Urology

The Section of Urology at Nationwide Children’s provides a full array of diagnostic and therapeutic services for an extensive range of urological disorders in children of all ages. From pioneering minimally invasive procedures to conducting bench research within The Research Institute, we are committed to the best outcomes for children everywhere.

Our surgeons are experts in minimally invasive surgery. By performing a high volume of robot-assisted procedures, we have the experience and expertise to provide outstanding care and to train the next generation of urologists. Our fellows have the unique opportunity to receive advanced training in robotic renal procedures as well as pure laparoscopic, endoscopic and open reconstructive procedures.

Many urological procedures, such as pyeloplasty, ureteral reimplantation and bladder reconstruction, are well-suited to robot-assisted surgery. We are proud to have a program invested in advancing minimally invasive care.
V. Rama Jayanthi, MD
Chief of Urology

Collaboration is essential to the continuum of care at Nationwide Children's. The Section of Urology is integral in numerous multidisciplinary programs including the Center for Colorectal and Pelvic Reconstruction and Sacral Nerve Stimulation, among others, such as the differences in sexual development program (THRIVE) and the adult transition program for spina bifida.

“We believe in caring for the whole patient, in advancing research to offer new treatments, and in educating the next generation of pediatric urologists,” says Dr. Jayanthi. “Everything that we do is in support of this mission.”

8,925 Clinic visits in 2015
2,067 Surgical cases in 2015
1 Fellowship/residency programs
5 Number of surgical faculty
Treating Ci Ci and Savvy

Just after giving birth to her first child, Mandy was baffled by her doctor’s comment: “We’re not sure if you have a girl or a boy.”

“What do you mean you can’t tell me?” she said. “It’s either a girl or a boy. How can you not know?”

So the doctor showed Mandy and her husband, Russ. The baby had genitalia resembling neither a typical girl’s nor a typical boy’s. The infant would be diagnosed with congenital adrenal hyperplasia (CAH), a condition in which the adrenal gland lacks a necessary enzyme to make certain hormones; meanwhile, the body produces too much androgen, including testosterone. CAH, the most common cause of ambiguous genitalia, occurs in 1 in every 10,000 births. People with CAH require medication to regulate their hormones throughout their life.

A month after delivery, Mandy finally named her child, Ci Ci. A series of tests had shown that she was female, including a blood test showing she had the typical female XX chromosome pair.

Though Mandy and Russ were relieved to know their child’s sex, Ci Ci still had to undergo surgery at six months old to reconstruct her genitalia.

“I still couldn’t believe that anything like that was possible,” Mandy said.

When Ci Ci was about 9 months old, Mandy discovered she was pregnant again. Savvy was also born with CAH. Though her genitalia appeared much closer to that of a typical female, her vagina was closed. At about seven months old, Savvy underwent reconstructive surgery.

Now, the girls are happy and healthy, enjoying school and other activities. “As frightening as both surgeries were for me, I’m glad to have them done,” says Mandy. “I want to be able to talk about the conditions and surgeries with my girls as they age, knowing that we’ve taken care of them.”

Specialized Care for the Whole Child

“Children like Ci Ci and Savvy need specialized care, and their families need unique support to make decisions about their care,” says Dr. Jayanthi. “We have been providing this care for years, and now, through the THRIVE Program, we are able to do it in a more expansive and structured way.”

The THRIVE Program specializes in the care for differences and disorders of sexual development (DSD), such as CAH, as well as complex urological problems and gender concerns. Because we see one of the largest populations of patients with DSD among children’s hospitals in the United States, we have the experience and expertise to drive the conversation surrounding the unique health care needs of these patients.

“In recent years, we have learned a lot about the impacts of DSD and other urological problems on children as they age,” says Dr. Jayanthi. “We work very closely with a multidisciplinary team of experts to educate parents, physicians, children and teens about their bodies and their options.”

Through the THRIVE Conference, first held in 2015 with more than 100 attendees, the team shares expertise and experience regarding the biopsychosocial approach to sex development and gender to advance care for every child.

“Many surgeons and programs can do reconstructive surgery. But recognizing that psychosocial issues are just as significant as their physical needs, we have built a program for the whole child and their family,” says Dr. Jayanthi.

Looking for a Better Solution to Urinary Tract Infections

Urinary tract infections are common in children and have been linked to many long-term effects, including impacts on kidney growth and development.

Christina Ching, MD, urologist and principal investigator in the Center for Clinical and Translational Research, and Sheryl Justice, PhD, principal investigator in the Center for Microbial Pathogenesis in The Research Institute at Nationwide Children’s, are partnering to solve the puzzle of significant and recurrent urinary tract infections (UTIs).

“One of our projects is to bring the clinical and research sides of the UTI equation together at the International Conference on UTI,” says Dr. Justice. “Our goal is to facilitate the mentality that we are in this together. At the conference, we focus on learning what is important for both sides, understanding priorities and seeing the common goal.”

In addition to organizing international conferences, Drs. Ching and Justice are working to evaluate how the body’s microbiome changes as children age and how the microbiome changes in response to UTIs and subsequent antibiotic treatment.

If we can understand what a ‘normal’ or healthy microbiome is, then we can look at interventions to restore it when an infection occurs. If we can restore the microbiome with probiotics, we may be able to treat UTIs without antibiotics.
Sheryl Justice, PhD
Principal Investigator in the Center for Microbial Pathogenesis

In addition to studies of the microbiome development and balance, Dr. Ching is also working with others in the Center for Clinical and Translational Research to understand antimicrobial peptides and their role in reestablishing the urothelium after a UTI. Potentially, manipulating this system could be another alternative to treating UTIs with antibiotics.

“Antibiotics are important tools for the treatment of UTIs, but they are not a panacea,” says Dr. Ching. “Our research focuses on that idea, in search of the best outcomes for these children.”

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