The urology specialists at St. Louis Children's Hospital perform some of the most technologically advanced procedures when treating children, and is one of only a few pediatric facilities in the country—and the only one in the St. Louis region—to offer robotic surgery for children needing urologic procedures. In most of these cases, the children experience less pain, heal faster and benefit from stronger restoration than with the standard open surgical techniques.
Dr. Vricella joins the show to discuss advancements in pediatric urologic surgery, and when a pediatrician should refer a patient to a specialist.
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Advancements in Pediatric Urologic Surgery
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Learn more about Gino Vricella, MD
Gino Vricella, MD
Gino Vricella, MD is a Washington University pediatric urologic surgeon at St. Louis Children's Hospital.Learn more about Gino Vricella, MD
Transcription:
Advancements in Pediatric Urologic Surgery
Melanie Cole (Host): Today we’re talking about advancements in pediatric urologic surgery. My guest is Dr. Gino Vricella. He’s a Washington University Pediatric Urologic Surgeon at St. Louis Children’s Hospital. Dr. Vricella, it’s a pleasure to have you join us today. Please give us a little basic overview of pediatric urologic services at St. Louis Children’s Hospital. What are you doing there?
Gino Vricella, MD (Guest): We carry out some of the most technologically advanced procedures when we treat our kids that have pediatric urology issues. Some of the conditions that we treat are going to be related to the kidneys, the ureter tubes that drain the kidneys, the bladder and then the genital organs. So, we treat conditions related to the testicles and urethra, penis in males and the ovaries and then the urethra and other genital organs in females. So, it really kind of really runs the gamut.
Some specific conditions that we often see are going to be related to the genitourinary system, so we see a lot of children with urinary tract infections and different anomalies of the kidneys and the bladder and testicles and the ureter tubes like we talked about before. So, some pretty common things that we see are going to be undescended testicles, where the testicles in males fail to descend properly and are not located in the scrotum where they are supposed to be. We see kids with something called hypospadias where the urethra tube doesn’t end up on the tip of the penis where it should, it is usually sort of makes it halfway, kind of on the underneath part of the penis. And then sort of prenatally, a lot of times we are going to be consulted for children where the ureter tubes can be blocked so something called prenatal hydronephrosis something that is very common that we see.
And then really, just any sort of genital anomaly, ambiguous genitalia is one of the common things that we often see kids for in the office as well.
Host: Wow. That’s quite a comprehensive program Dr. Vricella so tell us about some exciting new advances in your field. What’s exciting that’s going on in pediatric urologic surgery whether it’s robotic technology or just tell us what’s exciting going on.
Dr. Vricella: In terms of robotic surgery, it’s important to know that St. Louis Children’s is one of really only a few pediatric facilities in the country and really the only children’s hospital in the great state of Missouri that offers robotic surgery for children that need certain urologic procedures. We started this program when I finished my fellowship here. I sort of spearheaded this program at St. Louis Children’s in 2014. And it’s been growing every single year and it’s surgery that can benefit a lot of people, not only the patient but the surgeon and parents alike.
So, when we are looking at robotic surgery. Essentially robotic surgery is a specialized type of laparoscopic surgery so I think most people have heard about laparoscopic surgery and sort of the benefits of laparoscopy are going to be smaller incisions which hopefully would lead to being able to perform the same surgery that we would normally perform using a larger oftentimes more painful open incision and do the same surgical procedure on the inside of the body. But by performing it laparoscopically, you are hoping to reduce pain and discomfort that is typical for really any type of surgical procedure. And by reducing pain and discomfort, we find that oftentimes kids have faster recovery time, getting back to their normal activities. For the larger procedures, there’s going to be a shorter hospitalization usually. And then minimal scaring associated because the incisions are smaller. There’s going to be a reduced risk for losing blood and need blood transfusions for surgical procedures that are sort of associated with a higher degree of blood loss during surgery.
And one of the things that’s really come up in recent years and this has been true for the adult side for longer but we’re seeing it more and more now in children is surgical site infections. So, you can imagine, if you are trying to do a surgical procedure and you’re going to have to make a four or five, six, seven inch incision as opposed to three or four half inch incisions, that’s going to have a higher risk for infection and I think we’ve seen the risks for infection go down at an exponential rate and I think laparoscopy has been part of the reason for that decrease.
