Child with a rare kidney problem undergoes successful laparoscopic surgery in Navi Mumbai, Times of India, April 23, 2015

Picture: Purva with her parents and Dr A.K.Singal and DrRajkumar at MITR Hospital two days after surgery ready to go home.

Miss PurvaBhagat, 2 years female, resident of Pali, Raigad was born normally. She had continuous small amount of urine leak all the time from newborn age. In between she used to pass urine normally also. Initially the mother thought that this is because the child is small but she showed no improvement over a period of time and was treated for urinary infections many times. Finally an ultrasound was done which showed swelling in the half of upper half of right kidney with the urinary pipe also swollen till bladder. They showed the reports to Dr Pankaj Deshpande, Pediatric Nephrologist in Kharghar who referred the child to Dr A.K.Singal, Pediatric urologist at MITR Hospital, Kharghar. Dr Singal examined the child and the reports and got a nuclear renal scan called EC scan which confirmed that there were two pipes for both kidneys, the upper part of the right kidney was not functioning at all and had a separate urinary pipe. The lower part of the kidney had a separate pipe which was normal. Dr Singal suspected that that pipe of the upper part was opening into an abnormal location causing the urine leak and incontinence.  And since this was non-functioning, the removal of it by surgery was the only way to cure the incontinence.

The child was admitted for surgery at MITR Hospital in Kharghar for surgery and under a team headed by Dr A.K.Singal and with Dr Manish Dubey, Urologist and DrLovina Bhatia anesthetist, the surgery was planned. First a cystoscopy (telescopic examination of urinary system) was done and then the upper part of the right kidney was removed via laparoscopy. A Special device called harmonic scalpel was used for bloodless dissection during surgery. The surgery took 1.5 hours and was without any blood loss. The child was started oral feeds soon after surgery and will go home in 2 days without any bandages, catheters or stitches.

Dr A.K.Singal said “Duplex system on both sides is a rare clinical diagnosis and one of the urinary pipes opening abnormally to cause urine leakage and incontinence is further extremely rare. It is less than 1 case per 2 lakh newborn babies. Often girls with urinary incontinence sure to duplex system are treated with multiple courses of medicines when surgery is the only answer. Normally this surgery would have been done with large cut which would have caused pain and also left a large scar on the girl’s tummy. With the availability of pediatric laparoscopy equipments and expertise we are doing almost all kidney surgeries in small babies via laparoscopy. What Purva had was a very rare problem with instead of 2 urinary pipes one for each kidney, she had four pipes two for each kidney. This is called double or duplex system. One of these four pipes did not join bladder and was outside the control muscles giving rise to continuous urine leak. It was technically challenging surgery as the child was small, the kidney blood supply is generally very short on right side and all lover and major blood vessels are very close by. But I am happy that with Dr Manish Dubey’s and DrLovina Bhatia’s help we could finish the full surgery laparoscopically.

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