Torsion Testis
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The testis can go for a twist inside the sac it is held. This results in loss of blood supply. If left untreated for more than 6 hours the testis loses function. Typical presentation is a 14 year old boy who develops severe pain, red ness and swelling of the sac of testis suddenly. It is very tender to touch. It is necessary to do a surgery immediately. There is no point in wasting crucial time on different tests. Surgery is diagnostic and also curative; if blood supply returns after untwisting the testis is preserved. If the blood supply is lost the testis may have to be removed. In either case opposite testis has to be fixed to prevent twisting on that side.
Kidney Injury
Children can sustain injury to kidney when there is blow to the loin either during a road traffic accident or a handle bar injury during cycling. The damage to the kidney can very from mild to serious type. There may be pain, blood in urine etc. CT scan is often required to confirm the extent of damage. Often the treatment is bed rest. Surgery is required only if there is continuous blood loss.
Urethral Injury
When boys fall on to a branch of a tree while climbing, or on cycle bar during cycling, the urethra located in between the legs is injured. When there is severe injury there will be blood from the tip of the penis and the child might not be able to pass urine; with urine accumulating in the bladder. A temporary diversion of urine directly from the belly may be required
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Pyonephrosis
This term refers to pus in the kidney. This can be a result of obstruction to the urine flow and infection developing in it. It is a very serious problem requiring admission, IV fluids and IV antibiotics. In addition prompt relief of pressure has to be done to prevent complete loss of function in that kidney. The conditions that can lead to this include
- Blockage at the upper end of ureter (PUJ obstruction)
- Blockage at the lower end of ureter (VUJ obstruction)
Renal failure
If both kidneys are blocked then it can rapidly lead to renal failure. There can be very low to absent urine output (anuria). The conditions that can lead to this serious problem, even in the newborn period, include
- Posterior Urethral Valves
- Ureterocele blocking bladder outlet
They need to be carefully treated by experts in the field. Some times a simple catheter can revert the situation. Dialysis may be required before planning definitive surgery. Both of these problems can be tackled by a simple endoscopic surgery, relieving the blockage.
