Miss Marie-Klaire Farrugia

Miss Marie-Klaire Farrugia
Paediatric Urology
Central London


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Miss Marie-Klaire Farrugia Paediatric Urology
London

MD MD(Res) FRCSEd (Paed.Surg)

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Miss Marie-Klaire Farrugia areas of expertise:

Professional statement

Miss Marie-Klaire Farrugia is a consultant paediatric urologist based at Chelsea and Westminster Hospital and the BUPA Cromwell hospital in central London. She specialises in all areas of kidney, bladder and genital anomalies that babies are born with or develop later in childhood. In particular, she counsels pregnant mothers who's babies are prenatally-diagnosed with a kidney condition, so that the best postnatal plan can be made for the newborn.

Miss Marie-Klaire Farrugia is the clinical lead for paediatric surgery in the North West London Network, and writes guidelines and teaches in the major North West London hospitals. Her research interests include the long-term outcome of prenatally-diagnosed urological problems such as hydronephrosis and posterior urethral valves and vesicoureteric reflux. She is an experienced open, laparoscopic and robotic surgeon and performs neonatal and childhood circumcision; repair of simple and complex hypospadias including staged graft repairs; hernia and hydrocoele repairs; surgery for undescended testes; pyeloplasty; ureteric reimplantation; surgery on duplex kidneys and ureterocoeles; posterior urethral valves; nephrectomy and hemi-nephrectomy; Deflux injection for kidney reflux with urine infections; amongst others.

Miss Farrugia is an executive member of the Society for Fetal Urology and a member of the British Association of Paediatric Urologists, the European Society for Paediatric Urology, the American Association of Pediatric Urologists and the Societies for Pediatric Urology.


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How is hydronephrosis treated?

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When should my child's foreskin retract...

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 Credentials

GMC: 5207476

 Professional experience

• More than 20 years of experience
• Consultant Paediatric Urologist, Chelsea and Westminster NHS trust (2011 - present)
• Clinical Lead for Paediatric Surgery, North West London Paediatric Surgical Network (present)

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 Sub-specialties

• Paediatric urology
• Vesicoureteric reflux
• Genital anomalies
• Hydronephrosis
• Prenatally-diagnosed kidney and bladder anomalies
• Pelviureteric junction obstruction
• Congenital megaureter
• Posterior urethral valves
• Hernia / hydrocoele / varicocoele / testicular swelling
• Day and night wetting/ incontinence
• Urinary tract infections / pyelonephritis / cystitis
• Labial adhesions / vaginitis
• Dupex kidneys / ureterocoele

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 Teaching posts

• Regular lecturer and guest speaker at conferences all over London and internationally

 Education

• Medicine and Surgery degree, L-Università ta' Malta
• FRCSEd (Paed Surg), Paediatric Surgery, at the Royal College of Surgeons of Edinburgh
• Certificate of Completion of Surgical Training in Paediatric Surgery (2009) and Paediatric Urology (2010)
• MD(Res) postgraduate research degree, University College London (UCL) Institute of Child Health (2008)

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 Publications and conferences

• She is an expert reviewer and author of leading paediatric urology journals.

 Prizes and awards

• Awarded a joint European Society of Pediatric Urology and American Academy of Pediatrics travelling fellowship for my research on the congenital obstructive megaureter.
• Joint European Society of Pediatric Urology and American Academy of Pediatrics travelling fellowship 2010
• Kids Kidney Research Grant 2002

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 Professional membership

• Royal College of Surgeons of Edinburgh
• British Association of Paediatric Urologists
• Member of the British Association of Paediatric Endoscopic Surgeons
• British Association of Paediatric Endoscopic Surgeons
• European Society for Paediatric Urology
• American Association of Pediatric Urology
• Society for Fetal Urology

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Languages spoken

  • English
  • Italian
  • Maltese

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Diseases, Medical Tests and Treatments

Circumcision

Circumcision is the total or partial removal of the foreskin, which is the skin that covers the tip of the penis, by a surgical procedure. It is effec ...

