CHOC makes advancements for neurogenic bladder patients

The Urology Center at CHOC Children’s has implemented and evaluated a bladder pressure and volume diary for patients at risk for increased intravesical pressures.

“Patients dependent on clean intermittent catheterization used ruler-based manometry to measure intravesical pressures before leakage or scheduled drainage at home,” said Dr. Antoine Khoury, chief of pediatric urology. Patients were asked to record measurements while relaxed in a supine position.

Dr. Antoine Khoury, chief of pediatric urology at CHOC Children's
Dr. Antoine Khoury, chief of pediatric urology at CHOC Children’s

Study results

The study included 30 patients ranging in age from 1 to 20, with a mean age of 10.

“Home pressures measured at maximal clean intermittent catheterization volume and mean bladder pressure/volume diary pressures were most reliable in predicting urodynamic pressures greater than 30 cm water (AUC 0.93 and 0.87, respectively). Home pressures measured at maximal clean intermittent catheterization volumes less than 20 cm water were associated with normal bladder pressures (less than 30 cm water) on urodynamics, with a sensitivity of 100% and a specificity of 80%,” said Dr. Khoury.

To view this study in greater detail, click here.

A bladder pressure/volume diary helps patients monitor pressure at home and reduces the need for frequent video urodynamics (VUDS) or urodynamics (UDS). As a complementary tool to urodynamics, it provides early detection for high bladder pressures that have the potential to cause kidney damage and renal failure.

Our care and commitment to children has been recognized

CHOC Children’s Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the urology specialty.

Best Children's Hospitals, U.S. News & World Report, Urology, 2020-21

Learn how CHOC’s urology care, ongoing treatment and surgical interventions preserve childhood for children in Orange County, Calif., and beyond

CHOC pioneers medical home for children with autism

The nationwide prevalence of autism spectrum disorder (ASD) in children is one in 54. Finding the most appropriate care for children with ASD, as well as support and education for their families, can be a challenge — a challenge the Thompson Autism Center at CHOC Children’s seeks to make easier.

Thompson Autism Center: Filling the service gap

The Thompson Autism Center is committed to addressing autism defined core symptoms related to social interaction, repetitive behavior and communication via a medical home approach to reduce unmet healthcare needs.

“While our focus is on early diagnosis of ASDs between the ages of 1 and 6, we are also offering many services for the large percentage of children who have co-occurring medical and mental health disorders associated with autism,” said Dr. J. Thomas Megerian, pediatric neurologist and medical director of the Thompson Autism Center.

Dr. J. Thomas Megerian, pediatric neurologist and medical director of the Thompson Autism Center, examines a patient using a stethoscope
Dr. J. Thomas Megerian, pediatric neurologist and medical director of the Thompson Autism Center (left)

“The center is a place for families to come for most of the specialty care needs for their child. Our goal is to have all of the professionals who care for the child communicate with each other in creating a coordinated treatment plan all in one setting, answering questions that families have about their child’s diagnosis and helping to troubleshoot when they are not receiving needed services. We also have specialists who can partner with our families and their school programs to optimize intervention and educational programming and identify appropriate community resources specific to the needs of the child and their family.”

Medical home three-pronged approach

The multidisciplinary Assessment Program offers a comprehensive assessment with a psychologist-led full day evaluation with physicians, speech-language pathologists and occupational therapists as well as a brief confirmatory assessment that’s physician-led, aimed at reducing wait times when a diagnosis is clear.

The Behavior Program addresses refractory behavioral disabilities in a highly structured, safely managed setting to address children and adolescents presenting with agitation, self-injury or aggression. Evidence-based toilet training interventions are also addressed to support each child’s progression. The Behavior Program also offers consultation services for community behavioral therapy providers when a child’s progress stalls despite ongoing therapy.

The Co-Occurring Conditions Program facilitates multidisciplinary consultations, individual or group therapy, and targeting social skill groups to improve interpersonal relationships.

“We also provide transition services and specialists who work on plans for a child’s transition into adulthood,” Dr. Megerian said. “Our mission includes partnering with local organizations, including legal agencies and schools, to provide patients with integration paths into the community.”

Clinical research center of excellence

The Thompson Autism Center is committed to partnering with public and private institutions and government facilities to investigate innovative diagnostics and novel therapies for ASD. Research is ongoing to develop, study and implement behavioral treatments and programs.

“We’re providing a home for groundbreaking research and clinical trials. We’d like to be able to bring clinical trials to the community so that they have safe options for trying novel therapies,” Dr. Megerian said.

Our care and commitment to children has been recognized

CHOC Children’s Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings, and ranked in the neurology and neurosurgery specialty.

Best Children's Hospitals, U.S. News & World Report, Neurology & Neurosurgery, 2020-21

Learn how CHOC’s neuroscience expertise, coordinated care, innovative programs and specialized treatments preserve childhood for children in Orange County, Calif., and beyond.

Fertility future with testicular cryopreservation

Fertility preservation is now a reality for male pediatric and adolescent/young adult (AYA) patients with cancer or blood disorders.

The Hyundai Cancer Institute at CHOC Children’s is a center of excellence and the only program on the West Coast offering testicular preservation for prepubertal patients unable to bank sperm. Testicular tissue is biopsied and preserved in liquid nitrogen.

“Recent research indicates these biopsies contain stem cells, leading to the possibility of generating sperm in the future,” said Dr. Carol Lin, a pediatric oncologist at the CHOC Hyundai Cancer Institute.

Evidence-based research

CHOC participated in an eight-year study alongside U.S. and Israeli institutions to establish a standardized protocol and centralized process to freeze and collect biopsies.

A CHOC Children's pediatric urologist speaks with an adolescent male patient in an exam room

“In total, 189 patients provided samples. A quarter of each sample was used for research and the rest stored for future use. These patients ranged from ages 5 months to 34, with an average age of about 8,” said Lin.

The study discovered that a centralized process and testicular biopsies from multiple sites was a viable option and could accelerate recruitment. Click here to learn more about the study.

Sharing expertise

CHOC is a member of the Oncofertility Consortium, a group of scientists and providers who are committed to fertility preservation in cancer patients. The consortium studies the science of cryopreservation methods, storage of tissue, in vitro follicle growth and communication between patients and doctors, as well as ethical and legal concerns.

Our care and commitment to children has been recognized

CHOC Children’s Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Best Children's Hospitals, U.S. News & World Report, Cancer, 2020-21

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.