Nemours/AI DuPont Pediatric Urology Update Welcome New Pediatric Urology Faculty InterStim™ in Children

Nemours/Alfred I DuPont Pediatric Urology Update

2020 Pediatric Urology Visiting Professor John S. Wiener, MD, FAAP, FACS

On October 14 and 15, 2020, the Division of Urology at the Nemours/Alfred I DuPont Hospital Children hosted the 2020 Pediatric Urology Visiting Professor and William L. Ferris Memorial Lectureship in Pediatric Urology in a virtual format.

This year’s visiting professor was Dr. John S. Wiener, Head, Section of Pediatric Urology and Professor of Surgery (Urologic Surgery) and Pediatrics at Duke University School of Medicine in Durham, North Carolina. On October 14, 2020, Dr. Wiener gave Pediatric Grand Rounds at Nemours, and his lecture was titled, “A Pediatric Urologist’s View of Spina Bifida.” The lecture was followed by a series of case presentations and discussions by the urology residents, ably led by the senior resident on the Pediatric Service, Dr. Victor Kucherov (PGY-5), who served as master of ceremonies.

On October 15, 2020, Dr. Wiener visited the Department of Urology at Jefferson, virtually, where he presented the lecture on “Men’s Health in Spina Bifida.” Dr. Wiener has extensive experience in the urological issues of spina bifida, having served on numerous committees on spina bifida, including the Coordinating Committee, Centers for Disease Control and Prevention National; the Spina Bifida Patient Registry Advisor; Urologic Protocol for Neurogenic Bladder in Newborns & Young Children with Spina Bifida Centers for Disease Control and Prevention; Congenitalism Task Force, Society for Pediatric Urology, where he served as Vice-Chair. He has been part of the Examination Committee American Board of Urology/American Urological Association. John S. Wiener, MD, FAAP, FACS, 2020 Pediatric Urology Visiting Professor

Welcome New Pediatric Urology Faculty Keara N. De Cotiis, MD

Dr. Keara N. De Cotiis joined the Department of Urology as a pediatric urologist at Alfred I. DuPont Hospital for Children/Nemours in July 2020. Keara completed her undergraduate education at Villanova University and followed with her medical training at New Jersey Medical School in Newark, NJ. She then completed urology residency under Dr. Anthony Caldamone at Brown University. Next, she completed her training with pediatric urology fellowship at the Hospital for Sick Children in Toronto, where she focused on pediatric urologic oncology and renal transplantation. She feels privileged to join such an outstanding group of urologists and is excited to return to the Philadelphia area.

Keara N. De Cotiis, MD is our newest faculty member in the Department of Urology.

AI DuPont Pediatric Urologists Pioneer InterStim™ in Children

Sacral neuromodulation was first described in children 15 years ago but has lagged behind the adult population in regard to its widespread acceptance. While InterStim™ lacks formal FDA approval in patients under 16 years of age, it has been found to be an excellent option for children who struggle with chronic bladder and bowel issues.

Nemours, as the only institution in the Delaware Valley implanting InterStim™ in the pediatric population, introduced this technology to patients in 2016. Pediatric Urologist, Jennifer Hagerty, DO, and Pediatric General Surgeon, Erin Teeple, MD have implanted more than 30 children as young as 4 years of age.

The concept of neuromodulation involves implanting a neurostimulator with a lead that electrically stimulates the sacral nerve. Through this process, it is thought to normalize neural communication between the bladder and brain and between the bowel and brain and potentially treating both overactive and underactive bladders. conditions like cerebral palsy, mitochondrial cytopathy and anorectal malformations. These patients require extensive workups and trials of several other modalities prior to undergoing implantation.

There is very limited data in the literature regarding a condition known as mitochondrial cytopathy in pediatrics and this has been an area of focus for Dr. Hagerty and her team. This particular subset of patients, in addition to their other complex debilitating medical conditions, often have the additional burden of severe dysfunctional elimination and bladder discomfort. They tend to wear diapers and do not consistently empty their bladders. Catheterization is typically very difficult in this sensate group of children. InterStim™ has allowed these children to avoid intermittent catherization and be dry giving them one less stressor in their complex lives.

Dr. Patrick Shenot, Professor of Urology, has extensive experience in sacral neuromodulation and has collaborated with Dr. Hagerty in this area. “This approach to bladder dysfunction in adults has been a significant step forward in improving their quality of life. It is rewarding to see our pediatric colleagues at AI DuPont apply this technology to improve the lives of children who have benefitted from sacral neuro modulation with the InterStim™.” Dr. Jennifer Hagerty is applying sacral neuromodulation techniques in pediatric urology.