Fall 2010 - SSM Cardinal Glennon Children's Medical Center

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What is independence For many children it’s the first few moments away from their parents’ grasp, a slumber party in a friend’s basement or the first time they get the car keys. But for the patients within the Division of Pediatric Urology, it’s a lot of things people don’t want to talk about. Voiding dysfunction, incontinence and genital anomalies separate children from social norms and severely affect self esteem, bodily function and social interaction. So why doesn’t anyone want to talk about it “Many times, it is difficult for parents to find a venue to be heard and to thoroughly discuss these issues,” says Division Director Anand Palagiri, M.D. “But they are extremely important to quality of life and social acceptance, hence our mission to bridge the gap and address the problems either medically or surgically.” Dr. Palagiri and partner Casimir Firlit, M.D., provide comprehensive care, commonly treating conditions such as: • Undescended Testicle (Cryptorchidism) • Hypospadias (Abnormal urethral opening) The Silen SSM Cardinal Glennon Div • Hernia • Hydrocele • Vesicoureteral Reflux • Obstructed Kidneys (UPJ obstruction) • Hydronephrosis (Prenatal/Postnatal) • Kidney Stones • Nocturnal Enuresis (Bed Wetting) • Voiding Dysfuntion • Circumcision and its complications • Urinary/Fecal Incontinence But they certainly don’t do it alone. Within their division they call upon clinical coordinator Kelly Lepsky, RN, surgical physician assistant Jenny Deyto, PA, and clinical nurse Louisa Salvin, RN. With more than 20 years of experience, nurse practitioners Jeanne Hermann, PNP, and Nancy VanCleave, PNP, offer high-quality care as they triage patients through weekly clinics and address dysfunctional voiding. This group also works tirelessly to ensure care to expectant mothers whose prentatal ultrasounds reveal urinary tract mal- Treating Vesicoureteral Reflux 6 After his first day of kindergarten, Donald Horvath, 5, receives a renal and bladder ultrasound at his first appointment with urology nurse practitioner Jeanne Hermann, PNP. Donald was fully toilet trained when he was 2 years old, but within the last year he has experienced several accidents along with a urinary tract infection. In her effort to rule out any anatomical abnormalities, Jeanne utilizes diagnostic imaging in the form of a renal ultrasound and a voiding cystogram. James Shipley, 5, awaits his turn for surgery. Dr. Palagiri and his team schedule a day for endoscopic injection procedures every eight to ten weeks. Today they completed 11 cases. Nurse practitioner Nancy VanCleave, PNP, diagnosed James with VUR and addressed his dysfunctional voiding. With no improvement from conservative management, Dr. Palagiri suggested the minimally invasive injection procedure. Dr. Palagiri completes James Shipley’s 20 deflux injection procedure. He inserts an through the urethra and up into the blad he passes a tiny needle through the endo dispenses the gel (deflux ) around the ur ing to create a mound that stops urinary Over time, the gel combines with fibrobl collagen, which stabilize the position an implant. Afterward, Dr. Palagiri met wi family. He told them James will have no restrictions and can return to school the
t Service ision of Pediatric Urology formations such as hydronephrosis, posterior urethral valves and bladder extrophy. For many mothers, early diagnosis and a prenatal consultation with pediatric urologists provides comfort as they know their baby is going to be cared for possibly prior to delivery or quickly thereafter. Many of urology issues also require the expertise of other pediatric specialists such as Nephrology, Radiology, Sleep Medicine, Neurology, Gastroenterology, Anesthesiology and Neonatology. When seeing a patient in clinic with nocturnal enuresis (bedwetting), Jeanne and Nancy often consider whether or not the patient is a candidate for Sleep Medicine Specialist Shalini Paruthi, M.D., especially if everything anatomically is working properly. “It’s important we work together to ensure we provide the most comprehensive diagnosis,” Dr. Paruthi says. “Complications such as enuresis can be devastating to a child’s self esteem and restrict their activities. I recently had a teenage patient who had never been on a sleep over because of nightly enuresis. She was very ashamed.” The Division of Urology also stays on the leading-edge of care with education about the newest techniques and technologies available to pediatric surgeons. This winter, Dr. Palagiri and Dr. Firlit will begin using the robotic da Vinci Surgical System for routine surgeries that, in the past, were only performed through an open incision. Pediatric urology procedures such as pyeloplasty, ureteral reimplantation and partial or total nephrectomy can now be performed in a minimally invasive fashion with the use of the robot. However, these surgical advances do not overshadow the fact that many of the Division’s patients need much more than surgical care, Dr. Palagiri says. “When we take a patient under our care we understand we are responsible for the entire patient — medically, surgically and emotionally,” Dr. Palagiri says. “We also understand that a lot of the conditions we address are extremely taxing on the child’s family, and we pride ourselves on comforting parents and openly discussing any of their concerns.” Vesicoureteral reflux is a condition in which urine backs up from the bladder into the kidney. For many children, this is caused by a faulty valve at the junction of the ureter and the bladder. It should operate as a one-way valve. Instead, it operates as a two-way valve and can allow urine in the bladder to flow backwards (reflux) into one or both ureters and kidneys. Reflux is dangerous when there is an infection in the bladder because it makes it much easier for bacteria to travel up the ureters and enter the kidneys where it may infect and scar them. Treatment for persistent reflux include both endoscopic injection for minor reflux and open surgery (reimplant surgery) for severe reflux. -minute endoscope der. Then scope and eteral openreflux. asts and d size of th James’ physicial next day. Kaitlyn Wright, 8, models an anesthesia mask prior to her surgery. Kaitlyn would undergo a Bilateral Extravesical Ureteral Reimplant. With a success rate of 98 percent, this is a common procedure for Dr. Palagiri and his team to perform for a child with severe reflux. Dr. Palagiri isolates the ureter as he performs an ureteral reimplantation to correct severe VUR. 7
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Page 3 and 4: Announcements SSM Cardinal Glennon
Page 5 and 6: 1 Year Later Andre Byrd, Jr., has b
Page 7: Glennon Expands Cochlear Implant Pr
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Page 13 and 14: da Vinci Surgical System This winte
Page 15 and 16: Pediatric Urology Faculty Anand Pal

Fall 2010 - SSM Cardinal Glennon Children's Medical Center

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