FAQ

Will I be able to stay with my child overnight?  Yes, a bed will be provided for one parent to stay overnight.

What are the visiting times?  It is open visiting. However, we do recommend that visitors leave by 22:00 hours so both parent and child can settle for the night.

What do I need to bring with me?  If your child has got a favourite toy do bring them in. You will need a nightie/pyjamas and toiletries.

What is a general anaesthetic?  A general anaesthetic ensures that your child is fully asleep and free of pain during a test or operation. It consists of a combination of drugs given either as gas to breathe, or as an injection. General anaesthetics are only given by anaesthetists.

Why should my child not eat or drink before having an anaesthetic?  It is important that your child’s stomach is empty as possible as this reduces the risk of vomiting during the operation. Usually, no food or milk should be taken for six hours before surgery, but water and/or clear fluids can be given up to three hours before surgery.

Will I be able to stay with my child while he/she goes to sleep?  Yes, both parents are very welcome to go to the anaesthetic room and you will be able to stay until your child is asleep. Once he/she is asleep, the nurse will accompany you back to your room.

How will my child be given the anaesthetic?  Your child will either have an anaesthetic gas to breathe or an injection depending on age. Anaesthetic gas takes a minute or two to work. The anaesthetist uses a face mask to give the anaesthetic gas, while your child is in your arms sitting on your lap. If your child is having an anaesthetic by injection, ‘magic cream’ is put on the hand about an hour before surgery. This numbs the skin so that a small plastic tube (cannula) and needle can be put into the vein. The anaesthetic is injected through this cannula.

Will my child be in pain?  While your child is asleep, pain relief is given t help make him/her as comfortable as possible after surgery. The type and strength of pain relief given depends on the procedure or operation and this will be discussed with you beforehand.

Will my child need to have any tests?  It is our aim to reduce the number of visits you need to make to central London.
When there is a urological concern, we try to arrange diagnostic testing on the day of your consultation so that the results are available to the consultant at the time of your visit. If further assessment is required we will arrange this for your child after your initial visit.
With general surgical problems it is more common to attend the appointment with the consultant who will then decide whether testing is required.

What will the cost of my treatment be?   Costs vary depending on the type of surgery and the length of stay required.
If you are self-pay we will obtain a quote for you from the hospital. This quote will consist of the surgeon’s fee, the anaesthetist’s fee and the hospital charges.
If you have medical insurance we will provide you with the procedure code(s) for the operation.
Please note that medical insurance cover can vary significantly between policies and providers so it is always best to check with your insurer to find out if your treatment costs will be covered in full.

Childhood Bed Wetting – Your Questions Answered

Giggle Incontinence

Dysfunctional Voiding In Children

Urinary Tract Infections in Children

Umbilical Hernia

Gastroesophageal Reflux

Gastroesophageal Reflux

Paediatric Tumors

Paediatric Tumors: Teratoma

Paediatric Tumors: Kidney Tumors (Nephroblastoma)

Paediatric Tumors: Abdominal Tumors (Neuroblastoma)

Neonatal Circumcision

We perform all newborn circumcisions under strict asepsis in a dedicated day theatre. We utilise the plastibel® technique under local anaesthetic.

The procedure takes about 15 minutes and you will be able to take your baby home immediately afterwards.

Hirschsprung’s Disease

What is Hirschsprung’s Disease (HD)? is a rare condition which affects the nerve cells of the bowel, causing a blockage of the bowel. In HD, nerve cells (called ganglion cells) are missing from a section of the bowel. These cells normally control the muscles of the bowel, which push along the contents (poo). The contents move along the bowel until they reach the part where the cells are missing. This causes a blockage or the passage of poo to slow down. HD affects the rectum and a variable length of the bowel above it. This length is usually a few centimetres but sometimes may affect the entire bowel. There is no known cause for HD, although it can run in families.

