Miss Marie-Klaire Farrugia

Miss Marie-Klaire Farrugia
Paediatric Urology
Central London


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Miss Marie-Klaire Farrugia

Paediatric Urology in
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 whose 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.

 Videos of doctor

How is hydronephrosis treated?

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 Doctor's articles

PUJ Obstruction
What is PUJ obstruction?

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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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 Positions in public associations

• Clinical Lead for the North West London Paediatric Surgery Network

 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
• 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 ...

Hydronephrosis

What is hydronephrosis? Hydronephrosis literally translates to ‘water on the kidney’. It is a condition in which one or both of the kidneys swell a ...

Hypospadias

What is hypospadias? Hypospadias is a relatively common congenital condition found in baby boys, in which the opening of the urethra is not fou ...

Urinary incontinence

What is urinary incontinence? Urinary incontinence is an inability to control the bladder, meaning that urine is unintentionally passed. This is a ...

Urinary tract infection

What is a urinary tract infection? Urinary tract infection (UTI) refers to inflammation in the urinary tract caused by bacteria, the most common type of infection in the urinary tract. An infection occurs when bacteria reaches the bladder (cystitis) or kidneys, multiplying in the urine. If left untreated, the infection may cause permanent damage to the bladder or kidneys. Symptoms of urinary tract infections: There are various symptoms of urinary tract infections, including: The feeling of needing to urinate more frequently than usual, but not passing much urine. Pain or burning sensation whilst urinating. Incontinence, bloody or foul-smelling urine. Mild fever, sweating or chills. Pain in the sides, abdomen or pelvic area. Fatigue What are the causes of urinary tract infections? There are many factors that increase the probability of a urinary tract infection. Some of these risk factors are: A new sexual partner or multiple partners. More frequent sexual intercourse. Diabetes, kidney stones or any problem that means the bladder does not completely empty. Being pregnant increases the risk of infection. Waiting too long to urinate. Not wiping correctly, for females, who should wipe from the front to the back. Can urinary tract infections be prevented? There is no sure way to prevent UTIs, but there are recommendations for reducing the risk of developing an infection: Drink 6 to 8 glasses of water every day. Eliminate refined items, sugar, alcohol and caffeine. Take vitamin C and zinc. Urinate before and after sexual intercourse. Do not wear tight-fitting trousers. Urinate when necessary and empty the bladder completely. Wipe correctly after urinating, as detailed above. What is the treatment for urinary tract infections? Antibiotics are used to treat urinary tract infections. Your doctor may prescribe a single dose of antibiotics or a course of therapy over several days. It is important to follow your doctor’s instructions, even if the symptoms have gone away, because the infection may return. ...

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.  ...

Balanitis

What is it? Balanitis is a skin irritation on the glans penis (the head of the penis). The inflammation causes redness, pain, itching and swelling to the tip of the penis. It can affect men and boys. Balanitis can be caused by fungi (Candidal balanitis), by bacteria (Gardnerella or Trichomonas vaginalis), by a trauma or an irritation or by dryness (thus causing a contact allergic reaction). Balanitis can either be: acute : when it only lasts for a few days chronic : when it lasts for over two weeks What are the symptoms? Symptoms of balanitis usually include: inflammation genital erythema (redness) itching a burning sensation having trouble passing urine bleeding genital oedema (swelling) Other symptoms may include whitish or yellowish discharge, unpleasant genital smell and swollen inguinal lymph nodes. If you’re suffering from other conditions which may lead to a presence of bacteria in your blood, balanitis will become more severe. How is it diagnosed? To diagnose you with balanitis, your doctor will take a skin tissue sample (this may be done with a simple swab) and analyse it under a microscope. Sometimes, balanitis can be diagnosed by simply looking at your penis. What causes it? Balanitis is mainly caused by poor hygiene. Other reasons behind include: fungal or bacterial infections (caused by candidiasis or poor hygiene); sexually transmitted diseases (STDs), such as syphilis, gonorrhoea and herpes; psoriasis, lichen sclerosus or atopic eczema; irritation caused by harsh cleaners. allergy to latex, metal, drugs or cosmetic products Diabetic balanitis is a form of balanitis which develops as a consequence of diabetes. How can it be prevented? Balanitis can be prevented by keeping your genitalia clean and by making sure the head of the penis is always dry after passing urine. What is the treatment? If you have balanitis, the treatment will depend on which kind of balanitis you have and on what symptoms you’re showing. Usually, your GP will give you topical corticosteroids, or antifungal medications if the cause of balanitis is fungal. Which doctor should I talk to? A specialist urologist can diagnose and treat balanitis. ...