Cystitis

What is cystitis? Cystitis is a urinary tract infection (commonly referred to as a UTI), and is an inflammation of the bladder. This inflammati ...

Endoscopic surgery

Endoscopic surgery is the type of surgery in which a flexible tube (endoscope) with a light source and a camera is inserted into the body through the ...

Hydronephrosis

Hydronephrosis is the appearance of water in the kidney, and is most commonly found during an pregnancy ultrasound scan. It is a condition that most c ...

Kidney infection

Pyelonephritis is a kidney inflammation that affects the renal parenchyma, renal pelvis and calyces. The symptoms include back pain, fever and chill although only 60% of the people who have these symptoms checked are confirmed to suffer from pyelonephritis. In addition, cystitis and kidney stones can also be a cause. The main cause of pyelonephritis is the passing of microorganisms through the ureters from the faecal flora. ...

Urinary incontinence

Urinary incontinence is the inability to control the bladder, which means that you can not always hold urine. It can affect anyone, but is most common in people over 50 years. Most control problems occur because the muscles that keep the bladder are too weak or too active. If they are weak, small amounts of urine to perform actions such as laughing or coughing are lost, which is known as stress incontinence. On the contrary, if they are too active, you can have an urgent need to go to the bathroom while having little urine in the bladder (urge incontinence or overactive bladder). Other causes include prostate problems and neurological damage. The treatment of urinary incontinence depends on the cause and type, but in general usually includes simple exercises, medicines and special devices. Surgery may be helpful at times. ...

Balanitis

Balanitis is an inflammatory disease that occurs on the surface of the glans and foreskin. The causes can be bacterial infection or irritation. The most common symptoms are: swelling; itching; erythema; pain; irritation; presence of vesicles; narrowing of the foreskin (phimosis); difficulty urinating; bleeding. Treatment usually includes topical antimicrobials or creams containing cortisone. In particularly severe cases, the patient will have to undergo circumcision surgery. ...

Bedwetting

Enuresis is the medical term for what is commonly known as bedwetting. It is quite common during childhood, and is more common in boys than in girls. Bedwetting is not caused by taking too much fluid before going to bed, or by mental or behavioural problems, but by other causes: genetic factors, difficulty waking up, urinary tract infections, and slow development of the central nervous system, among others. Childhood nocturnal enuresis can occur because the child's bladder is still too small; also because the amount of urine produced at night is greater than the bladder can hold, or simply because it takes more time to learn to control this organ. As for treatment, bladder medications are generally used to retain more urine only when previous behavioural therapy has not worked.   ...

Benign prostate enlargement

The prostate is a male sex gland located below the bladder and above the rectum, and is responsible for producing the seminal fluid. TBPH occurs when there is an increase in the size of the prostate gland due to a hormonal imbalance in men: an increase in female hormones (oestrogen) over male hormones (testosterone). It usually occurs in men over 70 and some of the symptoms include: difficulty urinating, frequent urination, urgent feeling to urinate, need to press for emptying the bladder, etc. In severe cases, prostate hypertrophy can produce absolute inability to urinate, blood in urine or impaired kidney function. It is usually treated with medications (hormones) and, in more severe cases, surgery. ...

Chordee

Chordee is a congenital condition where the penis curves downwards, which can be due to the development of less elastic tissue on the underside of the penis. Chordee can often be associated with hypospadias, which is urethral opening appears on the underside of the penis. Chordee can be corrected by surgery in most cases.  ...

Cryptorchidism

Cryptorchidism or undescended testicles is a disorder that occurs in one or both testicles when they fail to descend into the scrotum. It is a problem that affects 4% of new-borns. During pregnancy one testicle, or both, do not descend into the scrotum. This occurs as a result of a deficiency of the AMH hormone. Premature infants are more prone to this disease, although it usually resolves when the baby is nine months old. It is not a serious problem but must be resolved by a simple operation called orchidopexy. ...

