WHEN SHOULD CIRCUMCISION BE APPLIED?

Traditional view is circumcision should be done at an early age. It is most appropriate to apply circumcision within the first 1 month or after 7 years.

Advantaged of the circumcision applied within 1st month of life:

Because of baby’s pain sensation doesn’t fully develop within the first month, circumcision can be done without anaesthetized.

Bleeding will not occur during circumcision because vascularity is not too much in penis.

Wound healing is quicker in infants, for this reason circumcision wounds heal faster.

By doing the circumcision in an early time, situation requiring emergency circumcision is prevented. The foreskin strictures may occur in an advanced age.

The Personality doesn’t develope in newborn, for this reason, the negative effect of the circumcision is prevented by doing the circumcision in an early time.

Between 1-6 years, especially between 4-5 years, is the period of psycho-social development of children. Children are afraid to lose their wienie in this periodAfter 7 years of age, this psycho-social circuit enters a recession and continues until the age of puberty. At this age the circumcision will develop the child in psycho-social aspects. He will distinguish he is is a member of the community, will understand the circumcision’s causes.

WHO SHOULD APPLY CIRCUMCISION?

A specialist (urologist – pediatric surgeons – general surgeon – plastic surgeon) needs to do healthy circumcision. Thus, a lot of circumcision faults can be prevented.

WHAT IS THE MOST APPROPRIATE METHOD APPLIED IN CIRCUMCISION ?

Intravenous Sedation + surgical circumcision application under local anesthesia is the most appropriate method.

WHAT ARE CIRCUMCISION FAULTS?

Less cutting of the foreskin

Cutting the head of the penis (glans)

Bleeding

Penis gangrene: it is the result of tight binding of the penis.

Inflammation: If hygiene is not cared.

Inablility to urinate Due to tight bandage after the circumcision

Narrowness on urine hole (meatus)

WHAT IS UNDESCENDED TESTIS? WHAT IS THE FREQUENCY?

It is the case one or both of the eggs (testicle) are not present in the sac after the birthUndescended testicle is seen %26-30 of the premature birth and also %2.7-3.2 of the patients born on time.

HOW IS UNDESCENDED TESTIS TREATED?

Treatment is to descend the testicle into the scrotum and fix there. Also, hernia is commonly seen with undescended testicle. Hernia is treated during the same operation. To be able to provide this, hormonal and / or surgical treatments are applied as a result of the assessment made by the physicians’ expertise in this subject.

WHEN IS UNDESCENDED TESTIS TREATED?

The distention of testicle to the sacs happen in the last 3 months in the mother’s womb that may continue after the birth and in the first birthday the frequency of the undescended testicle lowers to the % 5.4 at the premature and to % 1 at the ones born on time. İf it does not descend during that time it must be treated without losing time

WHAT PROBLEMS DO UNDESCENDED TESTIS CAUSE IF LEFT UNTREATED?

İf the undescended testicle is not treated on time, it may cause serious issues such as infertility, testicle cancer and testicle distortion. .

WHAT DOES PEADIATRIC INGUINAL HERNIA AND CORDON CYST FORMATION DEPEND?

Inguinal hernia does not occur by pressure as at adults. The babies extend from a glow finger kind of bulge from the membrane covering the abdomen while getting developed (process vaginitis). If this opening stays open even after the birth, it causes swelling in the testicle area. It is more stretched at men. If the relation between these residues with the abdomen is stretch, the abdominals liquid gets lower slowly and form a swelling full of liquid. This condition causes some diseases such as hydrocele and cordon cyst. If the relation of the related residue with the abdomen is large, or if the narrow passage gets larger in tine, intestines in the abdomen enter into this sac and causes inguinal hernia. As the reason of the inguinal hernia at children is a residue, there is no chance of getting healed on its own.

HOW IS PEADIATRIC INGUINAL HERNIA AND CORDON CYST FORMATION TREATED?

The main purpose of the treatment of all diseases is to find and remove the sac created by vaginal process and to close its intrabadominal contact.

WHAT IS HYPOSPADIAS, HOW IS IT TREATED, IS CIRCUMCISION NECESSARY FOR THESE CHILDREN?

