Most testes are easily to see and feel after a boy is born. If a testis is not descended at birth, it will be in a normal position by around three months of age if it is going to come down spontaneously. If it has not achieved this, then surgery to bring it down is usually best carried out between six and twelve months of age.
It is not unusual for toddler males to have ‘difficult to locate’ testes. In most cases they turn out to be retractile (which is normal) and no operative intervention is needed.
It can be difficult to determine that the testis is retractile rather than undescended, and given the desirability of ensuring both testis are in the scrotum by a year of age, your family doctor may recommend review by a paediatric surgeon to ensure that everything is okay.
Less commonly the testis can be observed over a period of years to be sitting progressively higher in the scrotum (the acquired undescended testis or ascending testis), for boys in this situation surgery often occurs at around five or six years of age.
Correction of improperly positioned testes is usually a day surgical procedure. Less commonly, if the testis is within the abdomen, two procedures may be required to maximise the likelihood of a successful relocation.
Dr Russell and Dr Dilley can discuss with you the association of undescended testes and the issues of infertility and testicular cancer.
Testicular self-examination, recommended for all boys after puberty, is the main surveillance recommended.
Make an appointment at Sydney Children’s Surgery to see Dr Anthony Dilley in Gymea or Randwick, or Dr Carolyn Russell in Gymea, Randwick or Liverpool.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
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Waking Up
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Going Home
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Special Needs
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Make an appointment to see Dr Anthony Dilley or Dr Carolyn Russell at Sydney Children’s Surgery at their clinic in Gymea or Randwick.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Your child may have surgery at one of these hospitals: • Sydney Children’s Hospital in Randwick • Liverpool Public Hospital • Royal Prince Alfred Hospital in Camperdown • St George Public Hospital in Kogarah • Sydney Southwest Private Hospital in Liverpool • Sydney Surgical Centre in Randwick • President Private Hospital in Kirrawee Please read the following information as admission processes differ at each hospital.
Admission Booking Forms
Dr Dilley and Dr Russell will complete hospital booking and consent forms for all hospitals.
Patients are required to submit the admission papers directly to:
Sydney Children’s Surgery will submit paperwork to Royal Prince Alfred Hospital. We will email information patients regarding admission details.
Arrival and Fasting Times
The hospital will call you 1-2 days prior to your child’s surgery with details of arrival time and where to present at the hospital. You will be given instructions regarding the fasting times which need to be followed prior to surgery.
Royal Prince Alfred Hospital You will not receive a call prior to surgery, however, you will be provided with written instructions along with your paperwork.
When general anesthesia is required, there are some important rules for fasting that need to be followed in the hours before the surgery. Fasting begins at midnight prior to surgery. Do not give your child anything to eat or drink from this time.
Food or liquid in your child’s stomach during an anaesthetic may cause vomiting which can lead to serious complications. The nurse will give you specific eating and drinking instructions for your child based on your child’s age. Do not give your child anything to eat or drink (not even a sip of water) from the time you are told to fast.
Day Surgery – What to Bring
Make sure you have everything listed below ready to show hospital staff: • Medicare card • Health insurance details • Family doctor’s name, address and phone number • Paediatrician’s name, address and phone number • Relevant x-rays and results from pathology tests • List of medications and/or treatments your child is taking, as well as the medications themselves to show hospital staff • Comforter, favourite toy, book, electronic device, colouring pencils or games
Make an appointment to see Dr Anthony Dilley at Sydney Children’s Surgery in Gymea or Randwick, or Dr Carolyn Russell in Gymea, Randwick or Liverpool.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Dr Carolyn Russell consults at Gymea, Randwick and Liverpool.
All appointments should be made by calling us on 02-9540 4409. Please have available the details of the referring doctor and your preferred location for your consultation.
On the day of your appointment
Initial consultations are 30 minutes.
What to bring
When you come to your appointment please remember to bring:
Your doctor’s referral letter
Medicare and Health Fund cards
Your child’s ‘Blue Book’
Any relevant X-rays or test results
If it is your first appointment you will be asked to complete a patient details form
Payment for your consultation fee
We can only process Medicare claims for Dr Carolyn Russell’s patients, not Dr Anthony Dilley’s patients. For Dr Dilley’s patients, you will be given a receipt to take to Medicare.
