As this photograph shows, it is possible to mobilise some testes through the scrotum itself thus avoiding any scar on the abdomen.  Not many surgeons, even now, are comfortable doing this surgery ‘entirely’ from the scrotum.

See paper published by me on this subject - 'Management of the low undescended testes by scrotal fixation'. D.Misra, L.Kapila.  Urol, 49:762-5, 1997.

How common are they?
About 4% of all boys are born with an undescended testes, however by the age of 1 year only 0.8% still have this problem.

Complications
Undescended testes do not form sperms well unless they are in the cold environs of the scrotum. There is also a 6-8 fold increase in development of malignancy later in life.

Surgery
The recommended age for surgery is 18 months, the surgery itself takes 30-45 mins and children are sent home the same day.

What are retractile testes?
A lot of young boys simply have a retractile testis, where the testis sometimes gets pulled up because of muscular contraction. It is vital not to label these as undescended testes and subject them to an unnecessary surgery.

How common is it? 
Surprisingly, all boys are born with a tight foreskin, however the foreskin starts opening up with age.

Complications
Some boys with a tight foreskin may develop balanitis (infection) at a later age. Rarely this may result in scarring with resultant difficulty in passing urine.

Non-operative treatment 
As long as the clinician can rule out BXO by clinical examination, it should be possible to treat some tight foreskins with steroid creams, the success rate is approximately 40-50%.

Circumcision
A circumcision surgery may be performed for religious or medical reasons. It may be done under local anesthesia, or under a light GA.

Constipation has almost reached epidemic proportions in the West, and the main reason appears to a deficient diet. Therefore the simplest measures involve increasing the intake of fresh fruits, salads and vegetables and ensuring an adequate fluid intake.

Pulses, lentils, rice, pasta, cereals like wheatabix and shredded wheat are all rich in fibre, Prune juice and bioyogurt are also helpful.

Laxatives may be tried under medical supervision, more resistant cases may require enemas. If all else fails, an anal dilation under anaesthesia may work wonders.

Rarely, the diagnosis of Hirschsprung's disease may be considered in cases of very severe constipation starting in the first few months of life. Here, the innervation of the rectum may be abnormal, treatment involves a major surgery.

What is it?
Some babies are born with a swelling in the belly button (umbilicus). This condition is more common in the afro-caribbean people and in the premature babies.

Complications
Surprisingly, rare. Most umbilical hernias get better in the first 18 months. Surgery may be considered in older children, partly the timing depends on the size of the defect.

This is the commonest referral in my practice. The possible causes are many but I have summarised the most important ones here:

• Gastro-enteritis
• Infant colic
• Food allergy
• Acid reflux
• Helicobacter infestation
• Appendicitis
• Urine infections UTI
• Intestinal obstruction
• Hydronephrosis – blocked kidneys
• Peptic ulcer
• Abdominal migraine
• Worm infestations
• Ovarian cysts
• Gall stones
• Mesenteric cysts
• Wilms tumour
• Meckels diverticulum

But by far the biggest category is NSAP- non specific abdominal pain. I see perhaps 200 children every year with this problem where children get repeated attacks of  severe abdominal pain or colics, which can sometimes result in  weeks or even months off school.

A careful evaluation is a must to pick up those that need surgery, thankfully a minority. Some do have a psychosomatic component and I do not hesitate to mention this openly and honestly to the parents.

(Meckel's Scan in Children: A review of 183 cases referred to two Paediatric surgery specialist centres over 18 years. Pediatr Surg Int. 2013 May;29(5):511-7. doi: 10.1007/s00383-013-3270-3. C Sinha, D Misra)

Dr Devesh Misra
Consultant Paediatric Surgeon and Paediatric Urologist