Stephanie S Collaborating for a Cure

“Her health problem was very stressful for us, but that’s all gone now — because she’s OK.”

When a child Developed a Serious Urological Condition, Pediatric Specialists Teamed Up To Find The Best Treatment.

Learning that your child has a serious medical condition is a parent’s worst nightmare. But for Petro and Halyna Savanchuk of Scotch Plains, the news was tempered with hope.

When a pregnancy ultrasound suggested that their daughter, Stephanie, had a dilated urinary tract system, a common urological problem that could be secondary to various conditions, hey learned she had a good chance of outgrowing the issue with little intervention. If that turned out not to be the case, expert pediatric nephrology and urology teams at RWJBarnabas Health (RWJBH) Children’s Health network would be able to help.

After her birth, Stephanie had an abnormal backflow of urine from the bladder up one or both of the ureters— the tubes that connect the kidneys to the bladder. (Normally, urine flows from the kidneys to the bladder before exiting the body.) The condition is most common in infants and young children.

“With this condition, the valve mechanism that prevents urine from shooting back toward the kidneys is faulty,” says pediatric urologist Haris S. Ahmed, MD, Co-Chief of the Robotic Surgery Program at The Bristol-Myers Squibb Children’s Hospital (BMSCH) at Robert Wood Johnson University Hospital in New Brunswick. “That can allow urine to back up to the kidneys, which can damage them.”

Although most affected children grow out of the problem, it became clear over time that Stephanie wasn’t going to be among the fortunate majority.

Weighing Multiple Factors

Doctors had first known something was wrong because Stephanie’s left kidney showed signs of hydronephrosis, a condition that occurs when one or both kidneys become stretched and dilated because urine has built up inside them.

When Stephanie was 2 months old, the Savanchuks met with pediatric nephrologist M. Isabel Roberti, MD, PhD, Director of the Children’s Kidney Center at Cooperman Barnabas Medical Center (CBMC), to discuss the problem. A procedure called a cystogram confirmed the reflux diagnosis.

Stephanie’s case was grade 5, which indicates greater severity. “You follow patients at this level closely,” Dr. Roberti says. “If the dilatation remains, patients often need surgery.”

Another factor to weigh was Stephanie’s kidney function. “The right kidney worked 71 percent,” remembers Petro. “But the left kidney was only 29 percent. At the time, it was not a big problem because both kidneys were adequately clearing waste products. But we didn’t know what the future would hold.”

A multidisciplinary team of RWJBH providers considered the complex variety of factors and consulted with one another to determine the best course of action as Stephanie’s condition evolved.

“The collaboration is immediate,” says Dr. Roberti. “If I have a serious case, I can text Dr. Ahmed and he replies right away. We work very closely together.”

RWJBH providers have access to a large and varied network of specialists who are able to bring their capabilities to bear on a given patient’s care. The system’s children’s hospitals were named among the nation’s Best Children’s Hospitals for 2023-2024 by U.S. News & World Report, with BMSCH ranking 47th for urology. The urology ranking recognizes a four-hospital practice that is based at BMSCH but also provides care at three other RWJBH hospitals: Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, McMullen Children’s Center at CBMC and Unterberg Children’s Hospital at Monmouth Medical Center. Similarly, pediatric nephrology care is offered systemwide.

“That breadth and depth of expertise is something we offer that not many places do,” says Dr. Ahmed. “It’s important to receive care in a center where doctors work together in order to prevent any complications and in general facilitate the care of the child,” Dr. Roberti adds.

Haris S. Ahmed, MD
Haris S. Ahmed, MD

A Minimally Invasive Solution

After Stephanie turned 18 months, her situation came into sharper focus. “She’d had recurrent febrile urinary tract infections [UTIs], which are severe UTIs that have been shown to cause scarring of the kidneys,” says Dr. Ahmed. “When a patient is on a suppressive antibiotic to prevent UTIs, it means a UTI that occurs is all the more severe because it managed to break through the antibiotic.”

Dr. Roberti and Dr. Ahmed began to talk seriously about surgery to reposition Stephanie’s ureter in a way that would prevent urine from backing up during urination and entering the kidney. “We didn’t want to risk further kidney damage,” Dr. Ahmed says.

As with specialized pediatric urology and nephrology care, pediatric surgery is available throughout the RWJBH system, giving Stephanie access to a robotic procedure performed by some of the most experienced pediatric surgeons in New Jersey. The RWJBH pediatric robotic surgery program is the first of its kind in the state to be accredited.

Robotic surgery is performed through small incisions using instruments that the surgeon controls from a console. The system can maneuver into hard-to-reach places and greatly magnifies the surgeon’s field of vision. Patients usually spend no more than a night in the hospital, and recovery time is short.

Maria Isabel Roberti, MD
Maria Isabel Roberti, MD

“It’s not very common to do this procedure in young kids,” says Dr. Ahmed. “The smaller a child is, the more challenging it is to do robotic surgery because the space inside the abdomen is limited. But this is something we specialize in.”

The alternative would be to make a larger abdominal incision and cut through muscles. Patients getting this traditional type of surgery usually have a three- or four-day hospital stay and a longer, more painful recovery.

On the day of surgery, Petro and Halyna were nervous and worried. While the procedure itself took about two hours, “We didn’t see our daughter for a few hours,” Petro says. “It was so hard to wait. I’ll never forget that day.”

But Stephanie did well—and has thrived since.

“Her condition is now in the rearview mirror,” says Dr. Ahmed. “Her reflux was cured, and she has not had any additional UTIs.”

“I’m thankful for the doctors and nurses who helped my daughter,” says Petro. “Her health problem was very stressful for us, but that’s all gone now— because she’s OK.”

Learn more aboutpediatric urology at RWJBarnabas Health.