Dr. Heidi Stephany Joins CHOC Children’s Urology Team

CHOC Children’s urology program, ranked one of the nation’s best by U.S. News & World Report, has grown with the addition of Dr. Heidi Stephany.   A fellowship- trained pediatric specialist Dr. Stephany most recently served as assistant clinical director for the division of pediatric urology at Children’s Hospital of Pittsburgh of UPMC (University of Pittsburgh Medical Center), where she was also an assistant professor.

Dr. Heidi Stephany, pediatric urologist
Dr. Heidi Stephany

“The pediatric program at CHOC is a distinguished specialty with a solid reputation. I was drawn to work alongside such remarkable physicians, including Dr. Antoine Khoury, who is world-renowned in the field of pediatric urology,” says Dr. Stephany. “I was also attracted to the opportunity to help educate and train residents and fellows, in addition to working on challenging patient cases.”

Dr. Stephany’s clinical interests include complex reconstructive surgery, specifically hypospadias and disorders of sexual differentiation. Her clinical outcomes research is focused on voiding dysfunction.  She hopes to develop a combined urology/gastroenterology clinic for patients suffering from the condition.

A desire to solve problems and help others sparked, during her high school years, Dr. Stephany’s interest in surgery. After shadowing a urologist at the start of medical school, she knew urology—offering the perfect mix of medicine and surgery— was the specialty for her. She was intrigued by the wide array of complex issues and procedures within the specialty.

Working with children is particularly fulfilling for Dr. Stephany.

“In pediatrics, we have the opportunity to identify, address and achieve positive outcomes that will have a lasting impact on our patients’ lives,” she explains.

Since joining CHOC, Dr. Stephany has enjoyed immediate camaraderie with her colleagues and the team approach to care, which she says extends beyond her specialty and benefits patients. “It makes working here a truly fulfilling experience,” she adds.

Dr. Stephany is dedicated to treating patients like her own family members, and communicating complex issues in a compassionate way that is easily understood. She looks forward to becoming an integral part of the medical community in Southern California.

“I am excited to be here and want to be a resource for serving children in the area who need our care. I pride myself on being approachable and am eager to work collaboratively with local pediatricians,” says Dr. Stephany.

For physician referrals to Dr. Stephany, call 888-770-2462.

Dr. Irene McAleer addresses urinary tract infections

A urinary tract infection is a common condition among children when bacteria gets into the bladder and possibly into the kidneys, Dr. Irene McAleer, a CHOC Children’s urologist, tells “American Health Journal.”

Symptoms depend on the child’s age: An infant may have a low-grade fever, be fussy and not feed, while an older child may complain of when urinating, says Dr. McAleer.

Learn more about diagnosis and treatment of this condition in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.

Irene McAleer, M.D., earned her medical degree at Ohio State University. She performed her internship at Naval Hospital in Oakland, Calif., and her urology residency at National Naval Medical Center in Bethesda, Md. Dr. McAleer served her pediatric urology fellowship at UC San Diego.

Get more information about referring patients to CHOC, including a referral information directory, services directory and referral guidelines.

In the Spotlight: Antoine Khoury, M.D. – Pediatric Urologist Brings World-Class Care, Fellowships to CHOC Children’s

Antoine Khoury, M.D., medical director of pediatric urology at CHOC Children’s
Antoine Khoury, M.D., medical director of pediatric urology at CHOC Children’s

In the relatively short time that Dr. Antoine “Tony” Khoury, medical director of pediatric urology at CHOC Children’s and professor of urology at the UC Irvine School of Medicine, has led the CHOC Children’s Urology Center, it has become a nationally recognized center of excellence in the subspecialty of pediatric urology.

Dr. Khoury came to CHOC in 2008 and brought leading-edge pediatric urology services to Orange County with the opening of the center in 2010. The center provides comprehensive care for children, from the most common conditions such as hernias and urinary infections to the most complex congenital abnormalities, such as bladder and cloacal exstrophy.

Recently, CHOC was nationally ranked in six specialties –one of them pediatric urology – in the 2013-14 U.S. News & World ranking of Best Children’s Hospitals. In addition, the number of patients the center helps continues to grow.

“We’re seeing 600 outpatients a month from the greater area, from Corona and Long Beach to as far east as Loma Linda and Riverside.  “In addition, we perform 80-100 surgical procedures a month,” Dr. Khoury said.