What are the symptoms of Hirschsprung’s Disease? Some infants with Hirschsprung’s Disease (HD) do not pass meconium-the dark poo normally passed in the first two days of life. Other symptoms include a distended (swollen) abdomen (tummy) and vomiting bile (green fluid). The main symptom of Hirschsprung’s Disease is constipation, which cannot be treated using laxatives or softeners. This occurs because faeces are pushed through the bowel until they reach the affected part. As this part of the bowel cannot squeeze rhythmically to push the faeces through the bowel, the faeces cannot move any further. As more food is digested and turned into faeces, the bowel becomes blocked causing discomfort and a distended abdomen. Your baby may be uncomfortable because of constipation and trapped air in the bowel.

How is Hirschsprung’s Disease diagnosed? An x-ray of your baby’s abdomen will show enlarged loops of bowel. The only way to diagnose HD is by taking a small piece of tissue from the lining of the bowel. This is called a rectal biopsy. The sample is sent to the laboratory for examination under a microscope. The laboratory will be looking for a type of cell called a ganglion cell. The results will be available in approximately five working days. If the piece of tissue does not have any ganglion cells, this means Hirschsprung’s disease has been diagnosed. Bowel washouts are continued while waiting for the results of the rectal biopsy. If HD is confirmed, they will be continued until your baby has an operation.

What is the initial treatment?

• Milk feeds will be stopped

• A tube will be passed through the nose into the stomach to remove any fluid and air collecting in it

• Fluids will be given through a vein (drip)

Your baby will need to have rectal washouts to decompress the bowel and reduce discomfort. Usually the washouts will need to be done once or twice every day and will take 20 to 30 minutes. Bowel washouts empty the lower large bowel of air and stool and reduce the risk of enterocolitis developing. Occasionally the abdomen cannot be decompressed adequately by washouts. Your baby would then need an operation (colostomy formation) to ensure that the bowel remains decompressed.

How is Hirschsprung’s Disease treated? All babies will need an operation to treat Hirschsprung’s Disease. This operation is called a ‘pull through’ and is usually performed at a few weeks/months of age. It involves taking out the part of the bowel affected by HD and connecting the healthy bowel to the anus. Your baby will be in hospital for five to seven days after the operation. Some surgeons may suggest creating an artificial opening on the abdominal wall (stoma) to remove faeces while waiting for the ‘pull through’ operation. Your baby may need to remain in hospital while having bowel washouts and waiting for surgery. Sometimes your baby may go home and the nurses will teach you how to do the rectal washouts. During this time your baby should be able to feed normally. If your baby is not able to feed normally for any reason, if you wish to breast feed, the nursing staff will teach you how to express and store your milk to feed your baby when they are ready. While awaiting surgery your baby remains at risk of developing enterocolitis.

What is enterocolitis? Enterocolitis is an infection of the large bowel and is a potentially very serious complication of HD. It is treated with antibiotics (given through a drip into a vein) and regular bowel washouts.

What are the symptoms of enterocolitis?

• Distended abdomen

• Reluctance to feed

• Vomiting – this may be green in colour

• A high temperature

• Tummy ache

• Dehydration (baby is pale and floppy)

We can provide you with a laminated medical alert card if you wish. Enterocolitis can occur both before and after surgery but the risk after surgery is much less. If you are at all concerned about your baby please seek medical advice urgently.

What does the operation involve? The surgeon will remove the part of the bowel with the missing ganglion cells and bring the healthy bowel with ganglion cells down to the rectum. This creates a working bowel, with enough nerve cells to control the muscles so that your baby can pass faeces as usual.