It is the case when the urine hole is opened somewhere under the penis apart from the place where it is supposed to be or somewhere between the sac or sac and the groin. It may not only affect the future psychological and sexual life of the child but it may also affect his fertility depending on the severity of the case. It is required to do the treatment as early as possible and surgically. It is very important not to circumcise these children in any way because the circumcision skin is used in the surgery of these children as the most ideal reparation material in the nature

WHAT IS EPISPADIAS, HOW IS IT TREATED?

It is the case when the urine hole is opened somewhere above the penis apart from the place where it is supposed to be. Usually this anomaly is accompanied by the skeleton and muscle system anomalies and development anomalies of the intestine front wall Wall and abdomen frontal Wall ( extrophy vesicle). The treatment is the early surgery

WHAT IS ENEURESIS NOCTURNA (BED WETTING AT NIGHT)?

We can mention about the presence of this disease at the children who urinates in bed more than one or two times in a month after 5 years old age. It is commonly believed that the diseases are related to the deepness of the sleep and bladder capacity. Also psychological factors also have role in the apparition of the disease. It is seen more often at boys than the girls

HOW SHOULD ENEURESIS NOCTURNA (BED WETTING AT NIGHT) TREATMENT BE PLANNED?

Actually for some cases with the age it is treated on its own. However it is wrong to let the child wait the end of something without knowing the final point of a condition as it will affect his mental condition .

Gece altını ıslatan çocuğu olan aileler eğer çocukları 5 yaşından büyük ise tedavi yollarını aramalıdırlar.

Motivation Techniques: Recording and Awarding

Liquid Restriction, Urinating Before Sleeping and Waking Up At Night :

Bladder Exercises, Bladder training exercises

: This method is quite successful with the children with smaller bladder.

Sphincter training exercises

While urinating the children are asked to stop and redo the urination. So that sphincter muscles are aimed to be reinforced

Conditioning (alarm device)

When the child starts to urinate, the alarm starts ringing.

Drug treatment

Drug treatment s generally started with the children who did not responds the behavioral treatments. Basic aims are two:

1. Decrease the deepness of the sleep of the child

2. Decrease the urine production at night

Drugs are recommended to be used maximum for 6 months. After stopping the drugs, enuresis may repeat. Tricyclic, antidepressants, İbuprofen, diclofenac, anticholinergic, antidiuretic hormones may be used for the drug treatment.

WHAT IS VUR (VESICOURETERAL REFLUX)? WHICH PROBLEMS DOES IT CAUSE?

During VUR, at each urination, one part of the urine in the bladder escapes to the upper system via urethra.

The microorganisms in this undercharged urine reproduce and cause urinary infection. Urine escaped to upper side with pressure, gets the tubes in the kidney wider ( pelvic laical system) and get then kidney parenchyma thinner and most importantly causes that infected urine to enter in this collective canals in the kidney( intra renal reflux) and scarification in the parenchyma

In this way, the most unwanted but expected result of the VUR: chronic pyelonephritis appears. The most common reason of the chronic pyelonephritis at children group is VUR.

HOW IS VUR DIAGNOSED?

There is continuously repeating urinary infection history in the history (anamnesis). Any particularity is not detected in the physical examination. Final diagnosis and grading of VUR is made, as stated above, placing catheter into the bladder and inserting colored substance into the bladder and the urine cystography (voiding cysturethrograph VCUG)

After the diagnosis, especially bilateral reflux cases kidney structures and functions should be assessed. Glomerular filtration rate must be detected and the its function at that time must be known which is important for the follow up

DMSA kidney cystography is the best method showing the parenchyma scares.

WHAT ARE TREATMENT ALTERNATIVES FOR VUR?

Treatment form is determined according to the VUR grade.

1) Medical (for grade I –II reflux) – Antibiotherapy for urinary tract infection and then chemoprophylaxis with low dose trimethoprim-sulphometoxasole for long term. . However Ist and IInd level of refluxed that does not disappear in spite of this treatment may require a more advanced level of surgical intervention.

2) Surgical Intervention:

a) Minimally invasive: suburreteral injection

b) Invasive: Uretereoneocystostomy (re-arrangement of the oreteropelvic joint)