recognition for CHOC’s cancer program is well-deserved. There’s nowhere else
I’d rather have gone through treatment than CHOC,” says 17-year-old Sydney
Sigafus, CHOC patient and cancer survivor. “Everyone who works at CHOC cares
about you as a person, not just a patient. I was included in every decision and
conversation about my care.”
Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or
life-threatening diseases find the best medical care available. Only the
nation’s top 50 pediatric facilities are distinguished in 10 pediatric
specialties, based on survival rates, nurse staffing, procedure and patient
volumes, reputation and additional outcomes data. The availability of clinical
resources, infection rates and compliance with best practices are also factored
into the rankings.
“We understand how scary it can be for parents whose children are dealing with life-threatening illnesses or injuries. That’s why we are committed to the highest standards of care, safety and service,” says Dr. James Cappon, CHOC’s chief quality officer. “While we are proud of our accolades, including being named a best children’s hospital, we remain focused on preserving the magic of childhood for all kids, whether they are seriously ill or healthy, or somewhere in between.”
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.
“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.
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 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
• Neurogenic conditions caused by birth defects like spina bifida
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.”
“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.