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Melanie Cole, MS (Host): There’s a lot of information out there about urological issues in men and women. We see it all the time. But children can have their own set of urological issues as well. My guest today is Dr. Amanda Saltzman. She’s a pediatric urologist at UK Healthcare. Dr. Saltzman, let’s talk about the difference between a urologist and a pediatric urologist. What kind of training do you have?

Amanda, Saltzman, MD (Guest): So, urologists and pediatric urologists actually start with the same training. We all go to medical school for four years, and then we do a urology residency which is five years. Then after we've finished our residency, a pediatric urologist does an additional two years of a fellowship just specializing in children and the diseases and operations that you need to become a pediatric urologist.

Host: So, we've also heard about incontinence. Of course, men have many issues when they're having prostate things going on, and women of course from having babies and everything else. What kind of conditions do pediatric urologists see in children? What are some of the most common issues you see Dr. Saltzman?

Dr. Saltzman: So, we see so many different issues. It’s not uncommon that people say, “Well what kind of problems do children have?” Because, exactly like you said, women after having babies have incontinence issues. Men as they get older with prostate issues, but really no one hears about children having issues. A lot of the common things we see will be different sort of congenital anomalies. So, this could be something called hypospadias where in a little boy the pee hole doesn’t get to exactly where it’s supposed to be, and it’s somewhere else along the penis or even in the scrotum. So, we deal with those patients and repair them surgically.

We also deal with undescended testicles. So, testicles that while the little baby was inside mom didn’t quite make it all the way down to the scrotum. And we see those patients, try to give them some time for Mother Nature to work and allow those testicles to come down on their own. But if they don’t, then we go in, we operate, and we can help them get down to where they're supposed to be.

We also see lots of patients who have incontinence. It’s not uncommon for little girls and little boys as they potty train for it to be difficult or for them to become potty trained, but then have a little bit of leakage afterwards. We can deal with all of those types of issues, whether they're anatomic or they're sort of behavioral where kids are so excited about playing and they don’t want to take the time to go to the bathroom. So, they keep playing until they leak on themselves a little bit. So, we deal with lots of issues actually with incontinence as well. Bedwetting is a common thing that we see. There’s no real surgery we do for that, but we certainly counsel patients and work on potentially adding medications as needed to get those kids dry at night.

We also see a lot of urinary tract infections. So, it’s not normal for children to urinary tract infections. So, they often will come and see us as a pediatric urologist to figure out why this is happening. So, there are lots of congenital conditions that can predispose a child to getting a urinary tract infection. So, what we do as the urologist is we figure out if they child has any of those congenital anomalies and then repair them as they need to be.

Another thing we deal with are patients who have spina bifida or anal rectal malformation or spinal cord injuries or issues with their spine that actually effect how the bladder works. So, what’s very important is that we get these kids so they can go to school, and they can have as much of a normal life as they can and not be leaking, not getting urinary tract infections and whatnot. So, we do this through a combination of medications and various reconstructive operations to try to let them gain independence as they get older.

Here in the south, actually kidney stones are very common both in adults and in children. So that’s another thing that we deal with very, very commonly. Then there’s also a whole host of very rare things that we see. I think as pediatric urologists, we sort of specialize in rare because everything we see is rare itself. So, we see sometimes babies while they're in utero that have dilation of their kidneys, dilation of their bladder. Babies either in utero or after they're born who have genitalia that’s ambiguous meaning you can't really tell if they're a girl or a boy. So, we work on figuring out how to determine which one the baby is, and then talk about surgery if that’s indicated and when to do it, et cetera, et cetera.

We also deal with kidney, adrenal, bladder, and various other cancers in pediatric patients. That would also include testicular cancer in teenagers. Which actually testicular cancer is the most common cancer that’s seen in the adolescent boys. It’s a very, very important condition that we deal with.

Host: Wow. What a broad field. It must be so satisfying for you Dr. Saltzman. When you're talking about treatments for children and whether you're dealing with little guys or adolescents as you say, things like urinary tract infections or even bedwetting, as you mentioned, can be embarrassing. Kids often have self esteem issues. Is part of your job to help them through those things as they go through whatever treatment you decide?

Dr. Saltzman: Yes, absolutely. I think one of the biggest things that we can do as pediatric urologists is to sort of normalize some of these more embarrassing conditions. You know, it is normal for 10% of 10-year-olds to wet the bed. Most patients and families that come to me if their children is seven or eight, they have no idea. They think it’s just their kids who wet the bed. So, a lot of it is normalizing it and really telling them how common these conditions can be. But they're embarrassing so people don’t talk about them.

Host: Well they are. As somebody who wet the bed until I was 12 or 13 years old, but then they found that I had an issue. So, I know I also had a lot of urinary tract infections. So that’s why I asked you because there were no real pediatric urologists way back when. So, it was kind of a different field. Tell us a little bit about what makes you unique and what sets you apart at UK Healthcare in your practice.

Dr. Saltzman: So, I think here at UK we can really deliver the entire breadth of pediatric urology. We can do the outpatient managements as far as counselling and medical management of every condition that I can think of. We can offer surgery for any condition that you can think of. We also are very highly trained in pediatric, adolescent, and young adult oncology and dealing with some very unique aspects of cancer treatment and cancer surgery for these patients. Also, survivorship issues.

