Urology

Ongoing research studies in a wide range of conditions offer patients the opportunity to participate in leading-edge therapies while contributing to future knowledge and helping the next generation of children with urological problems. Currently active trials include studies of optimal surgical treatments for undescended testicles, novel imaging and diagnostic testing for urinary tract obstruction diagnosed prenatally, new non-invasive biomarkers to predict outcomes in children with kidney problems, state-of-the-art MRI for measurement of kidney function in babies and children, and many others. We encourage our patients and families to ask questions about ongoing research projects.

The occurrence of kidney stones in children is on the rise. To manage the increase, the Boston Children’s Kidney Stone Program developed a forward-thinking approach to stone management, highlighted in a range of papers:

• Mutations in SLC26A1 cause nephrolithiasis
• Imaging and surgical utilization for pediatric cystinuria patients: a single-institution cohort study
• Nationwide emergency department imaging practices for pediatric urolithiasis patients: room for improvement
• Pharmacological dilutional therapy using the vasopressin antagonist tolvaptan for young patients with cystinuria: a pilot investigation
• The effect of surgeon versus technologist control of fluoroscopy on radiation exposure during pediatric ureteroscopy: a randomized trial

Michael P. Kurtz, MD, MPH, and the team at the Boston Children’s Fetal Care and Surgery Center are pursuing revolutionary strategies for management of fetuses with urinary tract obstruction diagnosed prenatally. Using novel MRI techniques, Dr. Kurtz and his team are developing ways to determine the severity of the kidney obstruction without risky invasive tests. Since MRI is a safe way to image pregnant mothers and their fetuses, this technique will dramatically change the way we assess these infants and allow us to much more accurately predict outcomes. Dr. Kurtz has also developed an ingenious drainage device that can dramatically improve the outcomes in babies with the most severe obstruction problems; preliminary testing of this device is continuing and has been very promising.

MIBEC was created to enhance collaboration, as well as improve care and outcomes for bladder exstrophy patients. The collaboration proved to significantly increase surgeon exposure to complete primary repair of exstrophy (CPRE) and the refinement of the technique, surgeon learning, and expertise. Read the outcomes in the Journal of Pediatric Urology: Short-term outcomes of the multi-institutional bladder exstrophy consortium: Success and complications in the first two years of collaboration.

Boston Children's Hospital's Richard Lee, MD, director of Pediatric Urologic Oncology at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, pioneered the adaption of adult minimally invasive surgical techniques to the pediatric world for the surgical management of kidney and testicular tumors. His efforts improved surgical outcomes while minimizing recovery. Read the paper.

Robotic assisted laparoscopic partial nephrectomy can be safely and effectively performed in pediatric patients for renal tumors while preserving renal function. Two pediatric cases from Dana-Farber/Boston Children’s Cancer and Blood Disorders Center demonstrate the effectiveness of renal preservation using robotic assisted laparoscopic surgery applied for renal masses. Download the case studies.