Cystocele

The cystocele is a protrusion or hernia in the bladder into the vaginal canal. It occurs when the muscle wall supporting the bladder is so weak that it is unable to hold it in its normal position, so the bladder tends to move downward. This weakness can cause urine to escape from the bladder when abdominal pressure increases, which is what happens when coughing or sneezing, for example. Cystocele is a relatively common disorder in women over the age of 40, and the likelihood increases with age, during menopause, after a particularly difficult birth and when there is obesity, among other reasons. In mild cases, the treatment consists of performing Kegel exercises, which strengthen the muscles of the pelvic floor. Surgery is needed in severe cases or when such exercises fail. ...

Cystoscopy

A cystoscopy is a procedure using a cystoscope to look inside the bladder. The cystoscope is inserted into the urethra (the tube that carries pee out of the body) through the opening to the outside of the body, and passed along the urethra until it reaches the bladder. A cystoscopy is used to detect conditions such as urinary tract infections, bladder cancer, bladder stones, and other conditions affecting the bladder and urethra.  ...

Deflux® injection

Deflux® is a treatment for vesicoureteral reflux (VUR), a condition where urine flows backwards from the bladder, up the ureters. Deflux® is a sugar based medicine that is injected at the site of the VUR via the use of a cystoscope, and prevents urine from flowing back into the ureters from the bladder.  ...

Duplex kidney

Duplex kidneys is a defect usually at birth, where two kidneys develop on one side (or both sides). The duplex kidney develops on top of the existing one on that side. A duplex kidney usually consists of the section of the kidney that collects urine (the renal pelvis) being duplicated, but sometimes the ureter may also be duplicated. A duplex kidney doesn’t usually cause problems, but in some cases it can make you more prone to urine infections. Surgery to remove the duplex kidney may be required in some cases.  ...

Ectopic testes

An ectopy is an anomaly of the situation of an organ or a part of it. When we talk about testicular ectopy, we refer to the abnormal position of a testicle caused by the lack of descent. That is, the testis has taken a different path and has descended through the abdominal cavity until it is settled in the prepubic area, perineal position, etc., rather than in the scrotum. The difference between testicular ectopy and cryptorchidism (or hidden testicle) is that in the latter case the testicle has not fully descended, so it is not in its normal position within the scrotum either. In both cases, an early surgical treatment, starting at two years of age, can be performed to correct this anomaly. ...

Foreskin problems

There are a number of problems that can affect the foreskin of a child. Phimosis is the condition where the foreskin is too tight and doesn't move on a child over the age of two years old. Paraphimosis is when the foreskin has been retracted but cannot return to the original position.  ...

Heminephrectomy

Heminephrectomy is a procedure for the condition duplex kidney, where part of the duplex kidney is removed. A duplex kidney is a congenital defect where two kidneys develop on one or both sides at birth. One of the ways to correct this is with a heminephrectomy procedure, which is either performed via a small incision, or may be performed as a laparascopic (keyhole) procedure. ...

Hernia

A hernia appears as a lump, most commonly in the abdominal or groin area. The occur when an organ, often the bowel, protrudes through the cavity which normally contains it. ...

Hooded foreskin

Hooded foreskin is a condition where the foreskin is not fully developed in a child, and may only partially cover the end of the penis. It is often associated with the condition hypospadias, but it is possible to have a hooded foreskin without hypospadias.  ...

Hydrocele

A hydrocele is the pathological accumulation of fluid within a cavity of the human body. The most common hydrocele in men appears in the testicles and occurs when fluid accumulates in the spermatic cord (the cord that holds the testicles), between the two layers that cover the testicle and the inner face of the scrotum. This pathology, which can occur in newborns or other ages, even in adulthood, occurs because either the body produces more fluid than necessary, or the scrotum does not absorb enough. Hydrocele in newborns is usually self-resolving in the first few months. Hydrocele in adults requires a small surgical procedure, consisting of making a slight incision in the scrotum or the lower abdomen to extract excess fluid. ...

