Children suffer from as many urologic problems as adults. They can have congenital abnormalities such as:
- undescended testes in male children;
- hydronephrosis (a dilation of the kidney’ part, often the result of a blockage in the ureter);
- renal obstruction or reflux disease.
Our board-certified, fellowship-trained pediatric urologist has the specialized training, skill and experience to help your child with virtually any urologic condition. Ask your primary-care doctor to refer your child to us and take comfort in the fact that your child will receive world-class care.
Center for Pediatric Robotic Surgery and Minimally Invasive Surgery (“Belly-Button” Surgery)
Our pediatric robotic surgery program is the most active in annual pediatric robotic surgery volume in Southern California. Our clinic has the most functional surgical robots in the world used to provide minimally-invasive surgical care exclusively for children.
Robotic surgery using the Da Vinci machine (Intuitive Surgical, Sunnyvale, CA) represents the next generation of laparoscopic surgery for pediatric urology. It is a pediatric urologic surgery revolution as it has done for adult urologic surgery (robotic prostatectomies for prostate cancer).
The Da Vinci robot has a feature of minimally invasive surgery for pediatric urology issues. It is accomplished thanks to three-dimensional and magnified visualization, intuitive computer-enhanced motion control, and its fully articulating “Endowrist” instruments. Essentially, the Da Vinci robot allows doctors to perform more reconstructive procedures in a minimally invasive fashion, where the experienced surgeon can mimic open surgical movements and techniques with the robotic arms. As a result, robotic surgery represents the latest advances in minimally invasive surgery for children, and the advantages include:
- Smaller incisions with improved postoperative cosmesis
- Better visualization and instrument control during surgery
- Shorter hospital stays
- Decreased postoperative pain medication requirements
Robotic surgery in pediatric urology is used for:
- Pyeloplasty for Ureteropelvic Junction Obstruction (UPJO)
- Ureteral Reimplantation for Vesicoureteral Reflux (VUR)
- Kidney Surgery, including kidney stone removal and nephrectomy
- Ureteral Reconstruction / Urinary Tract Reconstruction
- Bladder Reconstruction / Augmentation
Besides, as efforts are continuing in the field of minimally invasive surgery in pediatric urology to minimize surgical morbidity and to improve the postoperative cosmetic outcome to a virtually scar-free appearance, we also provide laparo-endoscopic single site (LESS) surgery (“Belly-Button” Surgery) for pediatric patients, including infants, where laparoscopic procedures are performed through a single skin incision in the umbilicus. It is also known as SILS, or single incision laparoscopic surgery. It builds upon our USC Institute of Urology colleagues’ initial experience with LESS urologic procedures in 100 adult patients where comparable outcomes were noted with several conventional laparoscopic techniques. Our experience has shown that pediatric LESS nephrectomy, including in infants, is feasible with similar perioperative parameters as conventional laparoscopic nephrectomy.
CHLA Center for Pediatric Voiding Dysfunction
Dr. Leonard Skaist directs our center for pediatric voiding dysfunction. It is comprised of a team of dedicated pediatric urologists and nurses who specialize in the non-operative treatment of pediatric voiding dysfunction, with particular emphasis on the following diagnoses:
- Enuresis (“Bed-wetting”)
- Urinary Frequency
- Urinary Incontinence
- Urinary Urgency
Pediatric Kidney Stone Center
Our pediatric stone center has a team of dedicated pediatric urologists, nephrologists, and nurses trained to manage children with stones in the urinary tract (kidney, ureter, bladder, and urethra) as well as the metabolic workup. In conjunction with the CHLA Burtie Green Bettingen Surgery Center and the USC Institute of Urology’s Center for Endourology and Stone Disease, we employ state-of-the-art equipment and techniques, where stones can be removed without incisions with the use of ultrasound and lasers. For more complicated situations, stones can be moved out through a small keyhole incision in the back. Robotic surgery is also utilized when necessary for stone removal. Regardless of the clinical situation, we can effectively treat a child’s stone disease with personalized, gentle care.
Common procedures performed in our center include:
- extracorporeal shockwave lithotripsy (ESWL);
- utereroscopy and laser lithotripsy;
- percutaneous nephrolithotomy;
- robotic-assisted laparoscopic nephrolithotomy;
- open cystolithotomy;
- endoscopic ureteral stone removal;
- urethrotomy with stone extraction.
The Endocrinology-Urology Center for Pediatric Disorders of Sexual Differentiation
Our center consists of dedicated pediatric urologists, pediatric endocrinologists, pediatric psychologists, and nurses trained to manage children with disorders of sexual differentiation, including congenital adrenal hyperplasia, androgen insensitivity syndrome, and other variations in sexual differentiation. Multi-specialty conferences between the Divisions of Pediatric Endocrinology and Pediatric Urology are held to coordinate the medical, surgical, and psychological care of these patients.
The Bladder Exstrophy / Genitourinary Reconstruction Program
Bladder exstrophy is, without a doubt, one of the most challenging congenital malformations to correct and should be undertaken by experienced reconstructive surgeons with the necessary infrastructure and team in place to care for these babies. These surgeries are usually performed at tertiary centers equipped to handle such complicated cases and with a team of specialists (pediatric urologist, orthopedic surgeon, and neonatologist) available to administer treatment.
The CHLA Division of Pediatric Urology has adopted almost exclusively the contemporary approach of complete primary (single-stage) repair for both the bladder and external genitalia (epispadias) in these children. The goal of the operation is to combine all the elements of a staged repair into one (bladder closure, epispadias repair, and urinary continence) to accomplish all three successfully while obviating the need for multiple surgical procedures in the future. It has been our institution’s experience since implementing this surgical technique, that our patients are experiencing better continence rates overall. Just as important, patients who have undergone complete primary repair demonstrate significant improvement in bladder growth and size, which should significantly impact long-term continence and avoidance of possible augmentation with a continent diversion to the skin in this patient population.