What is a Urologist? A urologist is a physician who has specialized knowledge and skill regarding problems of the male and female urinary tract and the male reproductive organs. Because of the variety of clinical problems encountered, knowledge of internal medicine, pediatrics, gynecology, and other specialties is required of the urologist. Urology is classified as a surgical subspecialty. Specialties Within Urology Pediatric urology Urologic oncology Renal transplantation Male infertility Urinary tract stones Female urology Neurourology Erectile dysfunction (impotence) Why did you choose this specialty, and what do you most like about it? One contributor described this specialty as ‘the last bastion of true general surgery.’ The work is varied and challenging and requires creative solutions since you are addressing problems not just for the short term, but potentially for the next 70-or-so years of the patient’s life. The specialty covers a broad range of areas including urology, gastrointestinal, non-cardiac thoracic and neck surgery in infants and children. What particular abilities are important in this specialty? To succeed in this specialty you need to possess a broad range of surgical skills and have an understanding of different malformations and disease processes. Communication skills are vital, as is the ability to empathise with children and their families. When working as a specialist in this area, what does a daily schedule look like? At times the workload can be busy. Paediatric Surgeons provide a range of secondary, tertiary and quaternary services and are based in Auckland, Hamilton, Wellington and Christchurch. They also care for patients from elsewhere in New Zealand and from the South Pacific. The surgery is mainly consultant-driven and is largely based across the public hospitals of the region. Paediatric surgeons are increasingly involved in providing outreach services, so the work can entail regular travel to smaller centres to hold clinics and perform day surgery. What are the challenges for the future for this specialty? There are about 15 specialists nationwide, and there is incredible breadth in the tasks that these specialists currently perform. There is also a trend for paediatric surgeons to develop sub-specialty areas of expertise for the rare and more complex conditions. With growing recognition of the importance of providing quality services and equity of access to these services, it is likely that there will be an expansion in the extent of outreach paediatric surgery. In many areas of New Zealand paediatric surgeons provide regular clinics and operating lists to the smaller regional hospitals. What advice would you give to someone thinking about this specialty? If you are interested in pursuing a career in this field you should first talk with practising specialists and work with them if possible. You will need to complete BST and it would be useful to gain some paediatric medical experience. It is now possible to enter the specialty training programme in paediatric surgery at the end of BST so you should indicate your interest early to the Chairman of the RACS Board of Paediatric Surgery, c/o Executive Officer, RACS, Spring Street, Melbourne, Victoria 3000 (phone 00613 9249-1200). What is your opinion about opportunities in this area? One contributor commented that the specialty does not require huge numbers across Australasia, but that surgeons who show promise are always able to gain employment. It is projected that there will be a shortage of paediatric surgeons in Australasia from 2005. The process for selection onto the specialty training programme is rigorous and fair, with the top three or four candidates getting selected over each of the last 2 years. Historically, New Zealanders have had a high success rate getting onto the specialty surgical training programme in paediatric surgery. How realistic is it to take time out to travel, have children, etc? A number of paediatric surgeons have successfully taken time out to start a family during training and the Board of Paediatric Surgery has allowed part time training in several instances. Travel is an important aspect of training: you cannot expect to complete your entire training period in New Zealand and it is likely that you may spend up to two years in Australia. The Board of Paediatric Surgery will organise this for you. Worldwide there are many reputable training centres for post-Fellowship registrars and New Zealand graduates are very highly regarded. Contributors agreed that it is useful for you to become familiar with the international community of paediatric surgeons since this community is relatively small and most paediatric surgeons know each another. How has your specialty impacted on your family? One contributor commented that travelling around the world after gaining Fellowship can be unsettling and may affect your financial circumstances, but that it is also interesting and provides you with international contacts that will remain for the rest of your career. Most