"It's often difficult to find an adult urologist who is comfortable
managing problems which originated in childhood, because a lot of pediatric urological problems are different from adult urological problems," says Dr. Ross. "So having Dr. Cherullo part of our team makes our Pediatric Urology Center unique." Having Dr. Woo on board offers advantages, as well. As a
female, she is the urologist that many pre-teen and adolescent girls prefer to talk to — especially when the topic is a sensi- tive issue like urinary tract infections, overactive bladder or sexual development. "Sometimes kids feel more comfortable talking about sensitive
issues with someone of the same gender," says Dr. Woo, who joined UH in 2010 after completing fellowship training in Pediatric Urology at Vanderbilt. Her special interests include congenital and acquired disorders of the genitals and urinary tract, and tumors of the kidney, bladder and testicles. Minimally invasive procedures, including robot-assisted surgery, are also her forte.
Minimally Invasive Treatments Robot-assisted surgery is utilized at UH for a number of
pediatric urologic problems, most often ureteropelvic junction obstructions — the most common urinary tract blockages in children. Dr. Woo has expertise with robotic assistance to repair congenital obstruction at the level of the kidney, which causes hydronephrosis in children. "We believe that adolescents particularly benefit from the
more minimally invasive robotic approach, because it's associ- ated with lower morbidity, shorter hospital stays and decreased pain medicine requirement," she says. Vesicoureteral reflux is another condition which Dr. Woo
treats minimally invasively at UH. The outpatient procedure is done endoscopically with an injectible agent. In comparison, the traditional surgery involves an open incision and reimplantation, requiring a one- to two-day hospital stay. "As with many other things, there's been a trend toward
minimally invasive approaches, and our physicians have a lot of experience with that. In fact, we were among the first to perform pediatric laparoscopic surgery to remove a kidney through a single small incision," adds Dr. Ross. "We perform partial nephrectomy for Wilm's and other tumors in appropriate patients where you can remove the tumor without removing the entire kidney. And we have extensive experience doing the same thing for testicular tumors in children." In another minimally invasive approach called ureteroscopy,
a two-stage procedure requiring two visits to the OR to remove urinary tract stones and blockages in children is reduced to one and one. Single-stage ureteroscopy has been commonly used for adults. "Because a child's ureter is small, most surgeons will first put a
stent in to dilate the ureter and then, in a second procedure one week later, take out the stent and remove the stone," Dr. Ross explains. "We've found we can treat most of our patients in one session. We presented a paper on this at the North Central Section of the American Urological Association last fall."
Pediatric urology consultative and surgical services are offered at six University Hospitals locations throughout Northeast Ohio. Dr. Ross is shown here with a patient at UH Westlake Health Center.
JULY-AUGUST 2012 ■ MDNEWS.COM ■ MD NEWS Cleveland-Akron-Canton | 29
Rainbow Connections Through the joint efforts of the UH Urology Institute and
UH Rainbow Babies & Children's Hospital, other cutting edge treatments developed for adults have been redesigned for children. For example, for children with complicated voiding problems that don't respond to standard therapies, botox can now be injected or neurostimulating devices can be implanted. Comprehensive biofeedback programs can also help improve pediatric voiding problems without medication or surgery, while a newly developed urodynamics program can help determine how a child's bladder is functioning without having to place a catheter or do anything else that's invasive. With its UH Rainbow connection, Dr. Ross and his team
members can collaborate with pediatric specialists from many other disciplines as well, including pediatric radiology to help assess the anatomy of the urinary tract in children with void- ing disorders and pediatric psychology to assist children and their families with the behavioral aspects of these problems. Pediatric subspecialists in oncology, nephrology, anesthesiology, general surgery, neonatology and intensive care also lend a hand as needed. "With all of our resources at UH Rainbow and at the UH
Urology Institute, we really are able to build a nationally ranked Pediatric Urology Center," says Dr. Ross, pointing to recent evidence. "We've once again been ranked for pediatric urology care in U.S. News & World Report's America's Best Children's Hospitals, 2012 issue."
Pediatric urology consultative and surgical services are offered at
several University Hospitals locations throughout Northeast Ohio, including UH Case Medical Center, UH Ahuja Medical Center, UH Westlake Health Center, UH Medina Health Center, UH Mentor Health Center and UH Twinsburg Health Center. For more informa- tion, call 216-844-8440 or visit www.UHHospitals.org/uro. ■
PHOTOS COURTESY OF UNIVERSITY HOSPITALS/KEITH BERR PRODUCTIONS
