The PedSpace

In this episode Dr. Ted Lee discusses his findings and thoughts based on recent studies that demonstrate trends of decreasing voiding cystourethrogram utilization rates and delayed vesicoureteral reflux diagnosis in some children. He explores the possibility that such delays could lead to more children sustaining repeated episodes of febrile urinary tract infection, and potential kidney injury, prior to diagnosis and treatment.Ted Lee, MD, MSc, provides care for children with pediatric urologic conditions while specializing care for those affected by exstrophy-epispadias complex and renal transplantation. Dr. Lee received his undergraduate degree from University of Notre Dame and medical degree from New York University School of Medicine. He completed his urologic residency training at the University of Michigan and pediatric fellowship training at Boston Children’s Hospital. Dr. Lee also completed the Harvard-wide Pediatric Health Services Research (HSR) Fellowship and obtained a Master’s degree in Computational Biology and Quantitative Genetics at the Harvard T.H. Chan School of Public Health. Read the article: https://pubmed.ncbi.nlm.nih.gov/33535798/

In this episode, Dr. Max Maizels discusses the difference between holistic training and historical medical training and explains how to leverage online training, simulation models, and proctored clinical cases for more robust procedural training programs.Dr. Maizels has been on staff at Chicago Children’s Hospital since 1980. Over the years of clinical pediatric urology practice, he has incorporated creation of e-learning platforms to promote effectiveness in the operating room. Since 2010 he has researched to promote best practices for newborn circumcision. He is especially adept at performing such procedures when referred because of Pediatric Urological concerns. Dr. Maizels received his medical degree in 1973 from the University of California, Los Angeles School of Medicine. His postgraduate training included residency at Boston University Medical Center, Urology and Pediatric Urology at Northwestern University and Children’s Memorial Hospital. He currently sees patients at Ann & Robert H. Lurie Children's Hospital of Chicago.NeoCirc.org is an educational resource of circumcision concepts and methods for skill training which applies to pediatric specialists who perform neonatal circumcision.If you would like to enroll in additional simulation training please visit NeoCirc.org and enter your professional e-mail address, click submit, and complete the registration form. Read Dr. Maizels e-book on training here: A Guide to Make Applications for Holistic Surgical Practice: The Computer Enhanced Visual Learning (CEVL) Manual | SpringerLink

In this episode, Dr. Prem Puri discusses how the advent of endoscopic therapy forever changed the treatment landscape for VUR in children.Professor Prem Puri is the Newman Clinical Research Professor at the University College Dublin School of Medicine and Consultant Paediatric Surgeon at the Beacon Hospital.  He is currently the Secretary of the International Board of Pediatric Surgical Research. He is Past President of the World Federation of Associations of Pediatric Surgeons (WOFAPS), and Past President of the European Pediatric Surgeons Association (EUPSA). He was the Editor-in-Chief of Pediatric Surgery International (2001-2021), and on the Editorial Board of several other journals. He was the Director of Research (1989-2009) and President (2009-2016) of the National Children’s Research Centre, Our Lady’s Children’s Hospital in Dublin, the single largest pediatric research institution in Ireland. Professor Puri is known internationally for his research into underlying mechanisms causing birth defects, and innovative treatments, which have benefited millions of children all over the world. His research on vesicoureteral reflux (VUR), the most common urological disorder in children has had a major worldwide impact on patient treatment, through the development of a 15-minute day care endoscopic procedure to replace a major open surgical procedure. As a direct result of his research, this endoscopic treatment has radically altered the management of VUR throughout the world. Professor Puri is one of the most cited pediatric surgical researchers in the world. His research work has been cited over 24,500 times in peer-reviewed articles with h-index of 77 and i10-index of 502. He has published 11 books and monographs, 147 chapters in textbooks and over 750 articles in peer-reviewed journals, including many in high impact factor journals, such as New Eng. J. Med, Lancet, British Medical Journal and Nature Genetics  Between 1985 and 2019, Professor Puri trained 80 research fellows in basic science research at the National Children’s Research Centre in Dublin. All these research fellows were young pediatric surgeons/pediatric urologists from 18 countries, who spent 2-4 years in the laboratory. Many of them are now professors and heads of departments of pediatric surgery in various parts of the world.He has been awarded many Honorary Fellowships, including the American Surgical Association (ASA), American Academy of Paediatrics, American Paediatric Surgical Association, Canadian Association of Pediatric Surgeons, Japanese Society of Pediatric Surgeons, and Argentinean, Austrian, Canadian, Czech, Croatian, Cuban, Indian, and South African pediatric surgical associations.Professor Puri is a multi-award-winning researcher whose previous awards include People of the Year Award (Ireland), the prestigious Denis Browne Gold Medal by the British Association of Pediatric Surgeons, Rehbein Medal by the European Paediatric Surgeons Association, and Colles Medal by the Royal College of Surgeons in Ireland, for outstanding contribution to pediatric surgery. He has been a visiting professor to many leading universities all over the world and invited speaker at over 250 international scientific meetings. 

