Leaders in Reconstructive and Other Urologic Surgeries
NewYork-Presbyterian's pediatric urologists are experts in performing reconstructive urologic surgeries in newborns, infants, children, adolescents, and young adults, with significant experience in the treatment of congenital urologic disorders. It's especially important for children with issues that are identified during pregnancy to be delivered and cared for in a medical center like ours, which has all of the pediatric specialties onsite these infants may need. We have pediatric urologists who perform complex reconstructive surgery, including care for abnormalities of the bladder and urethra (urine tube).
A Center of Excellence for CAH
NewYork-Presbyterian Komansky Children's Hospital is designated as New York State Newborn Screening Referral Centers for congenital adrenal hyperplasia (CAH), a birth defect in which the adrenal glands do not function properly. CAH is caused by an enzyme deficiency that prevents the adrenal glands from making cortisol (a hormone that affects the body's energy supply, blood sugar, and reaction to stress).
NewYork-Presbyterian Komansky is also home to the first Center of Excellence for CAH, as designated by the CARES Foundation (Congenital Adrenal Hyperplasia Research Education and Support). We provide a patient-focused multidisciplinary team approach for the medical and surgical treatment of our patients— including medical therapies, the latest surgical approaches, nutritional counseling, psychosocial support, and genetic counseling and testing.
Our Approach to Care
Our pediatric urologists, nurses, and nurse practitioners work closely with other specialists, such as endocrinologists, maternal-fetal medicine physicians (ob-gyns with advanced training in the care of complex pregnancies), prenatal pediatric professionals, nephrologists, registered dietitians, social workers, and child life specialists to provide compassionate, coordinated care. Your child receives follow-up care as they grow and transitional services to bridge pediatric to adult care.
Expertise in hypospadias repair
In boys with hypospadias, the urethra is short and does not come out to the end of the penis. NewYork-Presbyterian is a major referral center for boys with hypospadias. Pediatric urologists at both children's hospitals perform reconstructive surgery for hypospadias to restore both cosmetic appearance and optimal function in your child. We offer the most advanced surgical techniques for initial treatment and specialize in the care of those with challenging complications from prior surgery, including fistulae, curvature, and stricture. Our surgeons have streamlined hypospadias surgery to reduce the risk of complications after surgery and get boys back to their regular activities sooner. NewYork-Presbyterian Komansky is one of the only centers offering hyperbaric oxygen for the most complex cases.
Our pediatric urologists are highly experienced in treating all types of congenital urologic conditions, including:
Bladder and cloacal exstrophy. Exstrophy is a rare and complex disorder in which the abdominal wall fails to close during fetal development, the intestine may be abnormally connected to the bladder, and the urethra and genitals are not completely formed. Surgery must be performed in the first 24 hours of your baby's life.
Bladder issues related to spina bifida and anorectal malformations. Care for these conditions requires a team approach and often involves lifelong urologic follow-up. This includes diagnostic testing, management of urinary and fecal continence, and occasionally, surgical intervention. Our pediatric urologists have experience with these procedures, including "appendicovesicostomy," a surgery in which a channel is constructed out of your child's appendix to make is easier to insert a urinary catheter to empty the bladder. Children with neurogenic bladder may also benefit from a Malone procedure to facilitate emptying of the colon; our surgeons have experience using the appendix to create both channels.
Ectopic ureter. We individualize treatment for your child depending on the function of the upper portion of the affected kidney. We may remove that part of the kidney if no function is present, reimplant the affected ureter into the bladder, or connect the affected ureter to the unobstructed ureter if your child's kidney is functioning.
Hydronephrosis. Hydronephrosis (a swelling of the kidneys) often resolves within the first few years of a child's life. However, it is critical for an experienced pediatric urologist to determine if your child has "nonthreatening" hydronephrosis or hydronephrosis that requires treatment. In some children, the cause of hydronephrosis can lead to permanent damage of the kidneys if left untreated.
Posterior urethral valves (PUV). If your unborn baby has PUV, severe hydronephrosis, and low amniotic fluid, we may perform fetal surgery to insert a stent to drain urine from the obstructed bladder into the amniotic space. Once your baby is born, we'll insert a catheter to drain the bladder and monitor him closely to assess kidney and bladder function.
Prune belly syndrome (PBS). Since many other abnormalities can be associated with PBS, we work with subspecialists to assess heart, lung, and bone abnormalities, in addition to urologic concerns.
Ureterocele. We offer several surgical approaches to correct ureteroceles and restore proper urinary function for your child. Some are appropriate for newborns, while others are best done at an older age.
Ureteropelvic junction obstruction. We are highly experienced in performing surgery to remove a "lazy" or narrowed section of an affected ureter to reestablish the normal flow of urine in your child. We may use robotic surgery to perform this procedure.
Ureterovesical junction (UVJ) obstruction. While some cases of UVJ obstruction improve on their own over time, others need to be corrected. We can surgically remove the obstructed segment of your child's affected ureter and taper the remaining part of the ureter so it fits properly into the bladder.
Vesicoureteral reflux. We've been at the forefront in the use of an extravesical approach or robotic approach for minimally invasive surgical approaches to treat this disorder. Most of the time, it goes away on its own during the first few years of life. If your child needs treatment, we have great experience performing surgery to correct the issue, as well as injecting a material called Deflux into the bladder to prevent reflux.
Why Choose Us
The treatment of congenital urologic disorders is complex and may require the expertise and skills of multiple specialists before and after your child is born. When you come to NewYork-Presbyterian Komansky Children's Hospital or NewYork-Presbyterian Morgan Stanley Children's Hospital for care, you can take comfort in the knowledge that all of the healthcare professionals you may need during pregnancy and after childbirth are available through one medical center, resulting in state-of-the-art coordinated care. In addition when appropriate, both centers can offer urologic reconstructive surgery using a minimally invasive robotic approach, which results in smaller incisions, less pain, and a faster recovery for your child than conventional open surgical procedures. Make an appointment today for a consultation.