Bedwetting

What is enuresis in children? Enuresis is the medical term for what is commonly known as bedwetting. It is quite common during childhood, and happens more in boys than girls, since the development of the sphincters takes a little longer in boys. Prognosis  Enuresis in children is not a serious condition, but the reality is that it is a major problem for affected children, who may feel ashamed or helpless, as well as teased or bullied by their peers. Therefore, enuresis can cause psychological problems or traumas in children. Also, it can increase the risk of infections in the genital area if a child usually wets the bed. Symptoms of enuresis in children The symptom of enuresis is that a child is unable to control their sphincter properly, and they may wet themselves both during the day and more often, at night while sleeping. Causes of enuresis in children In children's bedwetting, bedwetting is not caused only by drinking too many liquids before going to sleep, nor by a mental or behavioral problem, but it has other causes: Genetic factors Difficulty waking up Urinary tract infections Slow development of the central nervous system In other cases, childhood nocturnal enuresis may happen because the child's bladder is still too small; also because the amount of urine produced at night is bigger than what your bladder can hold, or simply because you need more time to learn how to control this organ. Can enuresis in children be prevented? It is not possible to prevent this phenomenon before it happens, or to guess when exactly it will occur, but there are some risk factors that can develop an enuresis, such as stress, anxiety, or ADHD that is not treated properly. Treatments for enuresis in children Regarding the treatment, the first step is to visit a specialist in paediatric urology to rule out any physiological causes and other problems. The specialist will recommend  to attend behaviour therapies to correct enuresis, and it may be necessary to go to a specialist in child psychology if the child is suffering from stress or anxiety that causes enuresis in children. Therefore, medications that help the bladder retain more urine are usually used only when previous behavioural therapy has not worked. Which specialist treats enuresis in children? The first specialist to visit in a case of enuresis in children will be the paediatrician or the paediatric urologist, to rule out any physiological causes of the problem. In this case, you should consult a child psychologist to get a diagnosis and therapy for each particular case. ...

Benign prostate enlargement

What is benign prostatic hyperplasia? Benign prostatic hyperplasia occurs when the size of the prostate gland increases due to a hormonal imbalance in men. The prostate is the male sex gland that surrounds the urethra. It is located below the bladder and above the rectum and is responsible for producing seminal fluid. Prostatic hyperplasia is a common pathology in men after the age of 50 and can affect their quality of life. Prognosis of benign prostatic hyperplasia Benign prostatic hyperplasia, or enlargement of the prostate gland, is a common pathology in men after middle age. It is not serious, nor does it increase the risk of cancer which can also affect this gland. The main problem with benign prostatic hyperplasia is that its symptomatology is bothersome for the sufferer, and can even be incapacitating. However, the prognosis of this pathology is positive with the proper treatment, although it may return over time. Each case of hyperplasia will require the necessary follow-up with the urologist. Symptoms of benign prostatic hyperplasia The symptoms, which appear progressively, include: Urinary incontinence Difficulty urinating Urinating more frequently Urinary urgency Dribbling after urination Need to urinate several times a night Pain when urinating Blood in the urine In severe cases, prostate hyperplasia can lead to an absolute inability to urinate, urinary tract infections or impaired kidney function. Medical tests for benign prostatic hyperplasia If one or more of the above symptoms are present, the urologist will assess the person’s medical history, study the severity of their symptoms and perform a rectal examination to check the condition of the prostate. The person may also require clinical tests such as urine tests to rule out infection, or blood tests to examine prostate-specific antigen (PSA) levels and to rule out prostate cancer. What causes benign prostatic hyperplasia? Although there is no known direct cause or risk factor for benign prostatic hyperplasia, it occurs when the size of the prostate gland increases due to a hormonal imbalance in the testicles: the female hormone (oestrogen) increases, while the male hormone (testosterone) decreases. Can it be prevented? Benign prostatic hyperplasia cannot be prevented, but it can be detected in its early stage through regular check-ups with a urologist. Specialists recommend annual prostate screening after the age of 50 when there is an increased risk of prostate enlargement. Treatment for benign prostatic hyperplasia If symptoms are mild, the specialist may prescribe medication and recommend lifestyle changes (such as avoiding alcohol and caffeine, playing sports, and adapting urination routines). In more severe cases, surgery may be required. Operations for benign prostatic hyperplasia usually include: Transurethral resection of the prostate: This is the most common procedure, in which the prostate is removed through an endoscope inserted through the penis. Simple prostatectomy: The inside of the prostate is removed through an incision made in the abdomen. Prostate laser surgery: With this latest technique, the tissue is destroyed with a laser, making it a less invasive option. Which specialist treats it? The urologist is the specialist in charge of treating prostate hyperplasia. Due to the symptoms of urinary problems, the diagnosis may be made by an andrologist and a urologist. The urologist may also perform the surgery, although some general surgeons are also specialised in these operations.  ...