“The children are getting world-class care. We are now getting some international patients. We just operated on a patient from Israel who came here after having two unsuccessful surgeries.”

Born and raised in Egypt, Dr. Khoury attended Ain Shams University Medical School in Cairo and is board-certified in urology. He completed his residency in urology at the University of Toronto in Canada and a clinical fellowship and a research fellowship in pediatric urology at the Hospital for Sick Children in Toronto. He followed this with a research fellowship at the University of Calgary in Canada, in the area of biomaterial-related infections.

Dr. Khoury didn’t initially plan to become a pediatric urologist; he thought he’d become a surgeon for adults. He fell in love with the field during his residency and noted that pediatric urology was very different than urology for adults.

“Our patients are obviously much smaller and require advanced surgical expertise. Additionally, the majority of our procedures are reconstructive in nature, requiring imagination and constant surgical innovation.”

Fellowship and Clinical Research Innovations

Under Dr. Khoury’s leadership, CHOC offers a two-year fellowship in pediatric urology and several research and academic programs are underway. The fellowship program was accredited this year by the American College for Graduate Medical Education and 2013 marked the first time that CHOC, in partnership with UC Irvine, has offered an accredited pediatric urology fellowship.

Dr. Khoury is also proud of the clinical research innovations CHOC has accomplished in recent years in pediatric urology. For example, his team developed a highly regarded new bladder-to-kidney reflux risk calculator designed to help define the best treatment options for children with vesicoureteric reflux. The reflux of urine from the bladder back up into the kidneys is a common problem in children and can lead to infections and scar formation in the kidneys.

“We developed an app that takes into account all the risk factors involved in kidney infections so that the treating physician can determine the risk of a child developing a kidney infection within two years of treatment,” Dr. Khoury said. Patients are categorized into three specific risk categories and then treatment options are evaluated based on the risk.

On the academic front, Dr. Khoury and his colleagues are involved in multiple research projects, including one project for children born without a functioning bladder that involves bladder reconstruction using cell culture techniques. “We’re working on developing this in the lab and hoping to take this to clinical application in a few years. We’ve had three publications on that already. That work has won research prizes at national and international meetings,” he said.

Dr. Khoury’s pediatric urology colleagues and research associates include Dr. Gordon A. McLorie, Dr. Irene McAleer and Dr. Elias Wehbi. All three also have extensive academic and research credentials.


CHOC Children’s Urology Center 

The CHOC Children’s Urology Center is a state-of-the-art, one-stop facility where children with urological issues are tested, diagnosed and treated all in one place, without having to make multiple visits to different physicians and labs. CHOC’s highly specialized physicians diagnose and treat a wide range of urological conditions, including:

• Ureteral reflux, in which urine flows the wrong way

• Bladder and urinary tract infections

• Bedwetting (nocturnal enuresis), incontinence or loss of bladder control

• Kidney stones

• Tumors of the kidney, bladder or testes

• Hernias

• Neurogenic conditions caused by birth defects like spina bifida

• Genital anomalies

• Perinatal urology

To learn more about Dr. Khoury and the CHOC Children’s Urology Center, please click here: http://www.choc.org/urology/index.cfm?id=P00973

New Technique Reduces Post-Surgery Pain in Children

CHOC Children’s researchers have identified a new technique that significantly decreases pain and the need for pain medication in children following high-risk urology surgeries, a finding that was recently published in the “Journal of Pediatric Urology.”_MG_7464_1

“While pain management is a fundamental part of pediatric surgical recovery and care for pediatric patients, current options involve strong prescription painkillers that can put patients at risk for adverse side effects and possible complications,” said Antoine E. Khoury, M.D., urology chief at CHOC Children’s and a study investigator. “This study demonstrates a major advancement in pain management for pediatric urology patients, significantly reducing postoperative pain and the need for pain medicine.”

The research team evaluated the continuous infusion of local anesthesia using a pump pain relief system commonly used in adults to improve pain control in children who have undergone urological procedures. While the ON-Q system is well-established as an effective pain management technique for adults, this is the first study that evaluates its pain management effectiveness in children.

Published in December 2013, the study found that the ON-Q pump system decreased the amount of pain experienced by children on the first and second postoperative days, and that it significantly reduced the need for narcotics.

Because the device delivers the anesthetic in an automatic continuous drip, patients and their caregivers don’t need to adjust the dosage. It is also contained in a pouch, allowing children to move freely during recovery.

