The Children’s Hospital Urologist Performs Lifesaving Surgery on Infant

OKLAHOMA CITY – Edmond residents Juan and Bibiana Rodriguez were excited to welcome their first child into the world and, after a normal pregnancy, their beautiful boy Simon was born. But only 12 days later, Simon began running a high fever and the Rodriguez family started a journey of surgery and medical care that was crucial to their son’s future.

Initially, doctors thought Simon simply had a urinary tract infection, but it soon became apparent that something more was taking place. The Children’s Hospital pediatric urologist Adam Rensing, M.D., diagnosed Simon with posterior urethral valves, a condition in which extra flaps of tissue, or valves, block the flow of urine so that it cannot leave the body in a normal way. The condition is serious because the baby’s bladder and kidneys can be damaged, sometimes to the point of renal failure.

Posterior urethral valves is a congenital condition that is usually diagnosed during a prenatal ultrasound. However, for the Rodriguez family, the condition was not spotted during the pregnancy. Because the problem was diagnosed early, though, Rensing performed the surgery quickly.

The procedure involves using a scope and a small blade to cut the tissue away so that the urine can flow and the bladder can empty more normally. Rensing compared the condition to the sail on a sailboat that catches the wind.

“When someone needs to pass urine out of the bladder, the valves fill up like a pair of sails and obstruct the flow of urine,” he said. “The valves are an abnormality that only serve as a blockage.”

The Rodriguez family said Rensing and his team have helped them understand and manage a frightening and difficult diagnosis.

“Dr. Rensing is an incredible human being,” Bibiana said. “He is an amazing professional, and we feel like he’s become part of our family.”

Although the surgery was lifesaving and corrected the immediate problem, posterior urethral valves usually causes problems for years to come. The problem begins in utero, when the baby’s bladder fights against the blockage. Because urine can’t get through the urethra, the bladder becomes distended and pushes up against the kidneys, which either don’t develop properly or become damaged. And because of the pressure on the bladder, the urine often flows back up into the kidneys, causing further problems. Even after the valves have been cut away, the bladder can change from a dynamic organ to a static, inflexible state, unable to fill and empty properly.

“The No. 1 thing I tell families is that no matter how quickly we get to the patient and cut the valves, the changes to the bladder and kidneys are lifelong and need to be monitored closely, both by myself as a surgeon and by a nephrologist looking at the medical side of the urinary tract,” Rensing said.

Simon is now 13 months old, and Bibiana said she must insert a catheter three times a day and again just before he goes to bed. He also takes a low dose of daily antibiotics to ward off infections. The daily regimen can be challenging, she said.

“It’s tough for us because I had to stop working – I cannot put him in a daycare,” Bibiana said. “When we do the cathing, we make sure we’re in a clean space and I wash my hands and Simon stays clean. We also make sure he eats healthy foods so that his kidneys don’t have to work too hard. It’s a challenge, but I try to make him feel as normal as I can.”

The Rodriguezes monitor Simon for a return of urinary tract infections, and they see pediatric nephrologist at The Children’s Hospital regularly to assess his kidney function. There are no guarantees about how smooth or difficult the condition will be to manage as Simon grows up. Children born with the condition often wear diapers longer and need intermittent catheterizations to finish emptying the bladder because they have lost the sense of when they need to urinate. The condition can also affect quality of life as the child goes through adolescence and begins spending more time away from his parents.

“With this condition, I’m working with the family to prepare them to handle everything,” Rensing said. “That’s why I think so highly of the Rodriguez family – they are the best parents you could ask for. They’re very on top of things, compliant with recommendations and are forthcoming with any issues they’re having, which is so important with pediatrics.”

As new parents, the Rodriguez family gained the realization that they would do anything for their child, Bibiana said. That keeps her going during the ups and downs of managing Simon’s condition.

“He’s a very happy boy,” she said. “He likes to explore everything and wants to know everything. I know there are no guarantees about his future quality of life, but we are adjusting and we are hopeful.”

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