We don’t take payment for in hospital surgery at the time of the consultation, only consultation fees. If a patient decides to go ahead with surgery, we require at least one week notice.
Cancellations
Please call our office to make any cancellation as soon as possible so we can allocate this time to another child.
Parking Information
Gymea: There is some parking available on the grounds, or alternately, on the first side street to the left past the rooms (Talara Road).
Randwick: There is limited two hour street parking on Arthur Street and surrounding streets. Please allow extra time to find parking.
Liverpool: There is minimal parking available underneath the building. Alternately there is limited paid street parking on Bigge Street and surrounding streets. Please allow extra time to find parking.
How to contact us
Make an appointment to see Dr Anthony Dilley at Sydney Children’s Surgery in Gymea or Randwick, or Dr Carolyn Russell in Gymea, Randwick or Liverpool.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
We get many referrals of babies with feeding difficulties thought to be due to tongue tie. Not all children with a prominent lingual frenulum have a problem with tongue function, and we have found that around a third of babies we see end up not needing a tongue tie snip to get feeding back on track.
In our experience the most helpful component of the feeding assessment in newborns with breastfeeding difficulties is ultrasound assessment of the breastfeeding in progress. This is done by one of our practice nurses at the Gymea office. A management plan for you and your baby can be formulated with you based on our assessment findings and the degree of feeding difficulty that is present.
The main concerns for the tongue tie snip procedure include the pain involved (we do use a local anaesthetic cream), the risk of bleeding requiring a stitch for control, and the small (1%) risk of scarring causing re-tethering of the tongue and a recurrence of the problem. When we are confident that a tongue tie is causing feeding problems, these concerns are ‘acceptable’.
In some cases, if the mother is not experiencing significant pain or nipple damage, and alternate causes for the feeding difficulty seem to exist, non-surgical interventions can be tried for 5-7 days before a tongue tie snip is considered.
The assessment by our practice nurse can take up to an hour to collect the necessary information to assist you make an informed choice.
Post-operative care
Aftercare following release of tongue tie in the newborn period:
The main concern following the procedure is the low risk (less than one in a hundred) of bleeding once you go home. You will be provided with emergency contact numbers at the time of the procedure so that your surgeon is contactable.
Most babies resume feeding within 15 minutes of the procedure. Feeding is usually better immediately after the feeding, and further improvement is usually observed over the three to four days that follow. You will be advised a safe dosage of Panadol to be used based on the weight of your baby.
NO stretching exercises will be suggested for your baby following the procedure.
Our practice nurse will contact you 4-5 days following the procedure to check progress. Review by your surgeon is not necessary if feeding is progressing well, if you have concerns or there is a family history of problematic scarring, then review by your surgeon three weeks following the procedure will be recommended.
The risk of scarring requiring subsequent surgery following newborn tongue tie release is 1% in our practice. While a yellow scab like appearance under the tongue is normal following tongue tie release, wound infection is very rare.
If there is increased problems with feeding or redness/swelling under the chin, then contact your surgeon for advice.
Make an appointment to see Dr Anthony Dilley or Dr Carolyn Russell at Sydney Children’s Surgery at their clinic in Gymea or Randwick.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Circumcision is an operation to remove the foreskin. The medical indications to perform a circumcision include UTIs and pathological phimosis.
Parents often request that their boy is circumcised for religious, cultural or other personal reasons.
Anaesthesia
Circumcision can be performed in the newborn period (up to 12 weeks of age) with ultrasound guided local anaesthetic injections to ensure the penis remains completely numb during the procedure and for some time thereafter.
Boys over 12 weeks of age require a general anaesthetic for their circumcision and unless there is a medical need, these operations a performed from 6 months of age.
COMMON CONCERNS
Circumcision
The normal foreskin is usually adherent to the head of the penis at birth. The foreskin becomes separate from the head of the penis during childhood and allows the foreskin to retract. The normal foreskin completely covers the head of the penis.
