Children’s Hospital Los Angeles, one of America’s premier pediatric hospitals, offers families convenient access to pediatric specialty services at its new Santa Monica Outpatient Center – including child-focused urological care by fellowship-trained, board-certified pediatric urologists. Attending physician and surgeon Roger E. De Filippo, MD, discusses sound urological health for children in this Q&A.
Dr. De Filippo is Chief of Pediatric Urology and co-director of the GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics at the Children’s Hospital Los Angeles and Saban Research Institute. He is an Associate Professor of Urology at the Keck School of Medicine of the University of Southern California.
How common are urological problems among children?
Urological issues are the second most common conditions for newborns after heart defects. Many of these problems are diagnosed during pregnancy, enabling us to intervene quickly after birth before any symptoms arise. Children’s Hospital Los Angeles has one of the busiest maternal fetal health programs in the nation through its Institute of Maternal Fetal Health where a good majority these disorders are diagnosed prenatally. Other conditions are diagnosed during childhood. Urinary tract infection (UTIs) is still a common presentation and febrile UTIs can affect up to 3 percent of children in the United States every year. A febrile UTI can usually portend an associated genitourinary abnormality and is usually advised to involve the pediatric urologist early on in the evaluation of these children.
What kinds of conditions do you typically treat in Santa Monica?
We provide evaluation and treatment for a full spectrum of congenital and acquired conditions involving the urinary and genital tracts. These include UTIs, especially those involving a fever or failure to thrive, which may need further investigation to rule out a congenital condition, or they might jeopardize development. We also see and treat a lot of other conditions that may require surgical intervention at Children’s Hospital, such as phimosis, male and female hernias, hydroceles, kidney stones, undescended testes, urinary tract obstructions, vesicoureteral reflux, and hypospadias, a congenital condition in which the opening of the urethra, known as the meatus, which allows for normal urination is misplaced.
Tell us about the surgical capabilities of the Division of Pediatric Urology.
If your child needs surgery, he or she is in the best of hands. The Division is an extremely busy surgical program and that experience translates to better outcomes. We are in the top five programs in the country for minimally invasive and robotic surgical techniques, which offer smaller incisions and faster recovery time, especially in the older child that needs reconstructive surgery. In most cases of the infant, most of our open incisions are quite small and unassuming already. Our multidisciplinary team includes pediatric imaging specialists and pediatric anesthesiologists. All of which means greater peace of mind for parents.
How can families help instill sound urological health in their children?
Parents can encourage their children to develop regular bathroom habits and ensure that they have a healthy diet. Beyond that, keep in mind that occasional accidents don’t mean your child has anything significantly wrong with them.
What if a child or teen does seem to have more serious voiding issues?
You have to first determine what those voiding issues are. The greater majority usually reflects issues of frequent urination, and day and night time accidents. First and foremost, the majority of these symptoms do not require surgical intervention from the pediatric urologic surgeon. If your child is experiencing these symptoms, we can usually evaluate over the phone and refer families to our specialized Voiding Improvement Program (VIP) at Children’s Hospital. There, an experienced team works with children ranging from potty-training age to teenagers on such problems as frequent urination, day-time and night-time wetting. The team develops the right comprehensive care plan for each child’s unique needs. Among the techniques are biofeedback, computer game-assisted educational sessions, toileting practice and exercises. You can go to our website www.CHLA.org/Urology to learn more about our VIP program or call and ask for a personalized evaluation from our VIP nurse. You can also go to wetreatkidsbetter.org and look for Nicole’s blog.
You are leading innovative research projects that use stem cells from amniotic fluid to create new kidney tissue. What is your ultimate goal?
We are concerned about children who are born with or develop conditions that can create significant compromise to their kidney function. There are a lot of patients with chronic kidney failure waiting on a transplant list. So we’re pursuing research into other alternatives that don’t rely on traditional transplanted organs. In one study, we are literally “building” kidneys in the lab using stem cells from amniotic fluid. In another, by injecting these regenerative cells into damaged kidneys, we’ve been able to stave off organ failure. We’re hopeful that some of these technologies in some shape or form will make it to clinical trials within the next five years.
Why is it important for children with urological conditions to see a pediatric specialist?
The urological problems children have are different from typical adult problems. You need a pediatric urologic specialist’s perspective to get the best possible, most appropriate, and up-to-date care. We provide that expertise at the CHLA Santa Monica Outpatient Center, with all the weight of a top-tier children’s hospital behind it. The entire experience focuses on the child.
The Children’s Hospital Santa Monica Outpatient Center is located at 1301 20th Street, Suite 460, Santa Monica 90404. Hours: Monday through Friday 8 am-noon and 1 pm-5 pm. For referrals, call 888.631.2452 and for appointments, call 310.820.8608.