of the recent graduates in paediatric surgery have spent two years of training overseas. Consultant paediatric surgeons recognise the importance of maintaining a good balance between work and family. Disadvantages with the specialty Huge breadth of expertise is required as the specialty covers urology, general surgery and non-cardiac thoracic surgery (although most surgeons see this as a positive feature). You must be careful not to overlook details or symptoms: infants and children recover quickly but they can also deteriorate quickly. There is less margin for error. You regularly encounter new and unfamiliar cases and rare conditions, which is part of the challenge of the specialty. On-call commitments can be 1:3 or 1:4 since there are relatively few paediatric surgeons, although it is unusual to have to work after midnight (most children have gone to bed by then!). Comments on training One contributor commented that the training period is long and hard but that it is worthwhile if you enjoy the work. You should take opportunities to travel. If you are interested in pursuing the specialty it is recommended that you contact one of the paediatric surgeons for an informal discussion. Our kidneys are vital to our health and well-being. We have two kidneys, each about the size of an adult fist, located on either side of our spine just below the rib cage. Our kidneys perform many complex and life-sustaining functions that help keep our body in balance. They filter and return about 200 quarts of fluid to the bloodstream every 24 hours. Approximately two quarts of fluid are eliminated from the body in the form of urine, and the remaining 198 quarts, are retained in the body. Our kidneys perform many functions, including: * removing waste and excess fluid * filtering the blood * making vitamins that control growth * controlling production of red blood cells * releasing hormones that help regulate blood pressure * controlling the amount of nutrients in the body, such as potassium and calcium. Here’s how our kidneys perform their important job: * Blood enters the kidneys through an artery from the heart. * Blood is cleansed in the kidneys by passing through millions of tiny blood filters. * Waste material passes through the ureter and is stored in the bladder as urine. * Newly-cleaned blood returns to the bloodstream by way of veins. * The bladder becomes full and urine passes out of the body through the urethra. What is the Specialty of General Surgery? The Specialty of General Surgery remains the special domain of the General Surgeon who sees patients for the diagnosis and treatment of problems involving the abdomen, groin, breast, ano-rectal area, certain neck conditions, enlarged lymph nodes, skin lesions and growths and certain other conditions such as trauma and other injuries. General Surgery + Intro to tools, suture (inanimate) + SCARED course (HPS) + Suturing/knot tying/incisional biopsies (inaminate) + Central line (simulator) + Hernias (inaminate models) + Trachs and cricothyroid (simulator) + Chest tubes and thoracentesis (simulator) + Basic laparoscopy (FLS certification) + Lap chole ( porcine model) + Critical care management (HPS) + Endoscopy (simulators) + Bowel anastomosis (inanimate and animate models) + Vascular anastomosis (inanimate) + Basic ultrasound (inanimate) + Intro to lap suturing (task trainers and simulators) + Bowel anastomosis ( animate model) + Lap suturing ( task trainers & simulators) + Vascular anastomosis (inanimate) + Trauma mobilization ( cadavers) + Da Vinci robotic training + Advanced ultrasound (inanimate) + Trauma management (HPS) + Complete operations ( open) + Lap suturing (task trainer and simulators) + Lap splenectomy and adrenalectomy (cadaver) + Intraoperative ultrasound (inanimate) + Lap fundoplication (porcine model) + Crisis Resource Management (HPS) * Abdominal Abscess * Abdominal Angina * Abdominal Hernias * Acute Abdomen and Pregnancy * Acute Mesenteric Ischemia * Appendicitis * Bariatric Surgery * Benign Gastric Tumors * Benign Neoplasm of the Small Intestine * Bile Duct Tumors * Cholecystocutaneous Fistula * Chyle Fistula * Decubitus Ulcers * Gallbladder Mucocele * Gallbladder Tumors * Gallbladder Volvulus * Gastric Outlet Obstruction * Gastric Volvulus * Hepatic Cysts * Hepatocellular Carcinoma * Inferior Vena Caval Thrombosis * Intestinal Fistulas, Surgical Treatment * Intestinal Perforation * Intestinal Pseudo-obstruction, Surgical Treatment* * Lipomas * Liver Abscess * Meckel Diverticulum * Mesenteric Artery Ischemia * Mesenteric Artery Thrombosis * Mesenteric Tumors * Mesenteric Venous Thrombosis * Omental Torsion * Pancreatic Pseudoaneurysm * Perforated Peptic Ulcer * Peritonitis and Abdominal Sepsis * Postcholecystectomy Syndrome * Pyogenic Hepatic Abscesses * Radiation Enteritis and Proctitis * Short-Bowel Syndrome * Solid Omental Tumors * Splenic Abscess * Splenic Infarct * Temporary Abdominal Closure Techniques * Upper Gastrointestinal Bleeding, Surgical Treatment * Vermiform Appendix * Zenker Diverticulum