When a baby is born with an incomplete foreskin and the head of the penis is visible he may have a condition known as hypospadias and should be assessed for possible operative correction.
Non-retractable Foreskin (normal phimosis)
Concerns may arise if a child’s foreskin is unable to be retracted. Most newborns have a non-retractable foreskin. The foreskin becomes completely retractable with age, 10% of one year old boys have a completely retractable foreskin, 50% of 10 year olds and 97% of 15 year olds.
The foreskin will naturally separate from the head of the penis and when this process happens the child should gently retract their own foreskin form cleaning, remembering to replace it over the head. The foreskin is never to be forcibly retracted.
Redness of the Foreskin
Redness of the foreskin is a very common concern. It occurs due the prolonged contact of urine against the foreskin. Children may complain of discomfort or itching. It is easily managed with application of a barrier cream such as pawpaw ointment to tip of the foreskin. The ointment prevents prolonged direct contact between the urine and skin and the redness will quickly resolve.
Ballooning
Ballooning of the foreskin is a common concern. Most young boys have degree of ballooning when the urinary stream commences. The ballooned appearance resolves towards the end of the stream. This type of ballooning is normal. If the ballooned appearance persists after the stream has finished or there is associated dribbling of urine then your son should be assessed.
True Phimosis (abnormal)
True phimosis occurs when the opening of the foreskin becomes scarred. In this case, the boys usually have foreskins that have previously been retractable but are no longer.
This scarring may be caused by attempts to forcibly retract the foreskin before it has naturally separated. It may also be cause by an acquired scarring condition Balanitis Xerotica Obliterans (BXO). The child should be assessed by a paediatric surgeon.
CIRCUMCISION AFTER-CARE
If it is possible, stay in your normal routine.
Bleeding can occur during the first day or two. If this occurs, apply gentle pressure for 5 to 10 minutes and then re-check.
If a further application of pressure does not stop the bleeding, in the first instance contact Dr Anthony Dilley on 02-9540 4409 or, if unavailable, ring Sydney Children’s Hospital 02-9382 1111 and ask to speak to the Surgical Registrar on duty.
Bathing
Remove the dressing the day after the circumcision. Soaking in a bath for 10 minutes will help with this. This and subsequent baths can contain soap free baby washes or oil based cleansers. An application of olive oil may help remove the bandage if it remains stuck.
Apply Vaseline to the head and shaft of the penis after each bath and after each nappy change until the penis is fully healed (around 10 days). This provides a waterproof layer for any raw surfaces, and makes it harder for the penis to stick to the nappy.
Disposable nappies are preferable until the penis has healed – they will keep the penis drier and are smoother than cloth nappies.
The penis will look swollen and red for around 10-14 days. The raw area on the head of the penis will try to make a scab – this yellowish material is to be expected and will go away by itself as healing proceeds. The colour of the head of the penis may vary from a deep red to plum purple colour at different times, these vivid colours settle over a month or two. The appearance of the penis should improve each day – any setbacks in the form of new swelling, redness or fever may indicate infection and should be reported to Dr Dilley.
Panadol dose is 15mg per kg every four hours as needed, with a maximum of four doses per 24 hours. Infant Panadol strength is 100mg per ml. Your son’s weight is: kg, his Panadol dose is therefore mg or mls every four hours as needed for relief, with a maximum of 4 doses per 24 hrs.
The skin immediately under the head of the penis may look puffy for a couple of months, this settles as lymphatic drainage is re-established. A prominent pointy fold of skin underneath the penis may be noticeable after the circumcision, this usually flattens out after a month or two and is related to the use of a straight clamp device for the circumcision.
The raw surface of the head of the penis can stick back to the skin under the head of the penis (glanular readhesion). Left alone, these surfaces will separate eventually (months to years) or can be separated by Dr Dilley in the office if a quicker solution is desired. This may occur after around 3% of circumcisions. Much less commonly (less than 1%), skin from the shaft of the penis can attach to the head of the penis much like a skin graft, forming a bridge of skin that won’t separate easily. Separation can be done by Dr Dilley in the office using local anaesthetic cream.
