Fogarty balloon catheter ablation of posterior urethral valves in neonates

Neonates with posterior urethral valves in developing countries, where costly endoscopic instruments are usually not available, are a special problem. The objective of this study was to evaluate the efficacy of fogarty balloon catheter ablation of posterior urethral valves as an alternative to endoscopic valve fulgaration. From January 2006 to December 2006, we received 07 neonates with Posterior Urethral Valves which were subjected to this technique. Their age range was between 5-26 days, while the weight range varied between 2.5 Kg to 3.5 Kg. Valves were ablated by using size 6F Fogarty catheter in the main operation theater under general anesthesia. Technique was successful in all the 7 neonates which was evident by a good stream of urine. Two patients had Grade III, while two patients had Grade IV vesicoureterric reflux before ablation. In patients with Grade IV reflux, reflux downgraded to Grade III on MCUG done 3 months after ablation. Patients with Grade III reflux were lost to follow up. Ablation of posterior urethral valves with Fogarty balloon catheter in neonates is simple, economical and effective way to treat these patients. Endoscopic valve fulgaration in neonates is hazardous and this technique is a good alternative, especially in developing countries

Usefulness of ultrasound in the diagnosis of infantile hypertrophic pyloric stenosis [IHPS]

The aim of our study was to know the diagnostic accuracy of ultrasonography in infantile hypertrophic pyloric stenosis [IHPS]. Material and This Prospective study of patients with clinical features suggestive of IHPS was carried out from January 2002 to December 2003 [2 years duration], at paediatrics surgery unit of Lady Reading Hospital Peshawar. Patients with clinical suspicion of IHPS were admitted through casualty, OPD and also shifted from other units. After clinical diagnosis of pyloric stenosis, ultrasound scanning was performed in all cases by a single experienced sonographer. All patients underwent surgery and pyloromyotomy was performed in all patients. Patients were followed up for at least 3 months. Twenty patients with clinical suspicion of IHPS were studied. The age ranged from 19 days to 120 days with average of 49 days. Male to female ratio was 19:1. The most common presenting symptom was nonbilious vomiting [100%]. Ultrasound revealed IHPS in all twenty cases. Surgery confirmed the findings of ultrasound scanning, showing 100% sensitivity of ultrasound in diagnosing IHPS. Pyloromyotomy was performed in all cases. There was no complication observed in this study. Ultrasound scanning is a useful tool of investigation and should be done in all suspected cases of IHPS to reduce the diagnostic errors leading to mismanagement

Comparison of Magpi and Mathieu repair in distal hypospadias

To compare the outcome of MAGPI and Mathieu Procedures in the treatment of distal penile hypospadias in children. Material and This prospective comparative study was conducted in the Department of Paediatric surgery Lady Reading Hospital, Peshawar from Jan 2002 to Dec 2002. A total of 40 children with distal hypospadias without chordae were selected. They were divided into two groups. Group one consisted of 20 children with glandular, coronal and subcoronal hypospadias without a groove in the glans penis. For this group MAGPI procedure was performed. Group two consisted of 20 children with coronal and subcoronal hypospadias with a groove in the glans penis. This group was managed with Mathieu procedure. of the two procedures were compared. Age of these boys ranged from one to 10 years. 32 children had coronal and subcoronal hypospadias while 8 had glandular hypospadias. Functional and cosmetic were good in Mathieu procedure but the fistula rate was more as compared to MAGPI procedure. Meatal stenosis was more commonly observed in MAGPI procedure. Observed P valve of 0.02 between two procedure is significant statistically. The MAGPI procedure was found to have better as the fistula rate was significantly less in spite of the frequent meatal stenosis

Management of colostomies in infancy

The aim of the study was to assess the complications of colostomies and sort out the measures for the prevention of various complication.This is a prospective study performed on 88 patients in whom colostomies were performed for various problems and were admitted to Paediatric surgery unit of Lady Reading Hospital Peshawar during the year January 2000 to December 2000. Majority of the patients had Anorectal malformation and Hirschsprung's disease. Colostomies performed in neonatal period had a high complication rate and increased rate of mortality. Skin excoriation, colostomy prolapse, colostomy diarrhoea, and failure to thrive were the most common complications encountered. Proper stoma care, education of the parents regarding the stoma care and timely treatment of diarrhoea are important factors in the prevention of various complications of colostomy