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Urology

Center for Urinary Tract Reconstruction

The Division of Pediatric Urology at Morgan Stanley Children's Hospital has been an internationally recognized Center for Urinary Tract Reconstruction for more than 30 years. The Center calls on a number of clinical areas to collaborate in urinary tract reconstruction. The physicians in the Division of Pediatric Urology have years of experience and expertise in all aspects of this complex field.

Bladder reconstruction is often necessary in children and young adults born with congenital abnormalities such as bladder exstrophy, posterior urethral valves, and neurogenic bladder secondary to a multitude of conditions, the most common being spina bifida. The Division of Pediatric Urology has a large database of bladder exstrophy patients that was started by Dr. John K. Lattimer continuing through to the present.

Recently, the Hospital's pediatric urologists’ experience with bladder exstrophy has been published, looking for the first time at the long-term effects on the life and lifestyle of patients born with this devastating anomaly. The bladder exstrophy database has more than 300 patients, and our physicians are actively looking into the 25-year follow-up of both primary closure and continent urinary diversion in this group of individuals. In addition to the obvious advantage of having a large number of patients in the database, it makes networking between older patients and new patients something that is uniquely possible in our institution.

Bladder reconstruction is also necessary on occasion in patients born with other congenital abnormalities in the lower urinary tract, including posterior urethral valves (PUVs). PUV’s can destroy the bladder and make continent urinary diversion and/or bladder augmentation necessary. In addition, patients born with neurogenic bladder secondary to spina bifida are often candidates for bladder reconstruction. Morgan Stanley Children’s Hospital physicians have a long experience not only with continent urinary diversion, but also with the use of MACE procedure for management of neurogenic bowel dysfunction in patients with spina bifida.

A small number of females are born with an abnormality known as müllerian failure, or Mayer-Rokitansky syndrome. In these individuals, there is no normal development of the vaginal opening and that often leads to the necessity for vaginal replacement. We have developed a technique for vaginal replacement which has been done at Morgan Stanley Children's Hospital for the last 25 years. We have a long-term database looking at sexual function and satisfaction on a group of 70 patients who have undergone vaginal replacement therapy. Our experience with this type of anomaly is clearly one of the largest in the world.

There are a number of children born with ambiguous genitalia. In children born with ambiguous genitalia, there is often a need for genital reconstruction, including repair of hypospadias. There is often need for scrotal reconstruction as well.

The repair or treatment of ambiguous genitalia not only involves the physicians from the Division of Pediatric Urology, but also is most often done in consultation and coordination with the Hospital's Pediatric Endocrinology, Pediatric Genetics, and the Psycho-Endocrine programs. The management of these children requires a multidisciplinary effort that is best done by an experienced and widely based team.