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. ...

Cystitis

What is cystitis? Cystitis is a urinary tract infection (commonly referred to as a UTI), and is an inflammation of the bladder. This inflammation usually occurs as a result of a bladder infection. Cystitis is more common in women than it is in men. It usually goes away in a few days, but in more complex or recurring cases, it may need long-term treatment.  What are the symptoms of cystitis? Symptoms include: A need to pee more frequently than ususal A burning/stinging sensation when peeing Cloudy urine Dark, or strong-smelling urine Pain in the lower abdomen Fatigue Feeling generally unwell In children: Vomiting Fever Feeling irritated A lack of interest in food/low appetite Feeling weak What causes cystitis? Cystitis is most frequently caused by a bacterial infection, which happens when bacteria from other areas of the body (e.g from in the bowel or on the skin) get into the bladder. Bacteria are thought to come through the urethra, which carries urine out from your body. Women have a shorter urethra, which is closer to the anus and means that they more commonly experience cystitis. Bacteria can get into the bladder in several different ways: Through sex Through insertion of a tampon By using a diaphragm Insertion of a urinary catheter Wiping back to front when going to the toilet Cystitis can also be caused by a damaged or irritated bladder. How can it be prevented? Frequent cystitis infections can be difficult to deal with, but there are some measures which can help prevent it from re-occurring or occurring frequently. Showering, rather than bathing, is recommended as well as avoiding the use of perfumed bubble bath or shower gel. Keeping good sanitary habits, and wiping the bottom from front to back are also used as preventative measures. Cotton underwear, and wearing trousers which are not too tight can help as well. Keep hydrated and drink enough water, but make sure to go to the toilet when you need to pee rather than holding it in. You should also make sure to empty your bladder after having sex. If you use a diaphragm, you may want to consider using a different method of contraception if you frequently get cystitis.   What is the treatment for cystitis? Usually, cystitis goes away on its own in mild cases and can be treated from home using self-help methods to ease symptoms. A hot water bottle, placed on the stomach or between the thighs can help to relieve pain or soothe, along with over-the-counter painkillers. Avoid sexual intercourse until the infection has passed. In some cases, antibiotics may be prescribed, especially in recurring cases of cystitis. A doctor may prescribe a longer course of antibiotics, or continuous antibiotics for a number of months as a preventative measure.  ...

Cystocele

What is cystocele? Cystocele, also known as an anterior prolapse, occurs when the support tissue between the bladder and vagina weakens and stretches such that the bladder sags into the vagina. It can be divided into 3 grades: Grade 1 - mild: the bladder sags slightly into the vagina. Grade 2 - moderate: the bladder sags far enough to reach the vaginal opening. Grade 3 - severe: the bladder projects from the vaginal opening. Symptoms of cystocele: The symptoms vary according to the grade of the cystocele. In grade 1, there are usually no symptoms or visibile abnormalities. However, with higher grades, symptoms such as the following may appear: Feeling of heaviness or pressure in the pelvis and vagina Discomfort when straining: coughing, sneezing etc. Sensation of wanting to urinate, even after going to the bathroom Bladder infections Pain and/or urinary incontinence during sexual intercourse The symptoms may develop to the point where they start to dominate the patient’s day-to-day, affecting her quality of life. What are the causes of cystocele? There are various factors that cause the muscles, ligaments and tissues of the pelvic floor to weaken over time. These factors include: vaginal delivery, being overweight, repeatedly lifting heavy objects, pressure on the abdomen (e.g. constipation or a chronic cough). Can it be prevented? Women are recommended to undergo regular gynaecological examinations throughout their lifetime, but generally from age 45 cystocele is more common. However, cystocele due to vaginal delivery may appear earlier. What is the treatment? Treatment depends on the grade. Generally, grade 1 does not require treatment; however it is important to see your gynaecologist from time to time to determine whether the condition is worsening. It is also important to do exercises to strengthen the pelvic floor. In more severe grades, other types of treatment may be considered such as oestrogen treatment or a pessary device to maintain the bladder in its position. In extreme cases, surgery may be an option to place the bladder back in its normal position.   ...