Colorectal * Anal Fissure * Fistula-in-Ano * Gardner Syndrome * Gardner Syndrome* * Hemorrhoids * Lower Gastrointestinal Bleeding, Surgical Treatment * Perianal Abscess * Perianal Cysts * Perianal Granuloma * Pilonidal Disease * Proctitis and Anusitis * Pseudomembranous Colitis, Surgical Treatment * Rectal Prolapse * Rectovaginal Fistula * Thrombosed External Hemorrhoid Excision* * Volvulus, Sigmoid and Cecal Glands * Hidradenitis Suppurativa * Salivary Gland Tumors, Major, Benign * Salivary Gland Tumors, Minor, Benign Head and Neck * Bilobed Flaps* * Cerumen Impaction Removal* * Cheek Reconstruction* * Cleft Lip* * Cleft Lip Nasal Deformity* * Cleft Palate* * Craniofacial Distraction Osteogenesis* * Ear Reconstruction* * Forehead Flaps* * Forehead Reconstruction* * Middle Ear, Acute Otitis Media, Surgical Treatment* * Middle Ear, Chronic Suppurative Otitis, Surgical Treatment* * Nasal Polyps, Surgical Treatment* * Nerve Block, Mental* * Nitrous Oxide Administration* * Nonablative Resurfacing* * Pediatric Sinusitis, Surgical Treatment* * Pedicle/Interpolation Flaps* * Percutaneous Tracheostomy* * Perilymph Fistula * Peritonsillar Abscess * Sinusitis, Ethmoid, Acute, Surgical Treatment* * Sinusitis, Frontal, Acute, Surgical Treatment* * Sinusitis, Maxillary, Acute, Surgical Treatment* * Sinusitis, Maxillary, Chronic, Surgical Treatment* * Sinusitis, Sphenoid, Acute, Surgical Treatment* * Surgical Management of Chronic Aspiration* * Transposition Flaps* Lymphatic System * Lymphedema Other * Abnormal Labor* * Acetabular Wear in Total Hip Arthroplasty* * Allograft Reconstruction, ACL-Deficient Knee* * Amputations of the Lower Extremity* * Augmentation Cystoplasty* * Bedside Ultrasonography, Peripheral Line Placement* * Carpal Tunnel Syndrome* * Cesarean Delivery* * Dermabrasion* * Elbow and Above-Elbow Amputations* * Forceps Delivery* * Free Tissue Transfer, Lateral Thigh and Anterolateral Thigh* * Nerve Block, Superficial Peroneal* * Nerve Block, Sural* * Osteochondral Grafting of Articular Cartilage Injuries* * Polydactyly of the Foot* * Prostatectomy, Simple* * Pyeloplasty* * Radical Hysterectomy* * Skin Grafting* * Thumb Reconstruction* * Total Knee Arthroplasty* * Transureteroureterostomy* * Unicompartmental Knee Arthroplasty* * Ureterocalicostomy* * Ureterolithotomy* * Ureteroscopy* * Urinary Diversions and Neobladders* * Urinary Incontinence, Surgical Therapies* * Wrist Arthrodesis* * Wrist Arthroscopy* Peripheral Tissues * Frostbite Thorax * Cystosarcoma Phyllodes * Thymoma Wounds * Closure of Complicated Wounds* * Wound Care * Wound Infection 1. What is a paediatric surgeon? 2. Specialist paediatric surgeon 3. General paediatric surgeon 4. Should my child see a specialist or general paediatric surgeon? 5. Who decides if my child sees a general or specialist paediatric surgeon? 6. What is a paediatric urologist? 7. How can I arrange for my child to see a paediatric surgeon? 8. What other surgeons treat children? 9. My child has a disability. Where can I get help ? What is a paediatric surgeon? Paediatric surgery is the surgery of children. Many surgical specialities involve children but the term Paediatric Surgeon is used to describe a general surgeon (rather than an ENT, orthopaedic surgeon etc) who treats children. There are two recognised type of paediatric surgeons, specialist paediatric surgeons and general paediatric surgeons Specialist paediatric surgeon This is someone who only treats children. Such surgeons are generally based in large regional hospitals or children’s hospitals. They will have had at least 6 years training in the surgery of children. Although some of their work is the minor surgery of children (eg hernia repair, surgery for undescended testis, appendicitis etc) their main role is in the complex surgery of the newborn (neonatal surgery), major surgical diseases of children and surgery in children with complex medical disorders. These surgeons work with specialist paediatric anaesthetists and nurses General paediatric surgeon This is the term used to describe an adult general surgeon who treats children. Most adult surgeons do not treat children but in each District General Hospital there should be one or more general surgeon who treats the common minor surgical problems in children. Ideally such surgeons will have had at least 6 months training in a specialist paediatric surgical centre. They should provide dedicated children’s facilities for day surgery and work closely with medical paediatricians. Should my child see a specialist or general paediatric surgeon? This depends on your child’s problem. Most common problems can be dealt with by a general paediatric surgeon. Who decides if my child sees a general or specialist paediatric surgeon? This is usually decided by your GP or paediatrician, whoever makes the decision that referral to a surgeon is necessary. What is a paediatric urologist? Some specialist paediatric surgeons have chosen to sub-specialise in paediatric urology. Their training will be mostly as for specialist paediatric surgeons