So younger patients who develop a cancer, whether it’s urologic in origin like a kidney cancer or not. We have done so well with treating these patients. And they survive long term that now we’re realizing 15/20/30 years later, they are having issues related to the treatment of their cancer. So, what we can do as pediatric urologists dealing with very young patients as well as they sort of age out of the typical pediatric practice is address some of those long-term issues related to their cancer treatment. That’s something that I think personally is very, very satisfying.

One of the other unique aspects for us here at the UK is we can offer a complete breadth of surgery. So, we do very simple in office procedures. We can do something called urodynamics, which essentially puts little catheters in the bladder and measures pressures in the bladder and makes sure that bladders are working properly and that the pressures aren’t getting too high, which could potentially cause problems for the patient. We also can do advanced kidney stone surgery. Minimally invasive kidney stone surgery where we essentially take tiny, tiny little instruments and tiny cameras and are able to put that through the bladder up into the kidney, and to use lasers and other technology which kids usually find really cool when you tell them what you're doing. And use that technology to pull out stones and treat them.

Then the final thing that I think makes this program here unique and really unique to the region is that we provide advanced laparoscopy and robotics surgery for patients as well. So, laparoscopy and robotics allows really, really small incisions to do very, very large operations. And usually reconstructive operations where we take some type of congenital anomaly and we establish it back to normality. So, we make it normal again. With laparoscopy and robotic surgery, patients typically have less pain, go home faster, and their scaring is much better than a large incision over their side if we have to do kidney surgery work. So really the whole breadth of urology can be offered here at UK.

One other thing that makes us very unique is we have a total of four providers. Two of them are nurse practitioners and then there are two physicians that do surgery. We actually have the only female pediatric urologist who does surgery, who is myself, in the entire state of Kentucky and in a very, very large area. I think the next closest person is about three hours away.

Host: Wow. It’s so interesting what you do. I was going to ask you about being the only female pediatric urologist in the region. But you also have another unique quality to you Dr. Saltzman. You're involved in pediatric urologic oncology. Tell us a little bit about that and why it’s of interest to you.

Dr. Saltzman: So, when I was going through residency, I was really torn with wanting to do a fellowship either in pediatric urology, which is what I ended up doing, or in urologic oncology and doing cancers and treating patients with cancers. I eventually chose pediatrics because I really loved the patient population. I loved interacting with kids and making them better. What I sort of tried to do in my fellowship was go somewhere that had a very unique aspect to training, which was a focus on urologic oncology. So, I was able to sort of bridge those two interests I had, providing cancer to children, adolescents, and young adults. I’ll see even patients up to age 40 who have a urologic cancer.

What we’re realizing because the field of sort of this adolescent/young adult urologic oncology is very young, we’re realizing that the cancers. So, let’s say a kidney cancer that’s in an 18 or 20-year-old is really different and behaviors very differently than a kidney cancer that you would see in a more “typical” patient like a 68-year-old man. So, the type of cancer that it is is different and the treatment we have is different and the outcomes are different. Really if we are applying treatment methods for older patients in their 60s and 70s to these young patients, there’s some evidence that we might not be doing these younger patients as much as a service as the older patients.

So, this field is really unique, and there’s a whole host of unique issues for children, adolescents, and young adults with cancer. Fertility is a big issue. We are working here to get an oncofertility program started to have patients before they undergo their cancer treatment, which usually effects their fertility both boys and girls, to try to save some of their tissue so that they can have babies in the future. That’s something that when you're treating a 60 or 70-year-old man or woman, you're much less concerned about. Then the toxic later effects of chemotherapy and radiation, when a patient is 60 or 70, that’s much less of a concern than when a patient is four or five.

Some patients who develop kidney cancers that get radiation, depending on where the radiation is, they're at a very, very high risk, especially girls, for getting breast cancer later. That’s something that we don’t typically see in older adults. So, it’s a really, really unique field where you have to think a little bit more 360 degrees because you're treating this patient who’s hopefully going to live a long time. You really have to be thoughtful about what you do to make sure that you're not causing them future problems.

Host: Well I certainly agree with you that fertility preservation for adolescent oncology, that’s a fascinating field. Wrap it up for us Dr. Saltzman. You're such a great guest. Tell the listeners what you would like them to know about the field of pediatric urology, your practice at the University of Kentucky Healthcare, and your best advice for when parents should seek out a specialist such as yourself for situations they might have with their children.

Dr. Saltzman: So pediatric is such a broad, broad field, and that’s one of the main reasons I like it. We see kids that are really young, sometimes even prenatally while they're still inside mom and then up to I’ll see patients up to age 40. So, you get a really wide breadth of conditions and treatments and whatnot that no day is ever the same. I think at UK Healthcare, we offer the entire breadth of pediatric urology. Really, I don’t think there is ever a time that is too early to see a specialist. I think it’s very important to go to the pediatrician or your primary care doctor because they really know you the best. If you are ever concerned that you’d like to see a pediatric urologist or urologist in general, it’s always good to ask. I’d like to see a specialist or what do you think about me seeing a specialist? Because really as a patient and as a family, you need to be in control of your healthcare decisions and really feel like you are getting everything you need and that all your questions are being answered to the best of a physician’s knowledge.

Host: Wow, that’s great information. Dr. Saltzman, thank you so much for joining us today and sharing the information about your very unique field and yourself and your practice. We really appreciate you coming on and explaining what the field of pediatric urology really is. Thanks again. This is UK Healthcast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I’m Melanie Cole. Thanks so much for tuning in.