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. ...

Endoscopic surgery

What is endoscopic surgery? The term ‘endoscopic surgery’ encompasses various techniques, such as hysteroscopy and laparoscopy, in which an optical instrument (a tube with illumination connected to a video camera and a monitor) is introduced inside the body via the rectum or through the abdominal wall, permitting visualisation of the inside of an organ or cavity. Endoscopic surgery, as minimally invasive surgery, has represented an advance over traditional open surgery as it is a lot more reliable and precise, and is associated with less trauma and better aesthetic outcomes. It is usually done under general anaesthesia.   Why is endoscopic surgery done? Endoscopy is performed for diagnosis and observation as well as treatment and surgery. Specifically, endoscopic surgery is used in several fields of medicine: in gynaecology, endoscopic surgery, called hysteroscopy, is very common for treating uterine pathologies, such as cysts, endometriosis, myomas and also for performing tubal ligation, studying infertility, or hysterectomy (removal of the uterus). However, these pathologies are also frequently treated using laparoscopy, which differs in that the surgery is performed via a small incision made in the abdominal wall. It is also used in other fields, such as otorhinolaryngology, in which sinonasal endoscopic surgery is very common for treating lesions or problems of the nose that impair normal breathing, affect the sense of smell or cause face or head pain. Also, in general and gastrointestinal surgery endoscopy or laparoscopy may be used in surgery for obesity. Endoscopy may also be performed in emergency situations, for example in neurosurgery to treat brain haemorrhage or a cerebrovascular accident (stroke).   What does it involve? During endoscopic surgery an endoscope, which is an optical instrument in the form of a tube with a light source and a video camera at its tip, is introduced inside the body via the rectum or through an incision, thereby allowing the surgeon to observe the organ or area to be treated on a monitor. Furthermore, different tools for performing surgery can be introduced via the endoscope.   How to prepare for it Before surgery, you will have to tell your physician about your health and any medications you are taking. Your medical history will be reviewed and various tests performed to determine whether you are fit to undergo the operation. Generally, these diagnostic tests will include clinical analyses; however, depending on the surgery and your characteristics, the specialist may require further specific tests. Given that endoscopic surgery is performed under general anaesthesia, patients are usually asked to fast for 8 hours before the intervention.   Care following the intervention The main advantage of endoscopic surgery versus other surgical techniques is that it’s of a less invasive nature, which permits a faster recovery. So, you will remain in the hospital for only a few hours, sometimes being discharged on the same day as the intervention. Generally, you can resume work 48-72 hours after the intervention. Postoperative discomfort is also less, so absolute rest is not required and you can pursue your life as normal.   Alternatives to endoscopic surgery The alternative to endoscopic surgery is conventional open surgery, which is associated with a higher risk of complications, a longer and more complicated recovery period, and large, more-visible scars. Robotic surgery refers to minimally invasive techniques performed by the surgeon with the aid of a high-precision robotic system which permits better visualisation of the area to treat and surgical manipulations impossible to achieve without the aid of a robotic system. ...

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

What is a hydrocele? A hydrocele is a swelling of fluid, most commonly occuring in the scrotum between the thin layer of tissue surrounding the testes. These can be common in newborns, but also occur in older boys and men following injury to or inflammation of the scrotum. Generally, a hydrocele is not painful and may not need treatment, but it is always a good idea to visit a doctor. Prognosis: It is not a serious condition, and in newborns and children a hydrocele will usually go away without treatment over time. On the other hand, in adults, surgery is usually required, but it is a simple procedure with very good results. If pain is experienced alongside a hydrocele, see a doctor as soon as possible. Symptoms of a hydrocele: The key feature of a hydrocele is a swellin of fluid near the testicles. There is usually no pain experienced. They can occur on either side of the testicles, and can cause some discomfort for adults if the swelling increases in size. How is a hydrocele diagnosed? A doctor would first need to perform a full physical examination, checking the scrotum and the extent of the swelling. They will also check to see if the swelling is painful to the touch. Lastly, they would need to double check for an inguinal hernia, which may be done via ultrasound. It is also common to illuminate a light through the scrotum, as the transillumination indicates the presence of transparent fluids in the area of ​​the testicle. Blood tests may be done to rule out infection. What are the causes of hydrocele? Hydroceles are common in newborns. This is because during the development of a baby in the uterus, the testicles descend from the abdomen through a duct to the scrotum. If the duct is not closed, it causes hydroceles, as the fluid drains and becomes trapped in the scrotum, causing swelling. In older males, hydroceles can occur due to an accumulation of fluids around the testicle area. This could be caused by an overproduction of fluid by the body, due to injury or infection. Can hydroceles be prevented? Hydrocele cannot be prevented in babies. It is important to visit a specialist regularly if a hydrocele is found after birth. Treatments for hydroceles: As mentioned before, hydroceles usually disappear by themselves in male babies. If a hydrocele does not go away on its own in adults, surgery may be required to remove it. This surgery can be performed using general or local anaesthesia. The procedure involves making an incision in the scrotum or lower abdomen to remove the hydrocele. After surgery, a tube may be placed to drain the fluid, as well as dressing the area with a bandage for a few days. Hydroceles may reappear after surgery, which is why it is important to follow up with the doctor a while after the procedure. What specialist treats hydroceles? In babies, hydrocele should be treated by a specialist in pediatric surgery, and in adults by a specialist in urology. ...

