults.

It is recommended that all boys who’ve had undescended testicles undergo follow-up evaluations by an urologist for years after their corrective surgeries.

It is important for all boys — even those whose testicles have properly descended — to learn how to do a testicular self-exam when they are teenagers so that they can detect any lumps or bumps that might be early signs of medical problems.

Undescended testicle (cryptorchidism) is a testicle that hasn’t moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. Usually just one testicle is affected, but about 10 percent of the time, both testicles are undescended.

An undescended testicle is uncommon in general, but quite common among baby boys born prematurely.

The vast majority of the time, the undescended testicle moves into its proper position on its own, within the first few months of life. If your son has an undescended testicle that doesn’t correct itself, surgery can relocate the testicle into the scrotum.

Not seeing or feeling a testicle where you would expect it to be in the scrotum is the main sign of an undescended testicle.

Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually descend from the abdomen through a tube-like passageway in the groin (inguinal canal) into the scrotum. With an undescended testicle, that process stops or is delayed.
When to see a doctor
An undescended testicle is typically detected when your baby is examined shortly after birth. If your son has an undescended testicle, ask the doctor how often your son will need to be examined. If the testicle hasn’t moved into the scrotum by the time your son is 4 months old, the problem probably won’t correct itself.

Treating undescended testicle when your son is still a baby may lower the risk of complications later in life, such as infertility and testicular cancer.

Older boys — from infants to pre-adolescent boys — who have normally descended testicles at birth might appear to be “missing” a testicle later. This condition might indicate:

A retractile testicle, which moves back and forth between the scrotum and the groin and may be easily guided by hand into the scrotum during a physical exam. This is not abnormal and is due to a muscle reflex in the scrotum.

An ascending testicle, or acquired undescended testicle, which has “returned” to the groin and can’t be easily guided by hand into the scrotum.

If you notice any changes in your son’s genitals or are concerned about his development, talk to your son’s doctor.

Factors that might increase the risk of undescended testicle in a newborn include:

  • Low birth weight
  • Premature birth
  • Family history of undescended testicle or other problems of genital development
  • Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect
  • Alcohol use by the mother during pregnancy
  • Cigarette smoking by the mother or exposure to secondhand smoke
  • Obesity in the mother
  • Diabetes in the mother — type 1 diabetes, type 2 diabetes or gestational diabetes
  • Parents’ exposure to some pesticides

In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Until a boy is 3 or 4 years old, the testicles continue to undergo changes that affect how well they function later.

Complications of a testicle not being located where it is supposed to be include:

  • Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who’ve had an undescended testicle have an increased risk of testicular cancer. The risk is greater for undescended testicles located in the abdomen than in the groin. Surgically correcting an undescended testicle might decrease, but not eliminate, the risk of future testicular cancer.
  • Fertility problems. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who’ve had an undescended testicle. A decrease in cells in the testicle that produce sperm has been found as early as 1 year old.

Other complications related to the abnormal location of the undescended testicle include:

  • Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle. If not treated promptly, it might result in the loss of the testicle. Testicular torsion occurs 10 times more often in undescended testicles than in normal testicles.
  • Trauma. If a testicle is located in the groin, it might be damaged from pressure against the pubic bone.
  • Inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.

The goal of treatment is to move the undescended testicle to its proper location in the scrotum. Early treatment (before 1 year of age) might lower the risk of complications of an undescended testicle, such as infertility and testicular cancer.
Surgery
An undescended testicle is usually corrected with surgery. The surgeon carefully manipulates the testicle into the scrotum and stitches it into place (orchiopexy). This procedure can be done either with a laparoscope or with open surgery.

When your son has surgery will depend on a number of factors, such as your son’s health and how difficult the procedure might be. Your surgeon will likely recommend doing the surgery after your son is 3 to 6 months old and before he is 12 months old. Early surgical treatment appears to lower the risk of later complications.

In some cases, the testicle may be poorly developed, abnormal or dead tissue. The surgeon will remove this testicular tissue.

If your son also has an inguinal hernia associated with the undescended testicle, the hernia is repaired during the surgery.

After surgery, the surgeon will monitor the testicle to see that it continues to develop, function properly and stay in place. Monitoring might include:

  • Physical exam
  • Ultrasound exam of the scrotum
  • Tests of hormone levels

Hormone treatment

Hormone treatment involves the injection of human chorionic gonadotropin (HCG). This hormone could cause the testicle to move to your son’s scrotum. Hormone treatment is not usually recommended because it is much less effective than surgery.
Other treatments
If your son doesn’t have one or both testicles — either missing or didn’t survive after surgery — you might consider saline testicular prostheses for the scrotum that can be implanted during late childhood or adolescence. These prostheses give the scrotum a normal appearance.

If your son doesn’t have at least one healthy testicle, your doctor will refer you to a hormone specialist (endocrinologist) to discuss future hormone treatments that would be necessary to bring about puberty and physical maturity.
Results
The most common surgical procedure for correcting a single descending testicle (orchiopexy) has a success rate of nearly 100 percent. Fertility for males after surgery with a single undescended testicle is nearly normal, but falls to 65 percent in men with two undescended testicles. Surgery may reduce the risk of testicular cancer, but it does not eliminate it.