In this episode, Dr. Daniel Wood discusses the new emerging specialty of Adolescent Urology and common urological conditions affecting adolescent males and females.Dr. Daniel Wood is a Professor of Urology based at Children’s Hospital Colorado. He has previously worked at University College London Hospitals and was an honorary consultant at Great Ormond Street Hospital. His major interest and work is in adolescent and reconstructive urology – with an expertise in adult complex reconstruction, surgical aspects of bladder exstrophy, cloacal exstrophy, posterior urethral valves, disorders of sex development and neuropathic bladder.He qualified from St. Bartholomew’s Medical College (London, UK) in 1994, completed a PhD, at UCL and completed his higher training at the Institute of Urology where he was first appointed as a consultant in 2008. He maintains an active research interest and is widely published, he is a senior editor of the Journal of Pediatric Urology and has been an invited speaker as visiting professor across the US and Europe and at many international meetings.

In this episode, Dr. Timothy Bukowski and Valre Welch discuss the fulfilling work of volunteering with the World Pediatric Project to provide care to children in Belize.Dr. Timothy Bukowski received his undergraduate degree in economics at Georgetown University and his medical degree from SUNY at Buffalo School of Medicine. He completed a urologic residency at Wayne State University, then completed a research fellowship in Pediatric Urology at the University of Cincinnati College of Medicine and a clinical fellowship in Pediatric Urology at the Children’s Hospital of Michigan. He currently serves as the Director of Pediatric Urology at WakeMed Children's Hospital in Raleigh, North Carolina. He is Board-certified in Pediatric Urology and has a special interest in complex reconstruction of the genito-urinary system, the correction of hypospadias and management of the bladder exstrophy patient.Dr. Bukowski is a member of the American College of Surgeons, the Pediatric section of the American Academy of Pediatrics, the American Urological Association, and the Society of Pediatric Urology. He also serves as a Board member for the North Carolina Pediatric Society Foundation.Valre Welch received her BSN from the University of Pittsburgh and her MSN from Loyal University of Chicago. She is a certified pediatric nurse practitioner in the division of Pediatric Urology & Department of Surgery at Children’s Hospital of Richmond at VCU Health System. Welch also serves as research coordinator for various research projects within the division of pediatric urology. She is a member of Society of Urological Nurses Associates, Pediatric Urology Nurse Specialists and the Virginia Council of Nurse Practitioners. 