Interstitial cystitis

What is interstitial cystitis? Cystitis is the inflammation of the bladder. The term interstitial cystitis (also known as painful bladder syndrome) is used to designate cases that are considered a  chronic condition. What are the symptoms of interstitial cystitis? People affected by cystitis have the bladder wall completely swollen and is painful, they can even expel blood when urinating. This is due to scars or stiffness that are created in the bladder, which causes the inability to enlarge when it is filled with urine. Therefore, the symptoms usually include a strong urge to urinate, urinary frequency, and pain during sexual intercourse. What are the causes of  interstitial cystitis? The exact cause of these infections are unknown at the moment, although it is known that it is not a bacterial or viral infection. Interstitial cystitis is much more common in women than in men, as it usually happens from the age of 20 to 30 and it is quite common to develop after having sex or during the menopause. Can interstitial cystitis be prevented? The main way to prevent chronic cystitis is to prevent cystitis from occurring. Therefore, some guidelines to prevent or avoid cystitis are: Drink lots of water and fluids Urinate often Maintain adecuate daily genital hygiene Shower instead of bathing Do not use aerosols or deodorants in the genital area What is the treatment used for interstitial cystitis? There is no permanent cure for interstitial cystitis, although the initial treatment of cystitis is usually a course of antibiotics. In interstitial cystitis treatments are usually focused on improving the symptoms: diet, exercises to control the bladder, medication, physiotherapy, etc. ...

Kidney infection

What is pyelonephritis? Pyelonephritis a condition that causes the kidneys to become infected, resulting in inflammation. It can be of two types: acute: is caused by a urinary tract infection (UTI) chronic: it is more serious than the acute form. It is due to congenital anomalies that hinder the normal emptying of the renal collecting tubules. Pyelonephritis is a serious condition that can cause permanent damage to the kidneys. It’s important to seek medical attention immediately if you experience the symptoms listed below. What are the symptoms of pyelonephritis? The main symptoms are: low back pain fever shaking chills lack of appetite and malaise nausea and vomiting pain when urinating cloudy urine with strong odour presence of blood in the urine How is pyelonephritis diagnosed? Diagnosis principally involves taking a urine sample which can be tested for bacteria or blood in your urine. You may also have a blood sample taken – again, to check if there are bacteria or other pathogens in your blood that could be causing the infection. What are the causes of pyelonephritis? In the case of chronic pyelonephritis, the cause is usually a severe anatomical abnormality at birth. However, it can also be an acquired condition if you have a flaccid bladder due to spinal cord injury. Because acute pyelonephritis occurs as a result of a urinary tract infection, risk factors include having a weakened immune system, using a urinary catheter, or being female, as the urethra is shorter in women than in men. Can pyelonephritis be prevented? You can help prevent urinary tract infections by: drinking plenty of water through the day avoiding the usage of douches going to the toilet as soon as you need to How is pyelonephritis treated? The treatment aims to reduce the infection and reduce the acute symptoms. The first line of treatment is the prescription of antibiotics, and this should normally improve the symptoms within a few days. In the case of a severe kidney infection, you may need to take antibiotics in hospital. Finally, in the case of chronic pyelonephritis, scarring of the kidney can occur over time, so you may need to see a kidney specialist to discuss the option of repairing the kidney with surgery. ...

