Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)

Media Coverage

Nine-year-old gets new bladder in rare surgery,Times of India, Mumbai edition- Nov 24, 2009, Page 2,November 24, 2009

Spinal Cord Disorder Had Damaged Boys Kidney Function

Mumbai: Kalyan schoolboy Ankush Tripathi’s million-dollar smile doesnt waver despite having to carry the urine pouch attached to a catheter. He has been in and out of hospitals so often that he has quietly accepted his condition and its complications, says his mother Vimala Tripathi.

The nine-year-old suffers from a rare disease called Sacral Agenesis, in which lower segments of the spine are not formed properly. As a result, his bladder has never worked well since birth, resulting in a failure to pass urine completely. As a result, he suffered several bouts of infections that over the years led to irreparable damage to one of his kidneys.

But last week, Ankush and his parents got a reason to smile. Doctors at MGM Hospital, Vashi, operated to remove his damaged kidney and augment his urinary bladder. Moreover, instead of opening him up to perform the dual surgery, they used laparascopic surgery in which three or more holes are made for the operation.

Children born with Sacral Agenesis usually develop problems in passing urine and/or stools due to imbalance and improper development of nerves connecting the bladder and rectum, said Pediatric Urologist Dr A K Singal, who operated on Ankush. According to Dr Singal, the largest series on long-term follow-up of children born with Sacral Agenesis done by the Harvard Medical School showed that all 38 children seen in over 20 years required some form of surgery to prevent urinary infections or to gain control over urine.

Ankush’s condition was detected in his first year itself, but despite medication and minor surgeries, his kidney failed, said his mother. It was the kidney failure that necessitated the need for such a major reconstructive surgery of his bladder, said his father Lalit.

On November 12, the doctors, led by Dr Singal, first laparoscopically removed his non-functioning kidney. Then we used the urinary pipe connecting the bladder and kidney to enlarge his bladder. The procedure is called ureterocystoplasty, said Dr Singal.

As the procedures were done laparoscopically, Ankush could walk home on the fifth day after the surgery. He will need a catheter (for passing urine) all his life, but at least the frequent bouts of fever will ease, hoped his mother.

Dr Ketan Parikh, senior pediatric surgeon with Kokilaben Dhirubhai Ambani Hospital in Andheri, said that though ureterocystoplasty is a well known and common procedure it has rarely been done using laparoscopy.

As for Ankush, he is happy to be back home and with his cartoons. Fully aware of his condition, he doesn’t go down to play like other children but his numerous cousins keep him company.

A new lease of life

Ankush Tripathi suffers from Sacral Agenesis, a rare birth disorder in which the lower segments of the spine are not formed properly

No concrete cause for Sacral Agenesis has been identified though doctors feel the mother’s gestational diabetes (diabetes during pregnancy) could be a cause. Another theory is low folic acid intake during pregnancy

Ankush had problems passing urine and suffered repeated infections. As he turned nine, doctors found one of his kidneys had failed

Through laparoscopic surgery, doctors removed the nonfunctioning kidney and enhanced the size of his bladder using his urinary pipe (connecting the bladder and kidneys)

Ankush (centre) with his parents
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