Hypospadias

Hypospadias is a birth defect in which the urethra is located on the underside of the penis instead of the usual location on the head. In addition, patients have to sit in order to urinate, and suffer from a malformation of the foreskin and a curvature of the penis during erection.   ...

Interstitial cystitis

Cystitis is inflammation of the bladder. The term interstitial cystitis is used when the disease is chronic. It is much more common in women than in men, and the cause is unknown, although it is known to be not caused by bacterial or viral infections. People affected by this type of cystitis have a completely inflamed and painful bladder wall, which causes scars on the bladder or causes stiffness, which causes the inability to expand as it fills with urine. Symptoms vary widely, but often include impulses to urinate urgently, frequent urinating, and even pain during sexual intercourse. There is no definitive cure for interstitial cystitis, so treatments are usually focused on improving symptoms, and may include: diet, exercise to control the bladder, medications, physical therapy, etc. ...

Labial adhesions

Labial adhesions is a condition where the labia (the outer lips) of a girl’s vagina stick together. This is more common in girls between the ages of three to six months, but can repeatedly occur until puberty. The labia may become completely stuck together, with only a white line visible of the adhesion, and can cause some discomfort for the child, especially when peeing. It can be caused by low levels of oestrogen, or by irritation caused by different soaps. Treatment is usually the application of certain prescribed creams.  ...

Multicystic dysplastic kidney (MCDK)

Multicystic dysplastic kidney (MCDK) is a condition where the kidney is replaced by multiple cysts, resulting in little or no normal function of the kidney. The condition occurs during the foetal development of the baby, and of the kidney. The condition is usually detected during prenatal ultrasound screening, and is not treatable. The other kidney will be monitored, and the unhealthy kidney checked to ensure it is not causing adverse effects.  ...

Nephrectomy (kidney removal)

Kidney removal surgery or nephrectomy is the procedure to remove all or part of a kidney. This surgery is done in the hospital under general anaesthesia and is pain-free. The procedure can take 3 hours or more. ...

Orchidopexy

An orchidopexy (or orchiopexy) is a surgical procedure to correct an undescended testicle. The testicles usually move into the scrotum prenatally, or within the first three to six months of the child’s life, but in cases where one or both of the testicles don’t descend, corrective surgery is required. The surgery is either a simple procedure if the testicle can be felt in the abdomen, where a couple of incisions are made, and the testicle moved into place. If the testicle is higher up and cannot be located by touch, then a laparoscopic (keyhole) procedure is required.  ...

Paediatric urology

Pediatric urology and pediatric urology is the subspecialty within urology dedicated to the prevention, diagnosis and treatment of congenital malformations of the genital and urinary tract of children and adolescents. Most urological clinical problems in childhood are different in many respects to those seen in adults, there is the need for a specialized medical staff who care for them. Pediatric urology pathologies handles and processes such as phimosis, varicocele, urinary tract infection, vesicoureteral reflux, hydronephrosis, undescended testes, hypospadias, stones, trauma, congenital genitourinary malformations, typical tumors of childhood, etc. However, testicular cancer, cancer of the bladder and urethra cancer are more suited to adults than children. ...

Phimosis

Phimosis is a disorder in which there is congenital or accidental narrowing of the preputial ring of the penis, which prevents it from being withdrawn to show the glans. It is common in children and may occasionally be caused by forced retractions of the foreskin at an early age. It can also be caused by an infection or by the scars that form after an injury. Phimosis can be corrected by a simple surgical procedure called circumcision, which involves removing excess skin surrounding the glans, leaving it permanently exposed. On the other hand, paraphimosis is when the foreskin cannot be placed above the glans. Generally, it causes pain and a little swelling, and usually occurs in children or elderly people who have not been circumcised. ...

