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Varicocele

Does My Child Need Surgery?

he decision to perform surgery on a child should never be taken lightly. As a doctor, I only advocate for surgery when it is absolutely necessary. Surgery has risks and these must always be carefully weighed.

Q: My child is five years old. He has a tongue-tie, but he speaks well and has no lisp. He also has low-hanging testicles. His paediatrician has no problem with these conditions but every time I take him to hospital for a minor cold in a children’s hospital, a nurse tells me to consider surgery to lift the ‘balls’ and the tongue. What should I do?The decision to perform surgery on a child should never be taken lightly. As a doctor, I only advocate for surgery when it is absolutely necessary. Surgery has risks and these must always be carefully weighed. Tongue tie: Medically known as ankyloglossia, this is a condition in which the strip of tissue connecting the tongue to the floor of the mouth is shorter than usual. There is no known cause for tongue tie although it may occur more in some families.—Babies born with it may have trouble breastfeeding.—Not all children with tongue tie need surgery. At five years, the only reasons a child should undergo surgery to get rid of his tongue tie are if he has speech or feeding difficulties. Although it may be challenging at first, most children can learn to eat meals that involve a lot of tongue movement like licking ice cream.—A tongue tie can also interfere with one’s ability to play musical instruments (specifically, wind instruments like pipes, flutes etc). Your child may need surgery if he wishes to engage in these activities.— In some cases, tongue tie may contribute to poor oral hygiene — but this is usually in severe cases.

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Usually, surgery for tongue tie involves cutting the tissue at the bottom of the tongue. In a five-year-old, you would likely need to sedation or general anaesthesia to do this procedure (he is unlikely to co-operate and have the procedure done whilst awake under local anaesthesia).If your child does not have significant problems resulting from the tongue tie, it may be best not to have any surgical interventions done.It is also important to understand that having a tongue tie does not cause your child to become more susceptible to throat infections or colds.Testes: For a child with low-hanging testicles, have a paediatrician or paediatric surgeon perform a thorough genital examination.It is normal to have one testicle hanging lower than the other. One may also be slightly bigger than the other. The doctor needs to ensure that both testes are in the scrotum. He/she needs to ensure that your son does not have testicular or scrotal problems such as:Undescended testes: this is when either one or both the testes fail to settle appropriately in the scrotum. This can lead to infertility later on in life. Hernia: this is when there is a sac in the groin area that allows for abdominal contents such as intestines to slid in an out of the groin. Hydrocele: this is when there is a congenital defect in the groin that leads to fluid accumulation in the scrotum. Varicocele: this is when enlarged blood vessels occupy the scrotum causing the testes to look low lying.If there is no abnormality in your child’s groin (testes and scrotum), there is no need for surgery.Surgery to correct low hanging testes is gaining popularity in developed countries as a cosmetic procedure. It is usually performed in adult males who are dissatisfied with the appearance of their genitals.Low hanging testes have not been associated with infertility or sexual dysfunction in adult life. They are also not associated with reduced testosterone levels or testicular cancer.

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