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

What is orchidopexy? Orchidopexy, or orchiopexy, is a surgical procedure which is performed in order to fix an undescended testicle into the scrotum. Why is it done? Undescended testicles generally move to the scrotum by the time your baby is 3 to 6 months old. If the testicles do not descend by this point, they will generally need to be surgically corrected. If orchidopexy is not performed, the chances of fertility problems or testicular cancer increases later in life. What does it involve? In cases where the testicle can be felt in the groin, a simple orchidopexy is done. First, a cut is made in the groin in order to locate the testicle. Then, a second incision is made, which repositions the testicle, moving it into the scrotum. In cases where the testicle is positioned higher in the abdomen, laparoscopy may be carried out. Laparoscopy is a type of minimally invasive surgery where a long tube with a light and camera attached is used to perform the procedure. Both types of surgery are performed under general anaesthetic. Aftercare After surgery, it’s normal for your child to feel unwell for a day or so, as the anaesthetic wears off. You can keep them distracted during this time to help them feel better, by doing activities such as reading together. Make sure your child drinks plenty of fluids and rests at home for a couple of days or more after the procedure. They should not return to school or nursery for about two days. Your child may be more comfortable if wearing more loose-fitting clothing, as it is normal for their groin area to be sore and tender after the surgery. Make sure they also do not ride a bicycle or use any similar type of toy in the weeks following the procedure, as this can provoke the testicles to move back up into the abdomen. ...

Paediatric urology

What is paediatric urology? Paediatric urology is a subspecialty of urology that specialises in malformations of the urogenital system of children and adolescents. Some of them require surgical attention and others do not. What conditions does a paediatric urologist treat? The main conditions treated by a paediatric urologist are: Phimosis Paraphimosis Varicocele Cryptorchidism (undescended testes) Hypospadias (malformation of the urinary and genital system) Urinary incontinence (bedwetting) Pelvic Ureteric Junction obstruction (PUJ) Bladder or kidney stones Genitourinary malformations Neurogenic bladder (related to spina bifida) When should I go to the child urologist? Children should be taken to a paediatric urologist when they have abnormalities in their urogenital system, such as phimosis, urinary incontinence, or malformations. When in doubt, it is always preferable to go to a GP for specialist referral. ...

Phimosis

What is phimosis? Phimosis is a condition that inhibits the foreskin from being able to be pulled over the head of the penis (the glans) because the skin of the foreskin is too tight. It can be congenital (primary) or acquired (secondary). Having a tight foreskin is normal for baby boys who are not circumcised, but this normally stops being a problem by the age of 3. If phimosis is acquired, it happens as a result of scarring. What are the symptoms of phimosis? The main symptom of phimosis is the narrowness of the foreskin and difficulty in retracting it. Another associated symptom, although less frequent, is pain during urination, or swelling of the foreskin when urinating. If the phimosis is not treated, complications such as infection in the glans or paraphimosis can appear. Paraphimosis is when the foreskin gets stuck behind the head of the penis, which can result in circulation being cut off, and as such, it should be treated as an emergency. Additionally, if the glans becomes sore and inflamed, it is likely that the patient is suffering from balanitis (inflammation of the head of the penis). What causes phimosis? Congenital phimosis is naturally occurring, but it is not clear why some boys have this but not others. On the contrary, acquired phimosis can be caused due to repeated infections or tears. It can occur, for example, when the skin is violently and prematurely pulled back on babies. Also, when the foreskin or glans become inflamed and scars, the scar tissue contracts and hardens slightly, which causes phimosis. In addition, conditions can increase your risk of developing balanitis, such as diabetes. Can it be prevented? There is no way to prevent phimosis of congenital origin, but in other cases it is possible to prevent it by practising good penis hygiene (i.e. gently washing it with warm water using mild or non-perfumed soap, taking care to gently pull the foreskin back and wash underneath it). It can also help to do daily, gentle retraction of the foreskin, to help loosen the skin. What is the treatment for phimosis? Phimosis is common in children under 10 years old and, therefore, in those cases no treatment is required. If phimosis is causing complications, such as balanitis, antibiotics may be necessary to overcome the infection. Along with gentle daily retraction of the foreskin, topical steroid cream can help to soften the foreskin, making retraction easier. In more severe cases, circumcision may be recommended, which removes the foreskin. ...