Posterior urethral valves (PUV)

Posterior urethral valves, or PUV is a condition where the urethra (the tube that drains urine from the bladder out of the body) develops abnormalities with the urethral valves, causing urine flow to be impeded, and for reverse flow to occur, causing problems with the urethra, bladder, ureters, and kidneys as they swell with the urine within them. PUVs are the most common cause of bladder obstructions in children, and are treated with endoscopic ablation, or vesicostomy in some situations, following treatment to correct the symptoms caused by the PUVs. ...

Preputioplasty

Preputioplasty is a surgical procedure on the foreskin of the penis to correct phimosis or other conditions causing a narrowing of the foreskin. Preputioplasty consists of short, longitudinal incisions which cause the widening of the stenosis, which is the constricting line of tissue. The incision is then sutured latitudinally, allowing for a wider foreskin and reducing constriction. ...

Prostatitis

Prostatitis is the inflammation of the prostate, a male gland below the bladder that helps in the production of semen. It is one of the most common disorders of the male genitourinary system, caused, in most cases, by bacterial infection, either chronic or acute. Other inflammatory conditions of the prostate may be chronic nonbacterial prostatitis (producing perineal or pelvic pain) and asymptomatic inflammatory prostatitis (the symptoms are not obvious). The most common symptoms that can lead us to think that there is an inflammation of the prostate are associated with urinary disorders. When the cause is an infection, it is treated with antibiotics for several weeks to remove bacteria from the prostate. ...

Pyeloplasty

A pyeloplasty is a procedure to remove a blockage in the ureters, which are the tubes that carry urine from the kidney to the bladder. Blockages can develop in the ureter, though in most cases these blockages are present at birth. A pyeloplasty is performed under general anaesthetic, and usually via open surgery, or with laparoscopic surgery and the blockage is cleared.  ...

Robotic surgery

Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques. Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field. ...

Scrotal swelling

Scrotal swelling, which is a swelling of the scrotum, or sac that holds the testicles, is a fairly common problem, with a number of different causes. The most common causes of scrotal swelling include hernias, hydroceles (a collection of fluid in the scrotum), and varicoceles (enlarged veins in the scrotum). In some rarer cases it may be due to testicular torsion, where a testicle becomes twisted, orchitis (an infection in the scrotum), or by damage to the scrotum. Treatment is observation, a course of antibiotics, or in some cases, surgery.  ...

Short frenulum

The frenulum of prepuce of penis is the fold of the skin in charge of attaching the underside of the glans with the inner surface of the foreskin. Its function is to help to contract the prepuce on the glans. Short frenulum is when the frenulum is so short that it restricts the movement of the foreskin, which causes discomfort during sexual activity. One of the consequences is that it can get torn, causing pain and some bleeding, which is not a medical emergency, but if it gets complicated it requires medical treatment. There are different methods for this: from the use of creams with corticosteroids and exercise for the manual extension of the frenulum, to repair plastic surgery (fenuloplasty), elimination (fraenectomy) or circumcision. ...

Undescended testicle (Cryptorchidism)

An undescended testicle, medically known as cryptorchidism, where one (or both) of the testicles have not moved into position in the scrotum. The testicles usually descend into position prenatally, or shortly after birth, but in some cases they may not descend from within the abdomen. The condition, which is more common in premature babies, is corrected by a surgical procedure to move the testicle into the scrotum.  ...

Ureteral reimplantation

Ureteral reimplantation is a surgical procedure to reattach a ureter (the tube that carries urine from the kidney to the bladder) to the bladder. Some conditions and congenital defects can cause the ureter to be incorrectly connected to the bladder, and urine may travel back up the ureter to the kidney, leading to kidney infections. Ureteral reimplantation surgery connects the ureter in the correct way to the bladder.  ...