Now laparoscopy in and of itself is great, however, what we found that laparoscopy is good for like removing stuff, right like taking out stuff but in pediatric urology, we’re not – although we will remove things, our main goal is to reconstruct. So, either reconstruct the genitourinary tract or bring back the child from a state of having an anatomic defect to one in which is more normal and can function appropriately. And so, part of that reconstruction involves fine suturing and if you can imagine typical laparoscopy you are sort of operating on the end of two chopsticks. And it doesn’t really allow you that manual dexterity and that’s really where robotic surgery I think shines.
So, those surgical complex reconstructive procedures that would have taken much longer years ago, even during my fellowship where we still did a majority of our laparoscopic procedures without robotic assistance, I think now with the robotic technology we can more closely recreate the open experience where you have the manual dexterity and wristed movements to allow you to perform those reconstructive procedures and do them in a timely fashion.
So, that’s really what I’ve seen over the past five years and I think the program will continue to grow and I’m very proud that St. Louis Children’s Hospital is the only hospital in Missouri that’s currently offering this technology.
Host: Well it is amazing technology and certainly the benefits to both the child, the patient and to the surgeon are so important. Tell us about your team Dr. Vricella. Who is doing these there? Tell us about your team.
Dr. Vricella: As it stands right now, I’m actually the only surgeon at St. Louis Children’s Hospital who is currently offering these robotic procedures. That just kind of goes to the fact that there are just not a lot of places with providers that are trained in robotic technology and our offering this. So, in terms of surgeons I would be the lone person here. As time goes on, robotic surgery is now becoming a large part of certainly pediatric urology and other urologic fellowships across the country will have sort of more providers that have the skill set and that can offer it. And I won’t be unique in that regard for much longer. I’m excited about the potential for new graduates not only in pediatric urology but even general pediatric surgery sort of adopting some of these techniques in their more reconstructive types of procedures.
Host: As we wrap up, Dr. Vricella, when should pediatricians refer to the specialists at St. Louis Children’s Hospital? What would you like them to know? Give us a nice summary and when you think it’s important, they refer.
Dr. Vricella: I think prenatally, the most common thing that pediatricians should think about referral for is going to be hydronephrosis or basically a dilation of the urinary tract, dilation of the ureter tubes which would suggest that either there is some type of obstruction or reflux going on in the kidney. Sometimes it’s just a transient phenomenon and so once the child is born, once the ultrasound is repeated, sometimes that hydronephrosis, especially if it’s mild can go away. But I think if that persists, postnatally; then that is a perfect time to refer to a pediatric urologist.
One of the other key things we’re oftentimes going to see; genital anomalies or ambiguity so undescended testicles or abnormalities of the penis so either foreskin issues, hypospadias something very, very common that we should be seeing kids for. And then at around the time of toilet training, we tend to start seeing more urinary tract infections especially urinary tract infections that are associated with fever. Those should be seen by a urologist because the fever would suggest that not only is the urinary tract infection going to be localized to the bladder but it’s also going to be involving the kidney and while the kidney is still developing, growing, an infection of the kidney can do kidney damage and so we’d want to intervene as soon as possible.
And then along with the hydronephrosis and urinary tract infections, you’re going to have diagnoses like UPJ obstruction and vesicoureteral reflux, any type of urinary incontinence issues and then one of the sort of more specialty clinics, multidisciplinary clinics that we have at Children’s that we see probably the highest number of patients seen certainly in Missouri but one of the highest volume places in the Midwest is going to be for spina bifida which is an anomaly of the spinal cord and the reason why a urologist is involved is that oftentimes the neural abnormalities are going to be very related to the function of the urinary tract and the gastrointestinal tract and both urinary and fecal continence issues are going to arise and so we are very well versed in taking care of those spina bifida kids. And as I mentioned before, we have a multidisciplinary clinic where we see these patients with other providers from neurosurgery and orthopedic surgery to really give them comprehensive care.
