The Culture of Different MKTG_150064494_2018 Service Line Big Book Full_FIN | Page 82

UROLOGY
Born into
Good Hands
LEADERSHIP:
Duncan Wilcox, MD,
Chief, Pediatric
Urology
The Ponzio Family
Chair, Pediatric
Urology
READ MORE ABOUT
UROLOGY:
“For Adrian to Live, His
Immune System Had
to Die,” p. 68
“A Lifetime of Care,”
p. 76
At Children’s Hospital
Colorado, care for kids with
rare urogenital and urological
defects often begins before
they’re born.
“The majority of these kids
are diagnosed prenatally,”
says pediatric urologist
Vijaya Vemulakonda, MD,
JD. “That allows us to help
parents prepare and develop an
ongoing relationship that will
potentially last a long time.”
It also allows Dr. Vemulakonda,
Urology’s point person
for kidney and bladder
anomalies, to establish a team
encompassing nephrology,
maternal-fetal medicine,
neonatology, genetics, fetal
surgery and radiology. In many
cases, mothers can deliver
right in the Children’s Colorado
Maternal-Fetal Care Unit,
allowing the team to treat
complex conditions within
minutes of birth if necessary,
just down the hall.
A Three-Pronged
Focus for a Three-
Pronged Problem
Because the drainage system
of the kidneys, the ureter and
the trigone of the bladder share
a common developmental
precursor — the ureteric bud —
congenital problems with one
often affect all three.
The Least
Invasive Surgical
Reconstruction
“In fact,” says Dr. Vemulakonda,
“the number-one cause of
end-stage renal problems in
children is associated urological
problems.” For kids who need surgical reconstruction of the
bladder for congenital colorectal and urogenital
malformations, the invasive part begins hours
before scalpel touches skin and ends long after
the final suture.
Collaborating with pediatric
nephrologist Margret Bock,
MD, Dr. Vemulakonda formed
Children’s Colorado’s Clinic
for Congenital Anomalies of
the Kidney and Urologic Tract.
The clinic evaluates children at
risk for renal injury, employing
medical, surgical and dietary
interventions to stop kidney
damage before it can progress. To prevent infection, conventional wisdom has
long held that the bowel must be prepared for
reconstructions with “cleaning” — essentially 24
hours of diarrhea. The patient stops eating and
drinking the night before. Anesthesia involves
lots of intravenous fluids to compensate for the
dehydration, which disables the bowel, and then
patients go a few more days with no food or drink.
As Interim Surgeon-in-Chief at Children’s Hospital
Colorado — and urologist on those procedures
— Duncan Wilcox, MD, is always seeking to curb
invasiveness. A few years ago, he found inspiration
from the Enhanced Recovery After Surgery Society,
a European group that had been trying since the
1990s to standardize perioperative care for adults.
They’d come up with a method that seemed almost
drastic: Oral fluids up to two hours before surgery.
More local anesthesia, less general. Solid foods the
day after an operation.
Patients were getting better faster.
“I thought, ‘Why aren’t we doing that for children?”
says Dr. Wilcox. He laughs. “The fl