In this episode, Natalie Barganski, Pediatric Nurse Practitioner in Pediatric Urology, discusses how healthcare providers can use telehealth and personal digital medical files to instill confidence in adolescent patients as they make the transition to adult healthcare. Natalie Barganski is a pediatric nurse practitioner in pediatric urology at Children’s Physicians Services of South Texas, Driscoll Children’s Hospital, in Corpus Christi, Texas. Prior to this, she served as Pediatric Nurse Practitioner in Level II NICU at Driscoll Children’s, as well as Pediatric Nurse Practitioner in Pediatric Surgery at Driscoll Valley Physician’s Group. She also has experience as a Neonate ICU Nurse. Natalie received her B.S. in Nursing from Texas A&M University, and her M.S. in Nursing from the University of Texas Health Science Center. She also received her Doctor of Nursing Practice from Texas Tech University Health Science Center.

In this episode, Dr. Bradley Morganstern discusses some of the surprises and lessons he has learned in transitioning from fellowship to practice.   Dr. Bradley A. Morganstern is the new Chief of Pediatric Urology at Augusta University. He brings a patient centered approach to the management of pediatric urologic conditions with an emphasis on providing compassionate care focused on his patients and their families. He is skilled at both open and minimally invasive surgery for all pediatric urologic conditions. He looks forward to using his training to extend the use of the robot at our institution for major reconstructive surgeries as well as for minimally invasive procedures including pyeloplasties, ureteral re-implantations, urachal repair and others. His research interests include Health Related Quality of Life issues and novel investigations in obtaining functional data from sonographic images in pediatric urology conditions. He is available for consultations and treatment of all general and complex pediatric urologic disorders.  Dr. Morganstern completed his training in general urology and a fellowship in pediatric urology at the Smith Institute for Urology in Long Island, NY, a division of Hofstra University School of Medicine under the direction of Drs. Louis R. Kavoussi and Lane S. Palmer. He attended Albert Einstein School of Medicine in New York and did an additional year of research at Sloan Kettering Cancer Center and Montefiore Hospital as well as earned a certificate in Public Health. He received an undergraduate Summa Cum Laude degree in communications from Boston University and completed premedical courses at Harvard University.

In this episode, Dr. Katie Canalichio and Dr. Irina Stanasel discuss the benefits of simulator training in pediatric urology, their experience with the Deflux simulator model, and their role in its development.  Dr. Katie Canalichio completed her medical training and residency at the University of Texas Health Science Center at Houston. She completed a pediatric urology fellowship at Seattle Children’s Hospital, in which her final year she served as Acting Instructor in the Department of Urology at the University of Washington. Additionally, she is a graduate of Baylor University where she received her bachelor’s degree in biochemistry. Dr. Canalichio’s clinical interests include genitourinary reconstruction including hypospadias repair, spina bifida, and other complex urological conditions affecting children. She also performs minimally invasive and robotic surgery and treats pediatric stone disease.   Dr. Irina Stanasel is a pediatric urologist at Children’s Health℠ and an assistant professor in the Department of Urology at UT Southwestern Medical School. She provides care for children of all ages who have a variety of urologic disorders. Dr. Stanasel received her medical degree from Baylor College of Medicine in Houston, Texas and completed her residency in urology at Wake Forest University Baptist Medical Center. She completed a pediatric urology fellowship at Texas Children’s Hospital in Houston. Her specialties include fetal urology, bladder bowel dysfunction, complex hypospadias repair, prune belly syndrome and quality improvement in pediatric urology.

In this episode of The PedSpace, Dr. Dominic Frimberger discusses tips for delivering difficult diagnoses to caregivers. Dr. Frimberger is board-certified by the American Board of Urology. He is a Professor in the Department of Urology at the University of Oklahoma Health Sciences Center and the Chief of Pediatric Urology at the Children’s Hospital of Oklahoma.Dr. Frimberger received his medical degree from the University of Wurzburg in Germany and completed his urology residency in a combined program through the Department of Urology of the Ludwig- Maximilians University in Munich, Germany and the Brady Urological Institute at the Johns Hopkins Hospital in Baltimore. He went on to complete a fellowship in Pediatric Urology at the Johns Hopkins Hospital and afterwards came to Oklahoma where he has been practicing for the last 15 years. Dr. Frimberger serves on the Board of the American Academy of Pediatric Urology and is a member of several national and international Societies for Pediatric Urology. He has a general pediatric urology practice and specializes in neonates and children with severe congenital urologic birth defects such as hypospadias, bladder reflux (VUR), hydronephrosis, spina bifida, DSD, bladder exstrophy and cloacal anomalies. He established the first program for robotic surgery in Pediatric Urology here in Oklahoma and is a skilled reconstructive and minimal invasive surgeon. 

