Most common aspects of pediatric urology

By: Rafael Krupiniewicz- TrinCay Medical Services

Phimosis

Phimosis is a medical condition where the foreskin is tight or not retractable over the penis. At the end of the first year of life, the retraction of the foreskin behind the glans of the penis is only possible in about 50% of boys; it rises to approximately 89% by the age of 3. The incidence of phimosis is 8% in 6 to 7-year-olds and just 1% in males aged 16-18 years. Phimosis can be  primary (physiological) with no sign of scarring, or secondary (pathological) to a scarring which occurs in some types of balanitis (inflammation of the head of the skin of the penis). Phimosis is different from the normal agglutination of the foreskin to the glans, which is a physiological phenomenon.

The treatment of phimosis in children depends on parent’s preferences. Plastic circumcision has the objective of achieving a wide foreskin circumference with full retractability, while the foreskin is preserved (partial circumcision). However, this procedure carries the potential for recurrence. Radical circumcision prevents further re-ocurrence. These procedures can be performed after the second year of life.

Hydrocele

A hydrocele is a collection of fluid around the testicle. It is the result of an imbalance between the production and the absorption of fluid. Hydroceles should be distinguished from inguinal hernias: the protrusion of a portion of organs or tissues through the abdominal wall. In the majority of infants, the surgical treatment of hydrocele is not indicated within the first 12-24 months because they often heal spontaneously. Early surgery is only indicated if there is a suspicion of a concomitant inguinal hernia or an underlying testicular pathology.

 

Dr. Rafael Krupiniewicz MD, FEBU , Urologist

Education

• General Surgery Department Regional Specialist Hospital Slupsk, Poland.
• Department of Urology Regional Specialist Hospital Slupsk, Poland.
• Department of Urology Kantonal Hospital in Aarau, Switzerland.
• Fellow of European Board of Urology (FEBU).

Clinical Experience

•  Department of Urology Royal Cornwall Hospital in Truro, UK.
• Department of Urology East Kent Hospital in Canterbury, UK.
• Department of Urology Belfast City Hospital, Northern Ireland.
• Kantonal Hospital in Aarau, Switzerland.

Field of Expertise

• Bladder Cancer
• Prostate Cancer
• Kidney Cancer
• Testicular Cancer
• Benign Prostate Hyperplasia
• Kidney Stones
• Urinary Incontinence
• Infertility
• Vasectomy
• Testicle Surgery
• Circumcision

Other

• Member of European Association of Urology.
• Member of Polish Association of Urology.
• Specialist Registered in GMC, UK.
• He practices medicine in English, Polish, German and Russian.

ATOPIC DERMATITIS by Dr. Rebeca De Miguel, MD, PhD, Dermatovenereologist

June 8th 2012

Atopic Dermatitis is a chronic inflammatory skin disorder that affects 20% of children and almost 3% of adults. It has a huge impact in the quality of life of the sufferer and their relatives.  Atopic dermatitis is frequently diagnosed in early childhood but  75% of cases will improve spontaneously after puberty. The hallmark of this condition is itchy, dry, reddish and inflamed skin. In some cases cracked  and crusty skin appears.

Over this damaged skin bacterial infections occur. The most common agent for such infections is staphylococcus aureus.  This bacteria is responsible for the flare ups of the disease that most atopic children suffer during the course of the illness.  Antibacterial treatment improves the condition and reduces the risk of secondary infections. In addition, regular baths with bleach diluted in water and other medications, like  intranasal mupirocine are recommended by  many physicians.  These measures do not work in all cases, and treatment needs to be monitored by a doctor and tailored to the patient’s symptoms.

Flare ups and remission periods vary amongst patients. Even in remission periods the skin appears dry (these phenomena is also known as xerosis) and can be irritated easily.

The basic treatment for atopic dermatitis is corticosteroid  creams.  Strong corticosteroid creams cannot be used in face and body folds for more than a week. Treatments with these type of creams require supervision and monitoring by a medical specialist. Other therapeutic options include Pimecrolimus, Tacrolimus, UVB narrow band and oral treatments like ciclosporine, Metothrexate, Azatioprine, Mycophenolato mofetil and biological treatments (emerging therapeutic option that targets the immune system).

One of the great challenges of this illness is the constant itchiness, the technical term for this is  pruritus. Most cases are resistant to over the counter antihistaminic medication. If the children has a concomitant diagnosis of asthma Montelukast is one the alternative medications frequently prescribed.

There is no evidence linking atopic dermatitis with diet. However, some foods such as eggs, cow milk, peanuts, wheat and soybean,   can trigger atopic dermatitis flare ups in 20% of cases, particularly in children under 2 years old.

The use of probiotic foods  is another controversial issue. Experts have yet to reach an agreement on the role of these substances in atopic dermatitis. However, there is some evidence of symbiotic products reducing infantile asthma. Infantile asthma frequently accompanies atopic dermatitis in children.

Last but not least, flare ups tend to appear during periods of stress. Measures to reduce stress in the household,  psychological support and education regarding trigger factors for flare ups are important in order to prevent further complications of the condition .

 

Dr. Rebeca De Miguel, MD, PhD, Dermatovenereologist – Trincay Polyclinic , CamanaBay

Field of Expertise

• Her special interest is in education, prevention of skin cancer and also in its treatment, including the newest drugs available.

• PhD in Psoriasis with a new molecule.

• She has directed different Workshops of Atopic Dermatitis, Psoriasis, and Skin Cancer.

Others

•Member of the Multidisciplinary Team of Melanoma when she worked in Spain. •Member of the Spanish Academy of Dermatology. •Member of the Spanish Dermatologist Group of Magistral Formulation. •Member of the European Academy of Dermatology. •Member of “Médicos del Mundo” (Doctors of the World).

•Member of the CIMDS (Cayman Islands). •Registered in the Jamaica Medical Council.

•She practices medicine in English and Spanish.