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

What is a short frenulum? The frenulum of the penis is the elastic fold of the skin that joins the underside of the glans (head of the penis) with the inner surface of the foreskin. Its function is to help the foreskin to contract over the glans. A short frenulum (also known as frenulum breve) is when the frenulum of the penis is so short that it restricts the movement that the foreskin can make – the frenulum should be long enough to allow the foreskin to restract smoothly, but a short frenulum often makes this impossible. This causes discomfort during sexual intercouse. The short frenulum makes it difficult and even restrains pleasurable sexual intercourse. Prognosis The main problem with short frenulum is the discomfort it causes, as well as problems during sexual intercouse. Also, it can make maintaining hygiene difficult, as it can make it difficult to clean under the foreskin, increasing the risk of infections. One possible consequence of having a short frenulum is that it can tear, usually during sexual activity. This can be painful and may bleed, but is not a medical emergency. A torn frenulum may solve the problem if it heals in such a way that the frenulum is longer, but if scar tissue forms if becomes even less flexible and the problem worsens. If a short frenulum is impairing your ability to have sex or causing other serious issues, it requires treatment.   Symptoms of short frenulum The main symptom is difficulty pulling back the foreskin, as well as pain and tension in the penis. This pain increases during sexual intercourse and can tear and cause bleeding because of the concentration of blood in the area.   Medical tests for short frenulum A short frenulum is often misdiagnosed as phimosis (where the foreskin is too tight to be pulled back), due to the common major symptom of being unable to retract the foreskin, but it is not the same disease. The doctor should perform a physical examination to assess the problem and the degree of it.   Treatments for short frenulum There are different methods to treat a short frenulum depending on its severity. In some cases, steroid creams and stretching exercises can be enough to sufficiently elongate the frenulum. In many cases, however, surgery is the only real solution. There are several surgical techniques that may be used, including reparative plastic surgery (fenuloplasty), the resection of the frenulum (frenectomy) or circumcision.   Which specialist treats short frenulum? Urologists specialise in treating all conditions of the genitalia. Within this field, andrologists specifically deal with male sexual and reproductive issues. ...

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

What is urethra surgery? The urethra is the tube that takes urine from the bladder out of the body. In men, the urethra is about 20 cm in length, running from the bladder, through the length of the penis to the opening at the end. Along the way, it passes through the prostate gland and past junctions with the seminal ducts from the testes, meaning that in men it is used for ejaculation as well as urination. In women, the urethra is shorter, running from the bladder to an opening above the vagina, and is only used for urination. As with all parts of the body, the urethra can be afflicted with various illnesses and injuries, some of which require surgery.   Why is urethra surgery done? Urethra surgery may be done to resolve urinary problems in the patient, to remove scar tissue that is causing pain or inconvenience, or to reconstruct the urethra following serious injury. There are various procedures that can be performed on the urethra depending on the condition or injury.   Urethra surgery procedures Some of the most common surgical operations on the urethra are: Urethral strictures – a narrowing of the urethra, usually due to scarring of the tissue lining the tube. Strictures can be the result of inflammation, injury or trauma, infection, damage left by previous surgery, or one of many other reasons. Often the cause it not clear. More common in males than females, urethral strictures will not go away on their own, and if they cause significant pain or affect the individual’s quality of life (such as urination problems or recurrent urinary tract infections (UTIs)), surgery may be recommended. Sling surgery for incontinence – urinary incontinence occurs when the urethral sphincter, which controls urination, loses control of when the urethra opens during certain movements or actions that put pressure on the bladder, such as sneezing. By surgically implanting a sling made of mesh or tissue that lifts and supports the urethra, urinary control can be restored. ...