In this episode, Dr. Goran Läckgren discusses the early days of research and discovery with endoscopic treatment and what he has learned over three decades of study. Dr. Goran Läckgren is a Professor of Pediatric Urology at the University of Uppsala, Sweden. He has worked in the department of Pediatric Surgery at University Children’s Hospital of Uppsala as head for the section of Pediatric Urology from 1986 to 2009 and is currently a Consultant Pediatric Urologist.He has published numerous peer-reviewed papers and book chapters in Pediatric Urology: Morphological and Endocrinological research on the human undescended testis (Thesis); In Pediatric Oncology: Neuroblastoma (biochemical markers); Wilms’ Tumour (angiogenesis); Enuresis and Bladder dysfunction; Vesicoureteral reflux (particularly endoscopic treatment); as well as experimental and clinical studies on Deflux, particularly continuing F-U studies of children with VUR.  Dr. Läckgren has been a visiting professor and lecturer in more than 40 countries all over the world in the last 30 years and is a member of several national and international medical societies. He is an elected member of the Society for Pediatric Urology Surgeons (SPUS) since 1997, an international member of the American Association of Genito Urinary Surgeons (AAGUS) since 2005, the founding member of the Swedish Enuresis Academy (SEA) since 1993, and a member of the board of The European Society for Pediatric Urology (ESPU). He was also Treasurer from 2008 to 2010 and President from 2012 to 2014. He was elected Honorary Member of the ESPU in 2015. 

In this episode, Dr. Leslie Hsieh discusses benefits of the unique pediatrician and pediatric urologist working relationship within their clinic. This business model has increased collaboration between physicians and created an optimal environment for patient care. Dr. Leslie Hsieh is a board-certified pediatrician and works in the 2-B-Dry Program, where she treats children with bladder and bowel dysfunction.Patients are seen for various conditions, including daytime wetting, nocturnal enuresis, urinary frequency, urinary urgency, giggle or stress incontinence, dysuria, post-void dribbling, recurring urinary tract infections and encopresis. Dr. Hsieh employs a variety of treatment modalities, including tibial nerve stimulation, urodynamics, EMG uroflowmetry, biofeedback, counseling and medications when needed.Prior to working at Rady Children's, Dr. Hsieh practiced as a general pediatrician for eight years in San Diego and Washington, D.C. She earned her medical degree from the University of Vermont College of Medicine and completed her pediatric residency and internship at Georgetown University in Washington, D.C.

Quality is the framework used to systematically improve patient care. Quality improvement seeks to standardize processes and structure to reduce variation in care, achieve predictable results, and improve outcomes for patients, healthcare systems and organizations.In this episode, Beverly Kirchner and J.D. Buchert discuss the foundations of quality metrics in healthcare, in both inpatient and outpatient settings. Beverly Kirchner is the Founder, Chief Compliance Officer, and Chief Operating Officer at SurgeryDirect, a healthcare company focused on the advancement of ambulatory surgical care. She is also the Owner and Chairman of the Board of Directors at Genesee Associates, an Ambulatory Surgical Center and surgical hospital development and consulting company. She holds a BSN, RN, CNOR and CASC.J.D. Buchert is a Quality Specialist and Nurse Researcher for the Surgical and Trauma division at Parkland Health and Hospital System in Dallas, Texas. He holds a B.S. in Registered Nursing from West Coast University, a master’s degree in Family Practice Nursing from South University and a MSN in Quality, Safety & Compliance from Southern New Hampshire University.

