Duke Pediatric Urology Clinical Research Program

Duke Pediatric Urology is a leader in clinical research in the U.S. We participate in nationwide prospective patient research, conduct novel health services research, and perform translational research in conjunction with basic scientists. In addition, we work with industry to help develop and refine new products for clinical use in children with urologic disorders.

  • John S. Wiener, MD, has been involved in pediatric urology research at Duke since 1997. His primary clinical interests are urologic management of spina bifida and molecular biologic causes of urologic diseases.
  • Jonathan C. Routh, MD, MPH, has received federal research funding for health services research primarily focusing on vesicoureteral reflux, urologic management of spina bifida, stone disease, and pediatric urologic cancers.
  • J. Todd Purves, MD, PhD, in addition to his basic science laboratory, conducts clinical research involving neurogenic bladder and obstructive uropathy.
  • Maryellen S Kelly, DNP, CPNP, focuses her research on voiding dysfunction and the management of neurogenic bladder and bowel in the spina bifida population.

Program Highlights

National Spina Bifida Patient Registry

Duke is one of 14 funded centers participating in the registry administered by the Centers for Disease Control and Prevention. Duke researchers are leaders in the project, particularly in the development of measures of urologic outcomes (CDC Spina Bifida Registry). As of August 2018, over 435 patients at Duke are enrolled in the registry. Five of the 8 publications using data from the Registry have included Duke authors; four had Dr. Routh or Dr. Wiener as first author.

Urologic Management to Preserve Renal Function in Infants and Young Children with Spina Bifida (UMPIRE)

Duke is one of 9 funded centers participating in the registry administered by the Centers for Disease Control and Prevention. This prospective registry follows the urologic management of children with spina bifida from birth to age five years using a standardized treatment protocol. Duke researchers are been instrumental in developing and executing this protocol. Dr. Routh is the chair of the study Steering Committee with the team at CDC and was lead author on the initial publication.

Comparative Effectiveness of Pediatric Vesicoureteral Reflux Treatments

This NIH funded project aims to define the best way to make sure that every child with vesicoureteral reflux receives the best possible treatment, delivered the best possible way, at the best possible time.

Lower Urinary Tract Dysfunction in Patients with and without Diabetes

This project is funded by the NIH to determine the prevalence of lower urinary tract symptoms in pediatric patients with and without diabetes. Duke is the lead site of a multi-site investigation into these symptoms around the country.

Members

Trainees

  • Jason Chandrapal, MD – PGY3 resident 2016-17
  • Kirsten Simmons – MS3 medical student 2016-17