During the study, nurses assessed patients’ pain using the Visual Analog Scale (VAS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale, depending on the child’s age, for both the test group and a control group, which received standard-of-care pain management.

Researchers recommend conducting additional clinical studies to further validate this technique as a superior option for postoperative pain management in children undergoing surgery.

In addition to Dr. Khoury, authors for the research study, “Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery,” include Guy Hidas, Hak J. Lee, Blake Watts, Maryellen Pribish, Edwin T. Tan and Zeev N. Kain.

Meet CHOC Pediatric Urology’s “Triple Threat”

Two full-time pediatric urologists with extensive academic and research credentials recently joined CHOC Children’s Urology Center.
In addition to faster access to patient consults and expanded surgical capabilities, including robotics, CHOC Children’s Urology Center is the training site for the nation’s newest pediatric urology fellowship program sponsored by University of California, Irvine School of Medicine. Several research projects are also underway.
Established in 2010, CHOC Urology has already been recognized as one of the nation’s best by U.S. News & World Report. Medical Director Antoine Khoury, M.D., plans to be among the top 10 within fifive years.
One has trained physicians for most of his career and helped build one of the very fifirst pediatric urology fellowship programs. The second has held teaching appointments at several prestigious institutions and is a former president of the American Association of Pediatric Urology.

Together with Antoine Khoury, M.D., professor, Department of Urology, University of California, Irvine and medical director, CHOC Children’s Urology Center, pediatric urologists Gordon McLorie, M.D., and Irene McAleer, M.D., have tripled the clinical, teaching and research capabilities at CHOC Children’s Urology Center. “Our goal is to create a ‘one-stop’ center of excellence, where families receive a comprehensive treatment plan,” Dr. Khoury said.
With the addition of Drs. McLorie and McAleer, Dr. Khoury can now pursue another goal: establishing a pediatric urology fellowship at CHOC and UC Irvine.
“The educational component is key,” he said. “We also have several cutting-edge research projects underway, including a major project on bladder reconstruction using cell culture techniques, and have an opportunity to make advances in pediatric urology.”
CHOC Children’s Urology Center is located at 505 S. Main Street, Suite 100, in Orange. For more information, or to arrange a consultation, please contact (714) 512-3919. Patient records and reports may be faxed to (866) 529-9704.

Gordon McLorie, M.D.

“I am excited to be part of this expansion, which is so important to the children and the families who need this kind of care. There are not a lot of people in this specialty, and our hope is to be able to add a center that will help meet future need.”

Gordon A. McLorie, M.D., Professor,   Department of Urology and Director of Pediatric Urology Fellowship Program, University of California, Irvine School of Medicine and CHOC Children’s.

Fellowship, Urology oncology and Urodynamics:   UCLA Medical Center

Fellowship, Pediatric Surgery: with Dr. W. H. Hendren, Harvard University

Medical Training, including Internship, Residency: University of Toronto

There are only a few pediatric urology training programs available within the U.S. and Canada, and Gordon McLorie, M.D., helped build one of the fifirst at the University of Toronto. An internationally recognized authority on reconstructive bladder and genitalia surgery, Dr. McLorie is currently concluding a fifive-year, $1.5 million NIH funded research into vesicoureteral reflflux and will be publishing the results of this 600-patient study after a two-year follow up and analysis.

Prior to joining CHOC, Dr. McLorie taught at Wake Forest University School of Medicine. He has also held academic appointments at several institutions.

Irene McAleer, M.D

“I enjoy the stimulation that comes from teaching, as well as by learning from medical students and residents. I look forward to establishing an accredited fellowship program to increase training opportunities for this region.”

Irene M. McAleer, M.D., HS Associate Professor, Department of Urology University of California, Irvine School of Medicine and CHOC Children’s

Pediatric Urology Fellowship:   University of California, San Diego

Urology residency: National Naval Medical Center, Bethesda

Internship: Naval Hospital, Oakland

Medical Degree: Ohio State University

Former president of the American Association of Pediatric Urology, Irene McAleer, M.D., has held academic appointments at several prestigious institutions, most recently at University of California, San Francisco. Special clinical interests include antenatal counseling, hypospadias, urinary reflux and hydronephrosis management.

Prior to joining CHOC, Dr. McAleer was at Children’s Hospital Central California, in Madera, where she was a former vice chair of surgery. She is a fellow of the Society of Pediatric Urology, American College of Surgeons and American Academy of Pediatrics, Urology Section