In this episode, Dr. Aaron Bayne discusses the results of a study he conducted entitled “Parental Perception of Bladder Spasms and Hematuria After Surgery for VUR: A Prospective Multicenter Study.” He explains how the data from the study now informs his patient counseling.To read the abstract, click here: https://pubmed.ncbi.nlm.nih.gov/32423705/Dr. Bayne has a special interest and training in pediatric minimally invasive surgery and has advanced training in minimally invasive reconstruction of the urinary tract. He is also part of the pediatric robotic surgery unit at OHSU. He has research interests in minimally invasive surgery, health disparities in treatment of urologic disease, fetal urinary tract anomalies and in advancing non-invasive methods for evaluation of childhood urologic conditions. He has expertise in all areas of pediatric urology and has published a number of book chapters and articles on various topics in pediatric urology.In his spare time, Dr. Bayne enjoys spending time with his wife and two children. He also enjoys running, swimming, hiking, skiing, rock climbing, singing and reading.

In this episode, Dr. Elizabeth Race discusses the prevalence of drug resistant bacteria in our community especially as it relates to complicated UTI in children with VUR. Elizabeth Race, MD, MPH is an Infectious Disease specialist in Dallas, Texas. She completed fellowships in Infectious Diseases & HIV Medicine at the Harvard Infectious Diseases Training Program. She received a Masters Degree from the Harvard School of Public Health. Dr. Race spent the next 12 years in academic medicine at the University of Texas Southwestern Medical Center at Dallas, where she attained the rank of Associate Professor. Dr. Race left academic medicine & currently practices Infectious Diseases in a community hospital setting in Dallas. Dr. Race’s interests include antimicrobial resistance, Community-Acquired MRSA, parasitology & opportunistic infections of immunocompromised persons. She is board-certified in Internal Medicine and Infectious Diseases.

In this episode, Dr. Shahira Khoury and Dr. Tony Khoury discuss the most common musculoskeletal injuries for pediatric urologists and provide ergonomic techniques and exercises for maintaining good posture.Dr. Shahira Khoury specializes in Physical Medicine and Rehabilitation (PMR). After many years in a busy multidisciplinary practice in Toronto, Canada, she moved to California. Ever Since joining the University of California Irvine in 2009, she has managed non-surgical Orthopedic patients in the Orthopedic Clinic in Orange, the Pain Clinic in Irvine, and UCI Tustin Ortho/PMR Clinic. Dr. Khoury manages all Musculoskeletal conditions as well as spine disorders including cervical and lumbar radiculopathy, spinal stenosis, degenerative disc disease, facet arthritis, and myofascial pain. Her goal is to enhance patients' performance, by tailoring their treatment plan to optimize their non-surgical management including soft tissue, trigger points and joint injections, structured exercises, coordinating their care with various allied health care professionals and overseeing their progress. Dr. Tony Khoury specializes in the medical and surgical management of complex pediatric urology anomalies, including reconstructive surgery for incontinence, genital anomalies, renal transplantation, and oncology. Dr. Khoury is the Chief of Pediatric Urology at both Children's Hospital Orange County and UC Irvine Medical Center.

In this episode, Dr.  Adam Rensing discusses the prevalence of urinary tract infections, how to diagnose them and when a patient should be referred to a pediatric urologist.Dr. Adam Rensing is a Board-Certified Urologist and is an Assistant Professor of Pediatric Urology at the University of Oklahoma. He completed his medical degree and urologic surgical training at Washington University in St. Louis. Additionally, he completed a fellowship in pediatric urology at Riley Hospital for Children at Indiana University. Dr. Rensing cares for children with all urologic conditions. He has a special interest in minimally invasive, robot-assisted surgery and reconstruction for the neuropathic bladder. He sees patients both at the OU Children’s Hospital Medical Center and at the OU Physicians Edmond clinic. Dr. Rensing is a member of the American Urological Association and the Society for Pediatric Urology.

