(From the January 2015 Issue of PediatricsOnline)
Urology is a specialty ripe for innovation in surgical techniques, investigation into the basic science underpinning clinical care, and enhancements in therapies for patients. By supporting the work of current and incoming clinician-scientists, urology programs can improve the state of the specialty. This year, our program welcomed two new physician-researchers to our faculty: Christina B. Ching, MD, and former Nationwide Children’s Hospital Urology Fellow Daryl McLeod, MD, MPH.
Dr. Ching: Uncovering the Complexity of the Urothelium
Christina B. Ching, MD, joined the Section of Pediatric Urology at Nationwide Children’s in September 2014. Straight on the heels of her training at Cleveland Clinic and Vanderbilt University, Dr. Ching hopes to build her career at Nationwide Children’s as a clinician-scientist investigating the urothelium of the genitourinary tract. Up to 40 percent of her time is dedicated to research.
Dr. Ching believes that the disruption of the urothelium can lead to damage of the underlying tissue layers, perhaps affecting detrusor muscle and nerve function. Currently, she plans to investigate how protein expression in the urothelium may affect susceptibility to infection and the influence of the underlying stroma on urothelial cell marker expression. She also will examine the urothelium’s underlying stroma in different regions of the genitourinary tract.
“There has not been a great deal of emphasis on the potential for urothelial markers to vary based on urothelial location — urethra vs. bladder vs. ureter vs. kidney,” says Dr. Ching, who is also trained in both open and minimally invasive surgery techniques. “I think it is possible that some of these differences may account for why some patients are more prone to infection or have certain urologic developmental disorders. For example, variation in urothelial protein expression may determine which children with vesicoureteral reflux develop recurrent infections and which do not.”
Dr. Ching intends to work toward funding from the National Institutes of Health. Future plans for research include the evaluation of urothelial protein expression in children with other significant urogenital malformations to understand whether specific regional urothelial markers or patterns of differentiation are important in the development of urologic pathology. Dr. Ching hopes that urologists may eventually be able to provide more tailored clinical care.
“If we were to find that a certain urothelial marker may indicate which patients with vesicoureteral reflux are likely to fail conservative treatment, we may be able to predict which patients should be offered surgery up front versus being more conservatively managed,” she says. “This may ultimately enable targeted gene therapy to treat patients with abnormal urothelial protein expression.”
Dr. McLeod: Adding Science to the Art of Urologic Surgery
Daryl McLeod, MD, MPH, officially joined the faculty of the Section of Pediatric Urology at Nationwide Children’s after completing his fellowship here in June. His fellowship efforts led to two peer-reviewed publications in just the first half of 2014. At the root of his research is the goal of improving outcomes for urology patients requiring surgical intervention.
“Historically, surgeons continue practices that they were taught by clinical mentors and rarely change their practice patterns,” Dr. McLeod says. “This model is changing, though, with surgeons realizing the need to critically analyze how patients are cared for and publish these results to improve overall care.”
By challenging surgical dogma, Dr. McLeod and his colleagues at Nationwide Children’s have already revealed the benefits of a simplified procedure for penoscrotal webbing called a Double-V, which reduces scarring. They have also demonstrated the clinical practicality of avoiding partial nephrectomies in the case of duplex renal anomalies. According to Dr. McLeod, this is just the beginning.
Other investigations Dr. McLeod has underway include identifying preoperative risk factors for children undergoing major urologic surgery from a national database, an international survey of practitioners on the urologic management of newborn spina bifida, and an analysis of pediatric foreskin surgery and general anesthesia following the recent American Academy of Pediatrics’ positive benefit-to-risk statement.
Fifty percent of Dr. McLeod’s time is protected for research. Over the next several years, he hopes to obtain funding from the National Institutes of Health and the Patient Centered Outcomes Research Institute for his planned work on newborn management of spina bifida. He is also designing a prospective study at Nationwide Children’s and other academic centers around the country to explore family-centered decision making for the care of these children.