Fall 2010 - SSM Cardinal Glennon Children's Medical Center

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.
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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.
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