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4 Seminar to discuss urinary tract infections in the very young rinary tract infection (UTI) is a common cause of fever in infancy and is probably the most common serious childhood bacterial infection. A seminar Monday, Oct. 22, at this year’s National Conference and Exhibition will focus on how pediatricians should manage a young patient with UTI. “After the First UTI: Controversies and Consensus” (S3091) will feature Ellen R. Wald, MD, FAAP, Chair of the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health, and Steven G. Docimo, MD, Vice Chair and professor of Urology at the University of Pittsburgh School of Medicine. Dr Wald will discuss the new AAP guidelines for managing the initial UTI in febrile infants and children up to 24 months of age. The original guidelines were published in 1999. In November 2011, the AAP revised these guidelines and Dr Wald served on the Subcommittee on Urinary Tract Infection that was Don’t miss the AAP Section on Urology Program’s Master Classes, a Live Robotic Surgery Pyeloplasty, and more! View urology program highlights at www2.aap. org/sections/urology/SOU_ Draft_Schedule-040212.pdf View all conference sessions at www.aapexperience.org/ planner. responsible for the update. She will review the guideline’s seven action statements, explain the rationale for these statements, and emphasize specific revisions. The most controversial change is Action Statement 6, which describes the criteria for performing a voiding cystourethrogram (VCUG). The original guideline called for routinely performing a VCUG after the first febrile UTI, Dr Wald said, but the updated guideline calls for postponing a VCUG until a second UTI occurs or if an ultrasound shows a worrisome abnormality. Dr Wald will begin the seminar with an overview of UTI, reviewing the pathogenesis, bacterial etiology, signs, and symptoms. She will define UTI in terms of the bacterial density required to determine whether the urine is infected and review laboratory diagnosis, including urine dipsticks and microscopy. “I think that people tend to underestimate the importance of pyuria,” she said. “Understanding that both a lot of bacteria as well an inflammatory response, which is what the pyuria indicates, are expected is an extremely important take-home message. It will allow the practitioner to know when a culture result is important as opposed to when it may be less important.” Dr Docimo will discuss management of recurring UTIs, which often require management of vesicoureteral reflux (VUR), along with the best ways to manage voiding dysfunction. He said voiding dysfunction is one of the most Ellen R. Wald, MD, FAAP common risk factors for recurring UTI, so a physician must assess for voiding dysfunction and, if present, manage it aggressively. All children with recurring UTIs should be evaluated for functional voiding disorders in addition to evaluation for anatomical issues, Dr Docimo said. “What we’ve learned over the years, much to our benefit and the benefit of the kids that we treat, is that managing voiding dysfunction and bowel dysfunction significantly decreases the risk of infection and, therefore, obviates a lot of other treatments that we otherwise might have to employ, including surgery,” he said. Non-surgical, non-invasive treatments include bowel management with longterm laxatives, timed voiding, double voiding to empty the bladder, and biofeedback to encourage pelvic floor relaxation. When surgery is indicated, Dr Docimo said, there are new techniques that can be done on an outpatient basis or require an overnight stay. These advanced techniques maintain the traditionally high levels of effectiveness in resolving VUR and decreasing the risk of pyelonephritis. “We find that we use surgery less frequently than in the past, but when needed, it’s still a relatively common set of surgical procedures for pediatric urologists,” he said. “When needed, it’s very effective — a low-morbidity, highimpact kind of surgery.”
5 July Preview Faculty Approach 25-Year Teaching Milestone at AAP Conference ost medical students are handed their direct ophthalmoscopes during the first week of their freshman year in medical school. Very little, if any, formal instruction is given on its use. Examination of the eye may be covered during one to two days of their senior year, if that. Examining techniques are sorely lacking, and most pediatricians know this,” said Steven Lichtenstein, MD, FAAO, FAAP, Associate Professor of Clinical Surgery and Pediatrics at the University of Illinois, College of Medicine. This fall, Dr Lichtenstein and Robert D. Gross, MBA, MD, FAAP, Clinical Associate Professor of Ophthalmology at the University of Texas, Southwestern Medical School, will celebrate a milestone of teaching 25 years for the AAP conference at their workshop “Eye Examination Skills: Using the Ophthalmoscope” (W1045/ W1132) Saturday, Oct 20. Over the years, their presentation became better and better. Dr Lichtenstein attributes their biggest teaching improvements to the quality of pictures and advancements in digital photography. “We started out using dual projector Kodachromes, which most of the younger physicians have never heard of! Today we can take a digital picture and insert it into our Robert D. Gross, MBA, MD, FAAP Steven Lichtenstein, MD, FAAO, FAAP PowerPoint Presentations instantaneously.” Another critical improvement is the equipment now available to the pediatrician. “While ophthalmoscopes have been around for a long time, it is really only for the past seven or eight years that we have had the capability of showing a view through an ophthalmoscope using video. Now we can show imaging of eye pathology via optical coherence tomography to further enhance the learning experience,” said Dr Gross. More than 20 years ago at an AAP conference in Atlanta, an 80-year-old pediatrician approached Doctors Lichtenstein and Gross after their first workshop and said, “I want to really thank you for presenting this workshop!” Dr Lichtenstein thanked him, yet the learner continued, “No, I REALLY want to thank you. I have been practicing for 50 years and today was the FIRST TIME I have ever seen the optic nerve!” Dr Lichtenstein reflected, “I was truly taken aback. I knew what we were doing was truly a Dr Robert Gross interacts with learners and reflects, “I would say that the most rewarding aspect of this course for a learner and for me is to hear them tell me that for the first time they could really see the optic nerve and the back of the eye. It is as if a whole new world has opened up to them. This is what keeps me coming back to teach year after year.” worthwhile and necessary endeavor, which continues to be why I so enjoy presenting this course.” Every workshop the doctors have presented has sold out, and they are frequently asked whether they can accommodate one or two extra participants. They appreciate the enthusiasm of learners and popularity of their session, reflecting on the overall value of the AAP conference, “What other forum allows you to come face to face with true experts in all subspecialties of pediatric medicine, walk up and ask them a question The experts that are just names in a journal article or a textbook are right there in front of you, and approachable,” said Dr Lichtenstein. “Where else can you also renew old friendships with colleagues and mentors that you may not have seen since medical school or training The AAP conference has long been this for me.”
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