Ureterocele

A ureterocele is a birth defect often associated with a duplex kidney, where a sac-like pouch forms where the ureter opens into the bladder. The condition is usually found during the prenatal ultrasound scan in most cases, but can cause multiple symptoms if not diagnosed early, such as urinary retention, pyelonephritis, and haematuria among others. Treatment is usually via endoscopic surgery to make an incision in the ureterocele.  ...

Urethra surgery

Urethra surgery involves removing the affected area, followed by a reconstruction of the urethra. Results vary depending on the size and location of the stenosis, and the surgeon’s experience. In cases of acute urinary retention, a super-pubic catheter can be used as emergency treatment. This allows the bladder to drain through the abdomen. There is currently no drug treatment for the disease. If no other treatment works, the surgeon can perform a urinary diversion, called appendicovesicostomy (Mitrofanoff procedure). This allows the patient to empty the bladder through the abdominal wall via a catheter. ...

Urinary tract infection

A urinary tract infection can occur in different locations: Cystitis is when infection occurs in the bladder. Pyelonephritis is when it occurs in the kidneys. Urethritis is infection in the urethra, the tube that carries urine from the bladder. The vast majority of infections are caused by bacteria. They are more common in women because their urethra is shorter and is closer to the anus. ...

Urodynamic testing

Urodynamic testing is a test to know how the lower urinary tract is functioning, that is, how urine is stored and eliminated. It is used to diagnose pathologies such as urinary incontinence, neurological diseases that affect the urinary tract, urinary tract infections, etc. The test consists of several parts. First, the patient must urinate in a container called a flow meter, which allows measuring the amount and speed of urine. A probe is then placed through the urethra with the aid of an anaesthetic gel that reaches the bladder and is used to measure its pressure and fill it with sterile saline solution. Finally, the patient must urinate with the probe placed, which is then removed. It is a simple procedure that takes about 30 minutes. ...

Urogenital injuries

A trauma is an injury to an organ or tissue due to external actions or causes. Urogenital traumatisms refer to lesions produced in the genital and or urinary tract. In this case, the organ that is most frequently damaged is the kidney, followed by the bladder, urethra, testicles and ureters. In addition, there are two types of urogenital trauma. On the one hand, there are the so-called closed traumas, which are the most common, and include injuries caused by falls from heights, traffic accidents, sports injuries and direct blows on the external genitalia. On the other hand, open traumas, which are caused mainly by stab wounds, gunshot or fire injuries and by abdominal surgery. ...

Vaginal problems

There are a number of vulval and vaginal problems that can affect young girls before going through puberty. Some of the common conditions include vulvitis, which causes the vulva to become red, sore and itchy and can be caused by soap, or a yeast infection. Vaginitis is an infection of the vagina, and can lead to a discharge, other conditions such as rashes, or foreign objects can be an issue that needs to be treated.  ...

Varicocele

A varicocele is a varicose vein tumour formed by an (unusually swollen vein) or a group of varices, usually located in the scrotum or in the spermatic cord. It usually develops during the course of puberty, most often on the left side of the scrotum, and although it is usually not harmful, in some people it can damage the testicles or decrease sperm production. If testicular varicocele causes infertility, surgery, called varicocelectomy, which involves cutting the affected veins for blood flow is performed. An alternative to surgery is varicocele embolisation, which makes a much smaller incision and involves placing a catheter into the vein. ...

Vesicoureteral reflux (VUR) (kidney reflux)

Vasicoureteral reflux (VUR), also known as vasicoureteric reflux, or kidney reflux is a condition where the urine flows backwards from the bladder to the kidneys. This can cause bacteria present in the urine to travel to the kidneys, causing kidney infection. In children, it can be caused by a birth defect where the ureters (the valves in the urethra) don’t develop correctly. Treatment involves antibiotics to treat infections, as the defect usually corrects itself by five years of age, however, surgery may be required in some cases.  ...

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