2021 was a challenging year for health care providers, including pediatric urology centers. But Craig Peters, M.D., sees reasons for hope, in part because his team moved forward on several innovations that will improve care in 2022.

“There are four important trends that I believe we can take away from our progress this past year related to robotics, multidisciplinary care for congenital anomalies, transitional care for spina bifida patients and outreach clinics in rural communities. These are the trends that will shape the future of our field in 2022 and beyond,” says Dr. Peters, Pediatric Urology Division Director at Children's Health℠ and Professor at UT Southwestern.

Expanding Robotic Surgeries and Simulation Safety Training

The Children’s Health Pediatric Urology Program performs some of the country’s highest volumes of laparoscopic and robotic surgeries, and all of the physicians are certified in the da Vinci Robotic Surgical System.

“There are two big things on the horizon when it comes to robotics,” says Dr. Peters, who received this year’s Menon Award and Lectureship from the North American Robotic Urology Symposium. “One is that we’re going to continue to explore robotics for more complex reconstructive surgery, especially as we look to upgrade to the da Vinci Xi model within the next two years, which could enable us to potentially reduce operating time. The second is improving simulation training to perform robotic procedures even more safely.”

Dr. Peters and his colleague Yvonne Chan, M.D., Pediatric Urologist at Children’s Health and Assistant Professor at UT Southwestern, have launched a safety program using a mechanical prototype that simulates real-life robotic surgical emergencies, like sudden bleeding during dissection.

“In safety training, it can be difficult to get away from a conceptual, scripted exercise that doesn’t mimic a real-life situation,” Dr. Peters says. “We’re moving toward simulations that enable an entire operating room team to actually practice acting in a coordinated manner if we have to deal with an emergency.”

Real-Time Multidisciplinary Care for Complex Congenital Anomalies

In 2021, Children’s Health established a dedicated multidisciplinary clinic for children with complex colorectal and pelvic defects. In 2022, we expect to help more patients. In the clinic, Children’s Health Pediatric Urologists and UT Southwestern Professor Linda Baker, M.D., and Assistant Professor Irina Stanasel, M.D., work alongside pediatric surgeons, gastroenterologists and gynecologists to provide streamlined, coordinated care for these complex patients.

“For complex patients, including children with bladder exstrophy or a cloacal anomaly, the care absolutely has to be coordinated,” Dr. Peters says. “Sometimes we'll do a simultaneous surgery with general surgery, other times patients need support from our gastroenterologist colleagues for nutrition and bowel motility. With this clinic, we’re working toward providing that multidisciplinary care in real-time as much as possible.”

The clinic is developing solutions for common logistical challenges facing multidisciplinary teams, such as scheduling and billing across departments. Our goals include continuing to improve the coordination between specialists and providing the best possible patient experience.

“This clinic is how we’ll take innovation to the next level and continue improving outcomes for some of the most complex patients in our field,” Dr. Peters says.

Improving Transitional Care for Spina Bifida Patients

Most children with spina bifida will have lifelong needs that require multidisciplinary care. One key challenge is ensuring these children can continue to receive the care they need beyond childhood.

“After 18, many young adult patients have insurance coverage challenges and end up with neglected issues that could have been better managed if they had access to the right care,” Dr. Peters says. “We’ve been building a transitional program to care for these patients up until age 26 and, hopefully, bridge that gap to adulthood.”

The transitional program is led by Children’s Health Pediatric Urologist and UT Southwestern Associate Professors Micah Jacobs, M.D. and Bruce Schlomer, M.D., who focus on treating urological conditions caused by spina bifida that often persist into adulthood, such as neurogenic bladder.

“Spina bifida is a rare condition, so we really benefit from putting our heads – and our numbers – together with other centers to draw stronger conclusions that will help improve the new transitional program,” Dr. Peters explains. “We’ve been working to centralize our data and leverage the EMR as a data source so we can better mine our data for trends. In 2022, we hope to have more in-person collaboration with other regional centers and share our data to fuel potentially practice-changing conversations and research.”

Meeting the Unmet Needs of Non-Urban Communities

As access to health care in non-urban and rural communities declines, our urology team has established an outreach clinic to provide care to children.

“Access to specialty care is particularly a growing concern in a state like Texas with a large sprawl and vast rural areas,” Dr. Peters says. “We began our outreach program in Tyler, Texas, about five years ago to reach children in the eastern part of the state, and surrounding states as well. Initially, we had a provider at that location once a month, and today, we have a presence there every week.”

At the outreach clinic, children in this region have in-person consultations for common procedures, like hernia repair and circumcision. For complex conditions, studies and treatment are provided in Dallas, but children and their families can still access a highly specialized provider in their community for an initial consultation or follow-up care.

“Because some children in these areas have difficulties even accessing primary care, I see these outreach clinics as a growing trend nationwide in the coming years,” Dr. Peters says.

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