Fall 2010 - SSM Cardinal Glennon Children's Medical Center

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Left: Using a video screen, Anand Palagiri, M.D., navigates through the ureter to the kidney to find Irhad Sehovid’s kidney stone. Using a laser fiber, he disintegrates the kidney stone and pulls out the smaller pieces. Right: Dr. Palagiri directs the laser fiber to the kidney stone and blasts it apart. It was a Monday morning at 5:00am when Irhad Sehovic, 15, woke up with a terrible pain in his left side. Silent Service Pediatric Stone Center factors is initiated. What we do now will impact these children positively for the rest of their lives.” 10 “I tried eating something, but it wouldn’t go away,” he says. “It was the worst pain I have ever experienced.” When Irhad began vomiting, his parents rushed him to the emergency room. When his vomiting persisted even after medication, he was sent to Cardinal Glennon via ambulance. Emergency physicians diagnosed him with a kidney stone. Little did Irhad know he had been taken to the right place. In 2007, Cardinal Glennon launched the Midwest’s first Pediatric Kidney Stone Center to address the painful problem that is increasing among young children. Kidney stones are caused by diet, dehydration or genetic factors, which must be addressed to keep stones from reoccurring. However, for children, once a stone has formed, they are usually difficult to pass due to the smaller caliber of the urinary tract. According to Dr. Palagiri, there is no stone the Center can’t remove in any child. “Kids have a bright future ahead of them when we deal with and treat the stones early on,” Dr. Palagiri says. “Currently, we offer state-of-the-art, minimally invasive techniques to remove stones. In collaboration with Dr. Ellen Wood and her team of nephrologists, a thorough evaluation of the etiology and risks To treat kidney stones, Dr. Palagiri established a protocol specifically tailored to children given the delicate nature of their urinary tract. It usually follows these steps and requires up to three separate procedures: 1. Placement of a ureteral stent: The stent protects the kidney and ureter and alleviates the obstruction caused by the stone. At the same time, it dilates the ureter prior to the second procedure. 2. Procedures: • Holmium Laser: Using a tiny camera and a scope, Dr. Palagiri inserts a small laser fiber that targets and breaks apart the stone so it can be removed in multiple pieces. • Extracorporeal Shock Wave Lithotripsy (ESWL): If the stone is in the kidney and can be seen on diagnostic x-ray, the Center may elect to use sound waves to target the stone. The stone is pulverized into sand and is much easier to pass. This option requires no invasion of the body. 3. Stent Removal: When a stone requires manipulation to be removed, often times the ureter can swell shut after the intervention. In these cases, Dr. Palagiri will leave a stent behind to protect the ureter. He then removes it
da Vinci Surgical System This winter, the Division of Pediatric Urology at Cardinal Glennon will begin using the da Vinci Surgical System. The robotic system offers even smaller instruments, which are beneficial for the smaller bodies of pediatric patients. Anand Palagiri, M.D., says the da Vinci is especially useful for procedures that require fine sewing, such as kidney procedures. The da Vinci also allows for procedures once performed openly, to be completed minimally invasively. These include: • Pyeloplasty • Ureteral reimplantation • Partial or total nephrectomy Features of the da Vinci Surgical System include: • High-resolution, 3D video • Fully articulating instruments • State of the art robotic technology Benefits for patients include: • Shorter length of stay • Lower complication rates • Less post-op pain • Superior outcomes one week later. 4. Testing: Once the stone is removed, it is sent for stone analysis. A 24-hour urine collection is also completed by the patients several weeks after the surgery. These values often help determine whether there are any metabolic abnormalities. Urology works closely with the Division of Nephrology based on the results of this testing. If there are concerns on the molecular level, the patient will work with nephrologists and possibly clinical nutritionists to determine the needed course. 5. Basic Preventions: To avoid stones, Dr. Palagiri suggests limiting dark-colored sodas, iced tea and salt. The stone center’s motto is as follows: “The solution to pollution is dilution,” so drink lots of water and remain hydrated. One week after his painful morning, Irhad underwent laser lithotripsy with the homenum laser. Dr. Palagiri inserted a scope through Irhad’s urinary tract and into his kidney. He located the stone and inserted the laser fiber, which successfully disintegrated the stone. The remaining pieces were then removed from the urinary tract. “My advice would be to not do what I did,” Irhad says. “Drink all the water you can. But, if you do end up here at Cardinal Glennon, you’ll probably end up having a good time.” 11
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Page 3 and 4: Announcements SSM Cardinal Glennon
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Page 7 and 8: Glennon Expands Cochlear Implant Pr
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Fall 2010 - SSM Cardinal Glennon Children's Medical Center

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