Meatal stenosis describes the condition in which scar tissue can make the “wee hole” smaller – this usually requires a simple operation under general anesthetic to fix. This happens after around one in a thousand circumcisions.
Appearance
The appearance of the penis will change with your son’s body shape. Newborns are often thin and have little fat over the pubic bone. They quickly become good at eating and develop substantial fat deposits, often over the pubic bone, in which case the fat pushes the skin forward along the penis giving it a buried appearance. This buried appearance usually goes when the rest of the puppy fat does, at around 4 years of age.
If the penis does become buried, ensure the penis is “popped out” with each nappy change for cleaning. Occasionally the circumcision scar can shrink and trap the head of the penis (pseudophimosis) in the buried position – Dr Dilley can usually relieve this in his office, again using a local anaesthetic cream.
Often the buried appearance gives parents concern that there may be too much skin present, but this is in fact uncommon – approximately one in 500 boys have additional skin removed by me at a later date at the parents request.
Make an appointment to see Dr Anthony Dilley or Dr Carolyn Russell at Sydney Children’s Surgery at their clinic in Gymea or Randwick.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Antenatal ultrasounds can detect a number of abnormal conditions in your foetus that may require surgery when your baby is born. Your obstetrician can advise you if it is appropriate to meet with one of our team at Sydney Children’s Surgery before the birth of your child.
You will want to get as much information as possible once you are aware that there is a possible problem with your baby. Dr Dilley and Dr Russell provide an antenatal counselling service whereby they can explain what to expect at the time of your child’s birth, and what is likely to happen afterwards.
Conditions that may be detected before your child’s birth include:
Abdominal wall defects such as gastroschisis or exomphalos
Blockages of the bowel such as duodenal atresia or small bowel atresia
Congenital diaphragmatic hernia
Cysts in the body such as cysts in the lung and chest, the abdomen or ovaries
Make an appointment to see Dr Anthony Dilley or Dr Carolyn Russell at Sydney Children’s Surgery at their clinic in Gymea or Randwick.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Pectus Excavatum, commonly known as funnel chest, is a condition where the central bone of the chest is sunken. The sunken appearance of the breastbone is commonly seen in young children and usually becomes more pronounced during adolescence when there is rapid growth.
In this condition, the cause of the unusual bone and cartilage growth is not unknown. In most cases there is no significant effect on heart or lung function. Children and teenagers come to the attention of a paediatric surgeon due to concerns about the appearance of the chest.
The deformity can be surgically corrected, and curved metal bars are placed behind the breastbone to push it forward. The bars stay in place for approximately two years at which point they are removed. This operation is performed under general anaesthetic. Thoracoscopy and sternal elevation are always used when placing a bar to ensure it is performed as safely as possible.
The patient usually stays in hospital for 4-6 days. There are restrictions on the patient’s activities for the first 3 months after surgery.
Dr Carolyn Russell has extensive experience in chest wall reconstruction and regularly performs these operations at Sydney Children’s Hospital (SCH) in Randwick. Dr Bruce Currie, a leading Australian paediatric chest wall and thoracic surgeon, together with Dr Russell currently consult at their multidisciplinary “Chest Clinic” at SCH, Randwick. They are very proud to be involved in a clinic that delivers exceptional assessment and care to their patients with chest wall deformities.
They also perform physiological testing of patients who wish to participate in their research projects.
Pectus Carinatum
Pectus Carinatum, commonly known as pigeon chest, is a condition where the central bone of the chest protrudes. This appearance is most commonly noticed in later childhood and becomes more prominent during adolescence. Similar to pectus excavatum, the underlying cause of the abnormal growth of bone and cartilage is unknown.
The condition causes no impact on cardiac or respiratory function. Commonly, the child or parents have concerns about the appearance of the child’s chest an seek and opinion. These days, most patients with pectus carinatum are suitable for chest wall bracing and are referred to the SCH orthotist for fitting of a personalised brace.