What are the long-term effects of Hirschsprung’s Disease? Many babies with HD experience long-term problems such as diarrhoea, constipation, soiling and abdominal pain and you may find that your child takes longer to toilet train. Sometimes medicines are needed to help with these problems. You will have specialist advice and support to manage and improve any symptoms in the longer term. Following discharge from hospital, your baby will be seen in the outpatient’s department by members of the surgical team, where help and advice will be available to you. Follow up appointments will usually occur on a regular basis for some years

Cystoscopy

What is a cystoscopy? A cystoscopy is a procedure where a small camera is inserted in through your child’s urethra (the tube through which they pass urine) into the bladder. A cystoscopy is performed in order to get a clear picture of what is happening in the bladder and the tube leading from the bladder to the outside.

Why do patients need this procedure? Cystoscopies are a frequently used procedure by Paediatric Urologists to investigate and treat young boys and girls with bladder difficulties, reflux or urinary tract infections.

Will your child need to be under anaesthetic? This is relatively straightforward and short procedure performed under general anaesthetic.

Will it hurt? This procedure is not usually associated with any pain or discomfort. Occasionally there can be a little stinging afterwards and sometimes a little blood can be passed with urine but this settles down very quickly.

How long will your child be in hospital? The vast majority of children can have this operation performed as a day case and go home the same day without any difficulties.

What happens next? Your consultant will talk to you about the results of the cystoscopy shortly after the procedure and discuss any treatments needed.

For example, the cystoscopy could identify reflux which can be treated by a small injection of material such as Deflux™. Or the procedure could identify inflammation of the bladder (cystitis cystica) which can be treated successfully with antibiotics.

Appendicitis

What is appendicitis? Appendicitis is an inflammation of the appendix, which is a small piece of bowel and lies in the right hand side of the abdomen. It has no useful or functional benefits in humans but occasionally it can get blocked or inflamed and cause appendicitis.

What are the symptoms? Appendicitis can present in children with pain, sometimes around the belly button which then moves to the right hand side. Children can also have high temperatures, they can vomit and they can be off their food. The other symptoms can include pain on passing urine, pain in the pelvis and generally feeling unwell with high temperatures and lower abdominal pain for a number of days.

How easy it appendicitis to diagnose? When your child attends the casualty department they will be evaluated by a number of doctors to see whether or not a diagnosis of possible appendicitis can be made. This can be quite challenging as it is one of the most difficult diagnoses to make in children and in adults. The vast majority of children who present with abdominal pain do not have appendicitis and unfortunately there are no quick and easy tests that can distinguish appendicitis from other causes of your child’s pain and discomfort. Your child will be evaluated by a surgeon and regular blood and urine tests will be performed to try to determine the diagnosis. Parents frequently ask and wonder whether a scan will be beneficial and the majority of times ultrasounds, scans or x-rays of tummy are of very limited benefit in diagnosing appendicitis. In reality the most useful thing is repeated assessments by the surgeon. Your child will be admitted and then reviewed on a number of occasions, and will be given IV fluids through a drip and pain relief. All the appropriate care will be provided until we can clearly diagnose what is going on.

What if my child is diagnosed with appendicitis? Once the diagnosis of appendicitis is made it may mean that your child will require an operation – an appendectomy. Although this is an urgent operation, it does not need to happen immediately. It is much more important that your child is treated with antibiotics and given fluids though a drip which will enable them to feel a lot better. The antibiotics and the fluids are actually very successful treatments for appendicitis and this way they have the best possible chance of recovering faster and being discharged quickly following surgery. Sometimes there can be a perceived delay from the time of diagnosis to the time of surgery, but as long as your child has been treated with antibiotics and the fluids, this is all part of the normal treatment plan.

What does the operation involve? Your child will go to theatre and have an operation. This is always a time of stress and anxiety for parents but the operation is being performed by skilled surgeons, anaesthetists and a surgical team who are experts in this procedure. We are children surgeons, and our nursing staff are dedicated to looking after children. The majority of children who do have an appendectomy now have it through a key hole technique which involves using a laparoscope or small camera which is inserted into the abdomen. With some children it is better that it is done in an open procedure.

