The past two years have seen a 27 percent increase in surgical volume in the department of Pediatric Urology. Surgical volume continues to grow in double figures annually with the total ambulatory and inpatient surgical cases in 2001 and 2002 surpassing 2,500 cases. Cases span a broad spectrum of clinical diagnoses from the simplest to the most complex. In 2002, the department was part of the multidisciplinary team that performed the 100th kidney transplant at The Children’s Hospital. The department has been the lead on a number of national clinical trials. In 2003, Martin Koyle, MD, will assume the presidency of the Society for Pediatric Urology, reinforcing Children’s commitment to collaborate nationally on the advancement of services for young urological patients.

Martin A. Koyle, MD, FAAP, FACS
Chairman with seven-year-old
Cody and three-year-old Riley

An extremely busy Dry Time Clinic cares for the increasing volume of children who suffer from daytime and nighttime wetting problems, urinary tract infections, control problems, painful urination, hematuria and vesicoureteral reflux. The clinic provides initial screening by skilled nurse practitioners and offers monthly parental educational seminars and follow-up treatment.
In conjunction with the perinatology program at the University of Colorado Obstetrics Department, the Prenatal/Neonatal Urology Clinic evaluates prenatal children and neonates who have been identified as having congenital abnormalities of the genitourinary tract. Parental counseling and follow-up treatment is offered. The department is also actively involved in the Spinal Defects Clinic, a multidisciplinary clinic that treats young patients who have congenital and acquired neurological disorders.

Advancements in Pediatric Urological Treatment
The department of Urology continues to pioneer and promote the most recent surgical treatments. The Malone antegrade continence enema procedure (MACE) was first done in North America by Dr. Koyle and has become a mainstay worldwide to provide stool continence in children with anorectal and neurological incontinence. The use of minimally invasive surgical techniques continues to increase in pediatric urology. The first laparoscopic nephrectomy performed on an infant was done at The Children’s Hospital.

The Children’s Hospital is one of 10 sites nationally chosen to study the bulking agent DEFLUX® and its use for the minimally invasive treatment of vesicoureteral reflux. Subsequently, The Children’s Hospital and Drs. Furness and Koyle were chosen to teach all graduating fellows in pediatric urology the technique of Deflux injection for the correction of vesicoureteral reflux.

Dr. Furness is leading a national study evaluating TGF-beta and its relationship to hydronephrosis. Ongoing research continues in the evaluation of the Mentor® testicular prosthesis, Ciprofloxacin® for complex urinary tract infections, and Ditropan XL® for neurogenic bladder dysfunction.

Multidisciplinary care of complex disorders includes involvement with experts in the fields of pediatric surgery, orthopaedics, neonatology, nephrology, oncology, genetics, neurosurgery, endocinology, rehabilitation and adolescent gynecology as needed.

Urology is actively involved in renal transplantation in partnership with Fritz Karrer, MD, and the nephrology team. This past year, the 100th kidney transplant was performed under the direction of Dr. Karrer, chairman of Pediatric Surgery.

In collaboration with the Oncology department, care is provided for children diagnosed with genitourinary malignancies, such as Wilms’ tumor and other kidney tumors, cancers such as rhabdomyosarcoma that involve bladder, prostate, and the female genital organs and testicular tumors. A vast number of complex patients with intersex or gender determination issues are evaluated and treated conjointly with our endocrinology colleagues.

Monthly educational conferences are held at The Children’s Hospital in which the radiological and pathological aspects of pediatric urology are correlated with clinical cases. Weekly participation at the University of Colorado Urology Grand Rounds updates interested physicians and coworkers about the ever-changing environment of pediatric urology. Tumor board and transplant rounds are attended. The Dry Time Clinic provides monthly lectures to parents to educate them about children with bedwetting and incontinence problems. Lunch and Learn lectures bring the latest in pediatric urology topics to community practices and regional groups. Children’s trains fourth and fifth year urology residents from the University of Colorado School of Medicine. When compared with their peers nationally, their experience and knowledge is ranked above the 95th percentile. A fellow from the United Kingdom is hosted annually to acquire knowledge of pediatric urology practice in America. Physician assistant and nurse practitioner students, as well as medical students, are welcomed on the service.

The challenge of the near future will be strengthening basic research within the discipline, attempting to provide continued excellence of care with double-digit growth in surgical volume, and preparing for the continued transitions in health care and the move to Fitzsimons.



Children's Urologists Host National Reflux Conference

As one of only 10 hospitals in the U.S. designated by the Food and Drug Administration to study Deflux® and as a leading training center for endoscopic procedures, the Urology department hosted a national conference in leading-edge minimally invasive techniques for correcting vesicoureteral reflux. Fellows from across the U.S. came to study Deflux as an injectionable agent used in the treatment of vesicoureteral reflux (VUR). Deflux is a non-toxic and non-migrating gel injected at the point where the ureters enter the bladder.

Historically, vesicoureteral reflux has been treated with traditional open surgery. While open surgery is still the preferred option for treating high-grade reflux, low-grade reflux can be successfully treated with the minimally invasive technique of injecting Deflux to correct impaired ureteral valves. The Deflux procedure results in less discomfort or pain, eliminates scarring and does not require the placement of a catheter.

The May 2002 conference featured Drs. Koyle and Furness, urologists at The Children’s Hospital who have performed nearly 100 Deflux procedures and Andy Kirsch, MD, from Emory University. Participants represented fellowship programs from nine different hospitals across the country.