but in addition they will have spent time training in paediatric urology. They are involved in managing complex genitourinary problems in children. In most specialist paediatric surgery departments there will be one or more specialist paediatric urologists or specialist paediatric surgeons who devote most of their time to urology In some District General Hospitals adult urologists also treat the common surgical problems in children (eg foreskin problems, undescended testis etc) as described for general paediatric surgeons (above). How can I arrange for my child to see a paediatric surgeon? You should consult your GP about your child’s problem. If you GP agrees referral is necessary your child will be referred to either a general or specialist peaditric surgeon, whichever your GP feels is necessary. What other surgeons treat children? There are many branches of surgery that treat children. These include Ear, Nose and Throat Surgery (ENT), orthopaedic surgery, plastic surgery, cardiac surgery, neurosurgery and ophthalmic surgery. Cardiac surgery, plastic surgery and neurosurgery are always based a large regional hospitals or children’s hospitals and within those departments there are surgeons who treat mostly or only children. ENT and orthopaedic surgery takes place at District General Hospitals as well as at specialist centres. In most hospitals surgeons in these specialities will treat both adults and children but in many regional hospitals and children’s hospitals there will be surgeons who exclusively treat children (eg Paediatric orthopaedic surgeons). Who should do Paediatric Surgery? Paediatrics Surgery is a distinctive specialty in that it is age related whereas other specialties are either system or organ based e.g. Neuro Surgery, Cardiac Surgery, or they are technique oriented e.g. Plastic Surgery. As a result of its specific nature it comes in conflict with not only General Surgery but also with other surgical specialties. Questions often come up like whether hydrocephalus in an infant is better managed by a Neuro Surgeon or a Paediatric Surgeon or in case of a hypospadius who should operate - a Paediatric Surgeon or a Plastic Surgeon or a Urologist. Such entities should be managed by any specialist who is competent irrespective of the label, but the fact remains that the most essential attribute of a Paediatric Surgeon is a perfect understanding of the child and not the surgical skill alone. The field of Paediatric Surgery varies from place to place. In general, Paediatrics Surgery covers all the abdominal surgery (G.I. Surgery & Genito Urinary Surgery), general procedures and a wide range of congenital malformations and deformities. Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the necessary nutrients the body needs. The method is used when a person cannot or should not receive feedings or fluids by mouth. Sick or premature newborns may be given TPN before starting other feedings or when they cannot absorb nutrients through the gastrointestinal tract for a long time. TPN delivers a mixture of fluid, electrolytes, calories, amino acids, vitamins, minerals, and often fats into an infant's vein. TPN can be lifesaving for very small or very sick babies. It can provide a better level of nutrition than regular intravenous. TPN can provide a better level of nutrition than regular intravenous (IV) feedings, which provide only sugars and salts. The infants requirements for nutrition must be closely monitored. Blood and urine tests help can alert the doctor if any adjustments are needed. HOW IS TPN GIVEN? An IV line is often placed into a vein in the hand, foot, or scalp of the baby. The belly button also has a large vein (umbilical vein) that may be used. Sometimes a longer IV, called a central line or peripherally-inserted central catheter (PICC) line, is used to provide long-term IV feedings. This type of IV can deliver nutrients of higher concentration to larger veins located centrally in a baby' s body. WHAT ARE THE RISKS? While TPN is a major benefit for babies who cannot otherwise feed, such feedings can result in blood sugars, fats, or electrolytes that are too low or too high. Problems can develop due to use of the TPN or IV lines. The line may become dislodged or clots may form. A serious infection called sepsis is a possible complication of a central line IV. Infants who receive TPN should be closely monitored by the health care team, since complications can be serious and are not unusual. ------------------------------------- Prolonged use of TPN may lead to liver problems. * Developmental milestones record - 4 months * Developmental milestones record - 9 months * Developmental milestones record - 12 months * Developmental milestones record - 18 months * Developmental milestones record - 2 years * Developmental milestones record - 3 years * Developmental milestones record - 4 years * Developmental milestones record - 5 years * Preschooler development * School-age children development * Puberty and adolescence http://www.umm.edu/ency/article/002456.htm