Surgery and Urology

The Department of Paediatric Surgery and Urology provides surgical management for children living within the greater Auckland and Northland regions, as well as children with complex paediatric surgical conditions New Zealand wide and for the Pacific Basin. Our surgical team consists of paediatric surgeons, a fellow, registrars, a nurse specialist, a charge nurse and nurse educator attached to the surgical ward.

Clinics are held at Greenlane Clinical Centre and Starship and we also provide Outreach Clinics enabling children to be seen closer to their home towns. Minor surgery is also offered at some of these centres.

Our team of surgeons performs routine day surgery to complex procedures on children with unique surgical problems. This includes:

Abdominal surgery
Thoracic surgery
Neonatal surgery
Genitourinary surgery
Oncologic surgery
Minimally invasive surgery
Trauma surgery.

What is Paediatric Surgery?

Paediatric Surgery is the specialty that includes surgeons who have specialist training in the management of children (usually up to the age of about 15 years) who have conditions that may require surgery. Paediatric surgery normally deals with non-cardiac thoracic (chest) surgery, general paediatric surgery and paediatric urology. It also covers the antenatal management of congenital structural abnormalities, neonatal surgery and oncological (cancer) surgery of children.

What is Urology?

Paediatric Urology involves the surgical management of genital and urinary problems that occur in children. There is a special emphasis on developmental problems affecting the kidneys, bladder, urethra or genital tract.

Consultants

Mr James Hamill Paediatric Surgeon
Dr Phil Morreau Paediatric Surgeon
Mr Vipul Upadhyay Paediatric Surgeon
Dr Stephen Evans Paediatric Surgeon
Mr John Atkinson Paediatric Surgeon
Dr Kimberly Aikins Paediatric Surgeon
Dr Shareena Lala Paediatric Surgeon

Referral Expectations

Referral to our surgical clinics must come from your doctor (GP), or from another specialist either within Starship or another hospital.

Due to the number of referrals the Department receives, referrals are prioritised by the triaging surgeon based on the information provided by your GP. This information determines how soon you will be seen by a surgeon. Where it is unlikely your child will require surgery the referral may be returned to your GP for them to manage your child's condition.

When you come to your appointment, the surgeon will ask questions about your child's illness and examine them to try to determine or confirm the diagnosis. This process may also require a number of tests (e.g. blood tests, x-rays, scans etc). Sometimes this can all be done during one visit, but for some conditions this will take several follow-up appointments. Occasionally some tests are arranged even before your appointment to try to speed up the process.

Once a diagnosis has been made, the surgeon will discuss treatment with you. In some instances this will mean surgery, while other cases can be managed with medication and advice. If surgery is advised, the steps involved in the surgical process and the likely outcome are usually discussed with you at this time.

Common Conditions / Procedures / Treatments

Umbilical Hernia

Umbilical hernias are very common in infants, with one in 10 young children being affected. They are especially common in babies who are premature (born early).

The hernia appears as a lump in the navel that may get bigger when your child is laughing, coughing, crying or using the toilet. It may shrink when your child is relaxed or lying down. It is not painful.

Most of these resolve by the age of three years. It is extremely rare for them to cause complications. Referral can be made once the child has turned three years old if the hernia still persists.

Inguinal Hernia

An inguinal hernia is an abnormal bulge, or protrusion, that can be seen and felt in the groin area (the area between the abdomen and the thigh). An inguinal hernia develops when a portion of the intestine (bowel), along with fluid, bulges through the muscle of the abdominal wall.

Inguinal hernias in children result from a weakness in the abdominal wall that is present at birth. The bulge in the groin might only be noticed when the child is crying, coughing, or straining during a bowel movement, or it might appear to be larger during these times. Of the newborns who have inguinal hernias, 90 percent are boys.

Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery can usually be done as a day case although infants less than 46 weeks post conception usually require an overnight stay in hospital.

Occasionally, if the weakness or defect in the abdominal wall is small, this can result in a portion of intestine becoming trapped. This is called an incarcerated hernia and can cause problems such as severe pain, nausea, vomiting, or absence of bowel movements. Larger abdominal wall defects allow the intestine to move freely in and out of the weakened abdominal wall and do not tend to be as painful.

Hydrocoele

A hydrocoele is a collection of fluid in the scrotal sac of male infants that drains downward from the abdominal cavity. The baby's scrotum will appear swollen or large, but he will not have other symptoms.

Unlike an inguinal hernia, a hydrocoele generally is not painful and does not have noticeable symptoms.

Most of these will resolve by the age of 2 years. If it persists after 2 years of age then you may need referral to see the paediatric surgeon.

Undescended Testes

Undescended testes occur when one or both of the testicles do not reach the scrotum and remain inside the groin and occasionally the abdomen. The condition occurs in two to three percent of newborns. They are more common in premature babies.

In approximately 50% of cases a testicle that is undescended at birth will naturally correct itself by the age of three months. If a testicle is still undescended after three months of age, a referral to a surgeon is required.

At the appointment, the surgeon will examine your child carefully to see if the testis can be felt in the body. If the testis can be felt then a reasonably straightforward operation is required to bring down and fix the testicle in the scrotum. This is usually performed between 9 and 12 months of age. If the testes cannot be felt, a different type of operation would be performed so that the surgeon can check where the testes are. In some cases, the testes are absent.

Depending on the type of surgery your child has he may need to stay in hospital overnight. For straightforward cases you will generally be able to go home later the same day.

Leaving an undescended testicle uncorrected can contribute to infertility and increases the risk of testicular cancer in later life.

Foreskin

The foreskin is normally non-retractile at birth and it is common for some boys to not have a retractile foreskin until after puberty. At no time should the foreskin be forcibly retracted.

If your son has a tight foreskin, ‘phimosis’ this can be managed by your doctor (GP) which normally involves the application of a steroid cream to the area for 4-6 weeks.

Hypospadias

Hypospadias (opening below) is an abnormal appearance of the penis, characterised by the abnormally situated opening of the urethra. This may be associated with a curvature of the penis.

This condition is seen in 1 in 300 - 500 male births.

There are varying degrees of severity and surgery is required to correct the hypospadias.

The aims of surgery are to:

provide a straight penis
move the urethral opening as far forward as possible to enable normal micturition (passing urine) and intercourse.

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