What happens after the surgery? Afterwards your child will require pain relief, fluids through a drip, and will need more antibiotics. Depending on how inflamed or complicated the appendicitis is will impact upon the child’s length of stay. Children with mild appendicitis will only be in hospital for a few days. Children with more severe appendicitis can be in the hospital, on IV antibiotics for at least five days. Over the next number of days the child will be encouraged to get out of bed and return to a normal diet as quickly as possible. As soon as they are well they will be discharged home, however in those children with more complicated or inflamed appendix they will stay for a minimum of five days and recovery can take longer than that. Surgeons and nurses will be assessing your child on a regular basis. If you have any questions or concerns please feel free to ask any member of staff.

Undescended testes

What are undescended testes? Undescended testes are a common childhood condition where a boy is born without one of his testicles in his scrotum.

3% of all boys born at full term will have undescended testes. The majority of testicles descend by three months and by three to six months only 1% of boys will still have the testicle in the wrong place.

What happens if my child has undescended testes? If your child is diagnosed as having a testicle that is not quite down at around three to six months of age your child may have to undergo an operation to bring the testicle down into the scrotum – known as an orchidopexy.

What does the operation involve? Orchidopexies are straightforward and uncomplicated procedures. It involves a small incision made into the groin above the testicle and a separate cut made in the scrotum to ensure the testicle is placed in a nice comfortable position. This is done under general anaesthetic.

Occasionally the testes cannot be felt in order to perform the incision so a camera is inserted in the bellybutton to look internally to determine whether the testicle is in the abdomen. If the testicle is in the abdomen it may be brought down in a single operation but in the majority of cases there is restricted movement and this is not possible. Two operations are then required – one straight away at the time of the initial keyhole procedure and the second six months later, at which the testicle is actually brought down into the scrotum itself.

What happens after the procedure? Your child will need some regular pain relief in the days following the operation but should recover quickly from the procedure. Sometimes there can be some swelling and bruising around the scrotum and around the incision in the groin but overall the risks of infection are remarkably low.

What if I have any more questions? Further information about the procedure, complications and long term implications of the surgery will be explained to you by your surgeon both in clinic and at the time of surgery.

Circumcision

What is a circumcision? Circumcision is an operation where the end of the foreskin is removed.

Why do patients need this procedure? Your child may have a circumcision because of tightness, ballooning or inflammation of the foreskin, or because they have a skin condition called balanitis xerotica obliterans (BXO).

Do patients need general anaesthetic? Your child will have a general anaesthetic and in the vast majority of children who are otherwise well, there is no reason for blood tests or investigations to be done prior to the operation.

What happens during the procedure? You will be able to bring your child into the theatre and be there while they drift off to sleep.

Are there any risks? Occasionally the surgery wound can bleed, especially within the first few hours but this does settle. Sometimes if bleeding does not stop your child may need to return to theatre shortly after the operation to have this looked at but this is extremely uncommon.

Too much or too little skin may be removed during the operation but this is rare. There is also a small risk of infection with a procedure like a circumcision. If you are concerned about anything please contact your GP or the surgical team for assessment

How long will it take to recover? There may be some redness, swelling and discomfort that can last for quite a number of days, but this does settle. The stitches will absorb and go away by themselves in around two weeks. It is not unusual for the surgeon to use tissue glue which can also take around two weeks to absorb.

How do I care for my son when he gets home? You will need to keep the area dry and clean for five days following the procedure.

Does the patient need any medication? Your son won’t need any specific prescribed medication after the operation. However, if there is an abnormality of the foreskin and some scarring already present, the tissue will be sent for histological review. If there is the evidence of BXO your child may require treatment with mild steroid cream after they have had the operation.

And finally…

The vast majority of children who have routine circumcisions done by us do extremely well with very little complications. Patients are very happy with the results, experience very little pain and are extremely comfortable afterwards.

We aim to ensure this procedure is stress-free for parents and their children and are here to support and advise the family where possible.

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