Host: Thank you so much Dr. Vricella for such great information on the services available at St. Louis Children’s Hospital. And that concludes this episode of Radio Rounds with St. Louis Children’s Hospital. To consult with a specialist or learn more about services and resources available at St. Louis Children’s, please visit the Children’s direct physician access line at 1-800-678-HELP. To learn more about this and other healthcare topics please visit our website at www.stlouischildrens.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s Hospital podcasts. Until next time, I’m Melanie Cole.
Advancements in Pediatric Urologic Surgery
Melanie Cole (Host): Today we’re talking about advancements in pediatric urologic surgery. My guest is Dr. Gino Vricella. He’s a Washington University Pediatric Urologic Surgeon at St. Louis Children’s Hospital. Dr. Vricella, it’s a pleasure to have you join us today. Please give us a little basic overview of pediatric urologic services at St. Louis Children’s Hospital. What are you doing there?
Gino Vricella, MD (Guest): We carry out some of the most technologically advanced procedures when we treat our kids that have pediatric urology issues. Some of the conditions that we treat are going to be related to the kidneys, the ureter tubes that drain the kidneys, the bladder and then the genital organs. So, we treat conditions related to the testicles and urethra, penis in males and the ovaries and then the urethra and other genital organs in females. So, it really kind of really runs the gamut.
Some specific conditions that we often see are going to be related to the genitourinary system, so we see a lot of children with urinary tract infections and different anomalies of the kidneys and the bladder and testicles and the ureter tubes like we talked about before. So, some pretty common things that we see are going to be undescended testicles, where the testicles in males fail to descend properly and are not located in the scrotum where they are supposed to be. We see kids with something called hypospadias where the urethra tube doesn’t end up on the tip of the penis where it should, it is usually sort of makes it halfway, kind of on the underneath part of the penis. And then sort of prenatally, a lot of times we are going to be consulted for children where the ureter tubes can be blocked so something called prenatal hydronephrosis something that is very common that we see.
And then really, just any sort of genital anomaly, ambiguous genitalia is one of the common things that we often see kids for in the office as well.
Host: Wow. That’s quite a comprehensive program Dr. Vricella so tell us about some exciting new advances in your field. What’s exciting that’s going on in pediatric urologic surgery whether it’s robotic technology or just tell us what’s exciting going on.
Dr. Vricella: In terms of robotic surgery, it’s important to know that St. Louis Children’s is one of really only a few pediatric facilities in the country and really the only children’s hospital in the great state of Missouri that offers robotic surgery for children that need certain urologic procedures. We started this program when I finished my fellowship here. I sort of spearheaded this program at St. Louis Children’s in 2014. And it’s been growing every single year and it’s surgery that can benefit a lot of people, not only the patient but the surgeon and parents alike.
So, when we are looking at robotic surgery. Essentially robotic surgery is a specialized type of laparoscopic surgery so I think most people have heard about laparoscopic surgery and sort of the benefits of laparoscopy are going to be smaller incisions which hopefully would lead to being able to perform the same surgery that we would normally perform using a larger oftentimes more painful open incision and do the same surgical procedure on the inside of the body. But by performing it laparoscopically, you are hoping to reduce pain and discomfort that is typical for really any type of surgical procedure. And by reducing pain and discomfort, we find that oftentimes kids have faster recovery time, getting back to their normal activities. For the larger procedures, there’s going to be a shorter hospitalization usually. And then minimal scaring associated because the incisions are smaller. There’s going to be a reduced risk for losing blood and need blood transfusions for surgical procedures that are sort of associated with a higher degree of blood loss during surgery.
And one of the things that’s really come up in recent years and this has been true for the adult side for longer but we’re seeing it more and more now in children is surgical site infections. So, you can imagine, if you are trying to do a surgical procedure and you’re going to have to make a four or five, six, seven inch incision as opposed to three or four half inch incisions, that’s going to have a higher risk for infection and I think we’ve seen the risks for infection go down at an exponential rate and I think laparoscopy has been part of the reason for that decrease.
