Goals of Urological Care

So the specific goals of urological care, once we've identified that your child does indeed have urological involvement based on their interectal malformation, our goals then are again, protect the upper tracts, and I can't say this often enough. In today's day and age, if a child is born with healthy kidneys, we need to keep those kidneys healthy. Allow for unobstructed urinary emptying without any episodes of incontinence or infections. So infections happen when there are two things happening in the urinary tract. One is that there is stasis, so the urinary tract is not emptying completely, and there's high pressure. The high pressure can come either from pressure within the bladder or pressure from outside the bladder from a child who's really, really constipated. We also want to allow your child to develop social continence, and we define this as being able to control the bladder for 3 to 4 hours during the daytime and 8 to 10 hours overnight. And last and most importantly is that we want their quality of life to be as good as we can make it and permit them to be independent in their care so they can go and enjoy life to its fullest. This is just a diagrammatic representation of our holistic care model. So again, we look at your child as a whole and not just as a as a collection of organ systems. And again, this is based on a Jesuit principle of kura personalis care for the whole individual. And our goal in the middle there is for them to have every one of our patients and children that we take care of to have a full and productive life. And that their overall health be maintained. And, uh, you know, we talk about the um the renal health. So I'm going to have Jay put up a a copy of our slide that we've created to help parents understand what does that mean. So here I have a a a a pictorial patient aid that we've created to help parents understand what is a chronic kidney disease stage and what does that mean for their child. The National Kidney Institute here in North America came up with a stratification system. That tells us how concerned we should be about a child's kidney health. And this, this is a year where there's been executive orders signed in place to ensure that individuals have access to care to ensure kidney health, because when the kidneys aren't healthy, the impact on the overall body's health is significant. So CKDU 0 is when your renal function is completely normal and there's nothing wrong with your child's urinary tract from a structural standpoint. CKD1 is that the kidney function is normal, but there is something structurally not normal with them. So either your child has only one kidney, um, they may have a bladder that doesn't work well, high grade reflux, some scarring in their kidney, but again, the kidney function is normal. And then we go down from CKD1 all the way down to CKD 5. Each change in stage is based on a measure of how much kidney function has been lost. And uh so on this side of our card here we actually show it in a diagrammatic manner that, uh, you know, so CKD1, you have between 100 and 90% of your overall kidney function still present. As you go to CKD2, now we're down to 89 to 60% of your overall kidney function being present, which means up to 40% of your kidney function may have been lost. And then CKD 3A, we're down to 45% kidney function present, 55% of your overall kidney function has been lost. A CKD 3B, 70% of the kidney function's lost. When we get to CKD4, we're now looking at 85% of the kidney function has been lost, and when we're at CKD5, it means that you're imminently looking at being started on either dialysis, some form of renal replacement therapy, whether it's dialysis or a kidney transplant. So this card helps parents understand what that CKD designation means, and it is important that at every visit, That the urologist is actually doing a measurement of your child's kidney function. I'm not just looking at an ultrasound, because how a kidney looks on an imaging test has really no bearing on how well the kidney is functioning. You can only get that assessment from a blood test, and it is critical that this test is done at least once a year. We also want to make sure that whatever care. Treatment interventions that we're going to be providing for your child will maximize their quality of life with minimizing the complications from multiple surgeries, and as Debbie Reeves correctly pointed out that, you know, we want to make sure that if we're going to the operating room, we're talking to other surgeons and saying, does anybody else need to do anything surgical? Can we minimize the number. Anesthetic complications that your child might be exposed to. There is now data coming out that repeated anesthetics do actually have an impact on the developing brain, and we are very cognizant here at Cincinnati Children's about that. And we really try to minimize the number of times that your child is exposed to anesthetics during our involvement in their care. We want to ensure that they achieve social continence at an age-appropriate time so they can go to school and not worry about being the child that's in the classroom that's being made fun of by other children because they don't have good control on their urinary tract or their um bowels. We want to ensure that an age appropriate time that they do have rewarding sexuality and fertility, and we're thinking about these things when your child is 2 or 3 years old to make sure that we are protecting all of the ducts and organs that are involved in ensuring those functions later in life. And lastly, we want to make sure that when your child becomes an adult that they can integrate into society with a very well formed sense of who they are, their body image, and what their quality of life is going to be. And we do this in the context of family-centered, patient-focused, but also culturally appropriate care.