The brace needs to be worn for long periods of time initially to achieve correction of the protrusion. The use of the brace is then weaned over several months. Some patients do not tolerate wearing the brace and may request surgical correction of their pectus carinatum.
Complex Chest Wall Deformities
Sometimes children develop complex chest wall deformities following surgery for correction of conditions they were born with, such as trachea-oesophageal atresia or a congenital diaphragmatic hernia. In other circumstances, a chest wall deformity may develop following resection of a tumour. All of these conditions can be assessed and managed at Dr Russell and Dr Currie’s multidisciplinary ‘Chest Clinic’ at Sydney Children’s Hospital in Randwick.
Dr Carolyn Russell would be delighted to meet with you regarding your child’s chest wall deformity. All necessary investigations will be arranged at your appointment at the ‘Chest Clinic’. Please ask your GP to refer you to the ‘Chest Clinic’ at Outpatients department of Sydney Children’s Hospital in Randwick.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Hypospadias is a relatively common condition affecting around one in 250 males in Australia. It presents with varying degrees of severity, and a number of different procedures have been described to correct it – for these reasons it can be difficult for parents to find information relevant to their child on the internet.
While most hypospadias repairs are intended to be successful at the first procedure, up to 15-25% of boys may require further a further procedure to achieve the desired outcome.
Most boys under 18 months of age are unaware that their penis is ‘different’ to other parts of their body, it is recommended therefore that correction be complete by then while they are relatively unaware.
The Procedure
Assessment of the condition, and subsequent repair, is tailored to the position of the urethral opening, the degree of bend (chordee) in the penis, the asymmetric foreskin that is usually present, and any flattened appearance of the head of the penis.
Postoperative care
A catheter is often required postoperatively to drain urine into the nappy, this is usually removed around five days after the procedure.
Further review is undertaken six weeks later, and if progress is satisfactory then a final review is performed 3-4 months postoperatively, by which time most swelling has resolved.
Fast Facts About Hypospadias Repair
Hypospadias repair is a surgery to fix the location of the opening in the penis when it is not in the right place at the end of the penis.
Your child’s surgery will be done under general anesthesia, which means that he will be sound asleep during the surgery.
Your child also will receive caudal anesthesia, which will give pain relief in the area below the waist.
A paediatric urology doctor – a specialist in surgery of the urinary tracts and reproductive organs of children – will do your child’s hypospadias repair.
This surgery is done through Children’s Hospital’s Same Day Surgery Center.
This surgery takes between 1 to 2 hours.
Proximal (severe) Hypospadias repair
The repair of proximal (severe) hypospadias, which is less common, is concentrated to a few surgeons in Sydney to optimise experience and results.
If you think your child falls into this category then Dr Dilley would be happy to arrange review by one of these surgeons.
Make an appointment to see Dr Anthony Dilley or Dr Carolyn Russell at Sydney Children’s Surgery at their clinic in Gymea or Randwick. Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
Paediatric surgeons specialise in diagnosing, treating, and managing children’s surgical needs. At Sydney Children’s Surgery we aim to provide a complete surgical service for the care of your child, from initial consultation, any operative procedures, through to long term health management.
Paediatric surgeons treat children from newborn babies through to late adolescence. We work closely with your GP and paediatrician who will usually make the initial recommendation for your child to see a surgeon. Children’s surgical care is the core of our medical practice. We are fully qualified medical practitioners with additional training and qualifications in pediatric surgery.
Problems seen by paediatric surgeons are often different from those seen by general surgeons. Children cannot always express what is the problem – Dr Dilley and Dr Russell specialise in examining and treating children in a way that makes them feel relaxed and cooperative.
Specialist paediatric surgeons, such as Dr Dilley and Dr Russell, usually deal with general paediatric surgery, non-cardiac thoracic surgery and paediatric urology. As well, their responsibilities include involvement in the antenatal management of congenital structural abnormalities, neonatal surgery and oncological surgery for children.
Make an appointment to see Dr Anthony Dilley or Dr Carolyn Russell at Sydney Children’s Surgery at their clinic in Gymea or Randwick.
Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.