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

What are urogenital traumas? A trauma is an injury caused to an organ or tissue due to external actions or causes. Urogenital injuries refer to injuries caused in the genital and/or urinary tract. In this case, the organ that is most commonly damaged is the kidney, followed by the bladder, the urethra, the testicles and the ureters. There are two types of urogenital traumas. On the one hand, there are also the so called closed traumas, which are the most common ones, and include traumas caused by falls from heights, traffic accidents, sports injuries and direct blows to the external genitalia. On the other hand, penetrating traumas are mainly caused by stabbing or gunshots and by abdominal surgery. Prognosis of the disease Most urogenital traumas do not represent an immediate threat to life, but if left untreated they can cause high morbidity over time. The main problem with these injuries is that as they are internal and often do not show external signs, they are not diagnosed properly at the time of the trauma, and they develop health problems, such as haemorrhages, abscesses, pyelonephritis, stones or hypertension, among others. Symptoms of urogenital trauma The symptoms of urogenital trauma can vary depending on the affected organs and tissues, but some of the most common symptoms are: Flank pain or in the abdomen Bleeding when  urinating Abdominal distension Nausea and vomiting Medical tests for urogenital traumas When a patient is admitted to the emergency department due to an accident, fall or severe damage, an emergency valuation of their health status is made, identifying those pathologies that represent an urgent risk to their health. As this valuation continues, the diagnosis of urogenital traumas can be addressed. Scaning tests are the most effective for detecting urogenital traumas, since it is usually necessary to explore the internal structures of the organism. Therefore, the most common tests used are the abdominal CT scan, pyelography, ultrasound examination and arteriography. The choice of diagnostic tests will also depend on the symptomatology and the organs and tissues that may be affected. What are the causes of urogenital traumas? Most urogenital injuries are caused in traffic accidents, which represent approximately half of non penetrating urogenital traumas, followed by accidents in the workplace and sports injuries. The least frequent ones are the so called penetrating urogenital traumas, which are caused by stabbing or abdominal surgeries, but represent a very small percentage. Can urogenital traumas be prevented? The only way to prevent urogenital traumas is to avoid the cause, and therefore avoid accidents, falls and strong blows. Taking precautions such as wearing a seatbelt when driving may help avoid trauma, or using protective sports gear when practising contact sports. Treatments for urogenital traumas The treatment will be considered depending on the affected organs and tissues, some of the most common are: Renal trauma: in many cases it can be resolved by a conservative treatment,  such as  taking absolute rest, a bladder catheter to drain the hematuria and anitbiotics or other drugs. In severe cases surgery may be necessary, such as the reconstruction of the kidney or part of it. Urethral trauma: in cases where it affects or there is damage of the urethra, it should be treated as soon as possible. Usually, surgery will be necessary, although in cases that are not too severe, it can be resolved with the implantation of a catheter. What specialist treats urogenital traumas? A urologist is usually the specialist who treats urogenital traumas. ...

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

What is a varicocele? A varicocele is formed by a varicose vein (an unusually swollen vein) or a group of varicose veins, located in the scrotum or in the spermatic cord. Varicoceles usually develop during puberty, growing larger and more noticeable with time. They occur most often on the left side of the scrotum, and although not usually harmful, in some people it can cause pain in the testicles, cause one testicle to grow slower than the other, and/or affect the patient’s fertility. There is also a female varicocele, which involves an enlargement of the ovarian veins and causes pelvic varicose veins. Varicocele can cause severe pain that becomes worse throughout the day. Prognosis of the disease Varicocele is not a serious disease, but it is a common cause of low sperm production and therefore can cause infertility. In some cases the varicocele can cause the testicles to shrink (atrophy) and not develop normally.   Symptoms of a varicocele Usually a varicocele is asymptomatic, but in some cases it can cause pain that varies from mild discomfort to acute pain. This pain may increase throughout the day. It may also be exacerbated by standing up or upon physical exertion. Over the years, the varicocele grows and becomes more evident. The testicle may appear swollen. Varicoceles are also known to cause infertility in some patients, making it more difficult to father a child.                                                Medical tests for varicocele The diagnosis of a varicocele is made by an urologist or andrologist, who carries out a physical examination in search of a firm lump in the testicle, a characteristic of a varicocele. If the examination is inconclusive, a scrotal ultrasound may be required.   What are the causes of a varicocele? A varicocele is the enlargement of a vein within the spermatic cord (which contains the vas deferens and blood vessels that provide the testicles with their blood supply). There are several theories as to why this happens, but the cause is uncertain.   Treatments for a varicocele In many cases a varicocele does not need treatment as long as it does not cause symptoms or affect fertility. If a testicular varicocele produces symptoms of pain and/or causes infertility, there are surgical options. The varicocele can be removed via a varicocelectomy, which involves removing the affected veins and redirecting blood flow through healthy veins. It is done on an outpatient basis and under general anesthesia, being able to return to your regular daily activities a few days later. The pain should subside within a few days or weeks. An alternative to surgery is percutaneous embolisation of the varicocele, where a much smaller incision is performed and involves placing a catheter inside the vein.   Which specialist treats a varicocele? Urologists specialise in treating the urinary system and male reproductive system, while andrologists are further specialised in the diagnosis and treatment of the pathologies of the male sex organs, including the testicles. In cases of varicocele in puberty, it is possible that a paediatrician notices the presence of a varicocele, since in many cases it develops at this point in the patient’s life. ...

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