In this episode of The PedSpace, Dr. Abd-El-Rahman Abd-El-Barr, more commonly known as “Dr. A.R.”, shares his experience starting a new pediatric urology practice. He discusses how he chose the specialty of pediatric urology, his experience practicing at a community hospital, challenges faced coming out of fellowship, and his advice for young physicians coming out of training.Dr. Abd-El-Rahman Abd-El-Barr is a pediatric urologist at Golisano Children's Hospital of Southwest Florida. He earned his medical degree from Saint Louis University School of Medicine, St. Louis and completed a General Surgery internship and Urologic Surgery Residency at Vattikuti Urology Institute, Henry Ford Hospital. Dr. A.R. completed his Pediatric Urology Fellowship at Miami Children’s Health System, Jackson Memorial Hospital. Dr. A.R.'s clinical interests include minimally invasive and robotic surgery, treatment of conditions related to spina bifida, abnormalities of the genitourinary system, treatment of urinary stone disease, circumcision and phimosis.

In this episode of The PedSpace, Dr. Dominic Frimberger shares his recommendations for establishing a good rapport with your referral community.Dr. Frimberger is board-certified by the American Board of Urology. He is a Professor in the Department of Urology at the University of Oklahoma Health Sciences Center and the Chief of Pediatric Urology at the Children’s Hospital of Oklahoma.Dr. Frimberger received his medical degree from the University of Wurzburg in Germany and completed his urology residency in a combined program through the Department of Urology of the Ludwig- Maximilians University in Munich, Germany and the Brady Urological Institute at the Johns Hopkins Hospital in Baltimore. He went on to complete a fellowship in Pediatric Urology at the Johns Hopkins Hospital and afterwards came to Oklahoma where he has been practicing for the last 15 years. Dr. Frimberger serves on the Board of the American Academy of Pediatric Urology and is a member of several national and international Societies for Pediatric Urology. He has a general pediatric urology practice and specializes in neonates and children with severe congenital urologic birth defects such as hypospadias, bladder reflux (VUR), hydronephrosis, spina bifida, DSD, bladder exstrophy and cloacal anomalies. He established the first program for robotic surgery in Pediatric Urology here in Oklahoma and is a skilled reconstructive and minimal invasive surgeon. 

In this episode of The PedSpace, Dr. Angela Arlen discusses the history of the VUR Index, the four studies that validated it, and how to clinically use the index.Dr. Arlen is a board-certified pediatric urologist at Yale Medicine and Assistant Professor of Urology at Yale School of Medicine. She earned her medical degree from The University of Iowa Carver College of Medicine and completed her pediatric urology internship and residency at University of Iowa Hospitals & Clinics. Dr. Arlen completed her pediatric urology fellowship at Emory University/Children’s Healthcare of Atlanta in 2014.   Stay tuned for the upcoming VUR Index Webinar featuring Dr. Arlen.

In this episode of The PedSpace, Dr. Steve Hodges discusses how to properly diagnose and treat children who turn their rectum from a sensing and emptying organ to a storage organ and its effect on the pelvic floor and bladder function.Dr. Hodges is a board-certified pediatric urologist and professor of pediatric urology at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Dr. Hodges earned his Bachelor of Arts degree from Duke University and his medical degree from Wake Forest School of Medicine. He completed his pediatric internship and residency at North Carolina Baptist Hospital. Dr. Hodges completed his fellowship at Children’s Hospital of San Francisco.   Dr. Hodges’ website and Facebook page called Bedwetting and Accidents serve as resources for parents, medical professionals and therapists. He has authored a peer-reviewed paper on his methods for treating constipation in the treatment of children with lower urinary tract symptoms.   Visit Dr. Hodges’ website