Now laparoscopy in and of itself is great, however, what we found that laparoscopy is good for like removing stuff, right like taking out stuff but in pediatric urology, we’re not – although we will remove things, our main goal is to reconstruct. So, either reconstruct the genitourinary tract or bring back the child from a state of having an anatomic defect to one in which is more normal and can function appropriately. And so, part of that reconstruction involves fine suturing and if you can imagine typical laparoscopy you are sort of operating on the end of two chopsticks. And it doesn’t really allow you that manual dexterity and that’s really where robotic surgery I think shines.
So, those surgical complex reconstructive procedures that would have taken much longer years ago, even during my fellowship where we still did a majority of our laparoscopic procedures without robotic assistance, I think now with the robotic technology we can more closely recreate the open experience where you have the manual dexterity and wristed movements to allow you to perform those reconstructive procedures and do them in a timely fashion.
So, that’s really what I’ve seen over the past five years and I think the program will continue to grow and I’m very proud that St. Louis Children’s Hospital is the only hospital in Missouri that’s currently offering this technology.
Host: Well it is amazing technology and certainly the benefits to both the child, the patient and to the surgeon are so important. Tell us about your team Dr. Vricella. Who is doing these there? Tell us about your team.
Dr. Vricella: As it stands right now, I’m actually the only surgeon at St. Louis Children’s Hospital who is currently offering these robotic procedures. That just kind of goes to the fact that there are just not a lot of places with providers that are trained in robotic technology and our offering this. So, in terms of surgeons I would be the lone person here. As time goes on, robotic surgery is now becoming a large part of certainly pediatric urology and other urologic fellowships across the country will have sort of more providers that have the skill set and that can offer it. And I won’t be unique in that regard for much longer. I’m excited about the potential for new graduates not only in pediatric urology but even general pediatric surgery sort of adopting some of these techniques in their more reconstructive types of procedures.
Host: As we wrap up, Dr. Vricella, when should pediatricians refer to the specialists at St. Louis Children’s Hospital? What would you like them to know? Give us a nice summary and when you think it’s important, they refer.
Dr. Vricella: I think prenatally, the most common thing that pediatricians should think about referral for is going to be hydronephrosis or basically a dilation of the urinary tract, dilation of the ureter tubes which would suggest that either there is some type of obstruction or reflux going on in the kidney. Sometimes it’s just a transient phenomenon and so once the child is born, once the ultrasound is repeated, sometimes that hydronephrosis, especially if it’s mild can go away. But I think if that persists, postnatally; then that is a perfect time to refer to a pediatric urologist.
One of the other key things we’re oftentimes going to see; genital anomalies or ambiguity so undescended testicles or abnormalities of the penis so either foreskin issues, hypospadias something very, very common that we should be seeing kids for. And then at around the time of toilet training, we tend to start seeing more urinary tract infections especially urinary tract infections that are associated with fever. Those should be seen by a urologist because the fever would suggest that not only is the urinary tract infection going to be localized to the bladder but it’s also going to be involving the kidney and while the kidney is still developing, growing, an infection of the kidney can do kidney damage and so we’d want to intervene as soon as possible.
And then along with the hydronephrosis and urinary tract infections, you’re going to have diagnoses like UPJ obstruction and vesicoureteral reflux, any type of urinary incontinence issues and then one of the sort of more specialty clinics, multidisciplinary clinics that we have at Children’s that we see probably the highest number of patients seen certainly in Missouri but one of the highest volume places in the Midwest is going to be for spina bifida which is an anomaly of the spinal cord and the reason why a urologist is involved is that oftentimes the neural abnormalities are going to be very related to the function of the urinary tract and the gastrointestinal tract and both urinary and fecal continence issues are going to arise and so we are very well versed in taking care of those spina bifida kids. And as I mentioned before, we have a multidisciplinary clinic where we see these patients with other providers from neurosurgery and orthopedic surgery to really give them comprehensive care.
Host: Thank you so much Dr. Vricella for such great information on the services available at St. Louis Children’s Hospital. And that concludes this episode of Radio Rounds with St. Louis Children’s Hospital. To consult with a specialist or learn more about services and resources available at St. Louis Children’s, please visit the Children’s direct physician access line at 1-800-678-HELP. To learn more about this and other healthcare topics please visit our website at www.stlouischildrens.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s Hospital podcasts. Until next time, I’m Melanie Cole.