Staff

  • Jennifer Stout, CRC

Selected Achievements

Urologic management of spina bifida

  1. Ortiz TK, Velazquez N, Ding L, Routh JC, Wiener JS, Seed PC, Ross SS. Predominant bacteria and patterns of antibiotic susceptibility in urinary tract infections in children with spina bifida. Journal of Pediatric Urology, 2018, in press.
  2. Wiener JS, Frimberger DC, Wood H. Spina bifida health-care guidelines for men’s health. Urology, 2018, 116: 218-226.
  3. Szymanski KM, Hensel DJ, Wiener JS, Whittam B, Cain MP, Misseri R. Sexual identity and orientation in adult men and women with spina bifida. Journal of Pediatric Rehabilitation Medicine, 2017; 10(3-4):313-7.
  4. Wiener JS, Suson KD, Castillo J, Routh JC, Tanaka S, Liu T, Ward E, Thibadeau J, Joseph DB. Bladder management and continence in adults with spina bifida: results from the National Spina Bifida Patient Registry 2009-2015. Journal of Urology. 200: 187-193, July 2018.
  5. Liu T, Ouyang L, Thibadeau J, Wiener JS, Routh JC, Castillo H, Castillo J, Freeman K, Sawin K, Smith K, Speybroeck A, Valdez R. Longitudinal study of urinary continence among people with spina bifida in the National Spina Bifida Patient Registry. Journal of Urology. 199: 837-843, March 2018.
  6. Routh JC, Joseph DB, Liu T, Schechter M, Thibadeau J, Wallis CM, Ward E, Wiener JS: Bladder reconstruction rates differ among centers participating in National Spina Bifida Patient Registry. Journal of Urology. 199: 268-273, January 2018.
  7. Lupo PJ, Agopian, AJ, Castillo H, Castillo J, Clayton GH, Dosa NP, Hopson B, Joseph DB, Rocque BG, Walker WO, Wiener JS, Mitchell LE. Genetic epidemiology of neural tube defects. Journal of Pediatric Rehabilitation Medicine. 10: 189-194, December 2017.
  8. Wiener JS, Suson KD, Castillo J, Routh JC, Tanaka S, Liu T, Ward E, Thibadeau J, Joseph DB. Bowel management and continence in adults with spina bifida: results from the National Spina Bifida Patient Registry 2009-15. Journal of Pediatric Rehabilitation Medicine. 10: 335-343, December 2017.
  9. Routh JC, Joseph DB, Liu T, Schechter M, Thibadeau J, Wallis CM, Ward E, Wiener JS: Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry. Journal of Pediatric Rehabilitation Medicine. 10: 303-312, December 2017.
  10. Freeman KA, Castillo H, Castillo J, Liu T, Schechter M, Wiener JS, Thibadeau J, Ward E, Brei T: Variation in Bowel and Bladder Continence Across US Spina Bifida Programs: A Descriptive Study.  Journal of Pediatric Rehabilitation Medicine. 10: 231-241, December 2017.
  11. Kelly MS, Thibadeau J, Struwe S, Ramen L, Ouyang L, Routh J. Evaluation of spina bifida transitional care practices in the United States, Journal of Pediatric Rehabilitation Medicine, 2017; 10(3-4):275-81.
  12. Kelly MS, Dorgalli C, McLorie G, Khoury A. Prospective evaluation of Peristeen® transanal irrigation system with the validated neurogenic bowel dysfunction score sheet in the pediatric population, Neurourology & Urodynamics, 2017; 36(3):623-5.
  13. Kelly MS, Hannan M, Cassidy B, Hidas G, Selby B, Khoury AE, McLorie G. Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida. Neurourology and Urodynamics 2016; 35(2):212-7.
  14. Routh JC, Cheng EY, Austin JC, Baum MA, Gargollo PC, Grady RW, Herron AR, Kim SS, King SJ, Koh, CJ, Paramsothy P, Raman L, Schechter MS, Smith KA, Tanaka ST, Thibadeau JK, Walker WO, Wallis MC, Ward EA, Wiener JS, Joseph DB: Design and methodological considerations of the National Spina Bifida Patient Registry Urologic and Renal Protocol for the Newborn and Young Child. Journal of Urology. 196: 1728-34. December 2016
  15. Chu D, Balsara Z, Routh JC, Ross SS, Wiener JS: Continence outcomes with glycerin versus tap water in antegrade continence enemas for management of neurogenic bowel. Journal of Urology. 189:690-3, 2013. https://pubmed.ncbi.nlm.nih.gov/22986031/

Health services research on urologic management of spina bifida

  1. Wiener JS, Antonelli J, Shea A, Curtis LH, Schulman KA, Krupski TL, Scales CD:  Utilization of bladder augmentation versus urinary diversion in patients with spina bifida in the United States. Journal of Urology. 186:161-165, 2011. https://pubmed.ncbi.nlm.nih.gov/21575969/
  2. Wang HH, Wiener JS, Routh JC: Emergent Care Patterns in Spina Bifida Patients: a Case-Control Study. Journal of Urology. 193(1): 268-273. Jan. 2015. https://pubmed.ncbi.nlm.nih.gov/25016137/
  3. Wang HH, Wiener JS, Ferrandino MN, Lipkin ME, Routh JC: Complications of surgical management of upper tract calculi in spina bifida patients: analysis of nationwide data. Journal of Urology. 193: 1270-74. Apr. 2015. https://pubmed.ncbi.nlm.nih.gov/25261805/
  4. Wang HH, Lloyd JC, Wiener JS, Routh  JC: Nationwide trends and variations in urologic surgical interventions and renal outcomes for spina bifida patients. Journal of Urology. 195: Pt 2: 1189-95, April 2016. https://pubmed.ncbi.nlm.nih.gov/26926542/

Health services research on urologic management of vesicoureteral reflux

  1. Tejwani R, Wang HH, Young BJ, Wolf S, Purves JT, Wiener JS, Routh JC: Open versus minimally-invasive surgical approaches in pediatric urology: trends in utilization and complications. Journal of Pediatric Urology. 13(3): 283 e1-6, June 2017.
  2. Wang HH, Tejwani R, Wolf S, Wiener JS, Routh JC: Readmissions, unplanned emergency room visits, and surgical retreatment rates after anti-reflux procedures. Journal of Pediatric Urology. 13: 507. e1-507, October 2017
  3. Wang HH, Gbadegesin RA, Foreman JW, Nagaraj SK, Wiener JS, Routh JC: Efficacy of Antibiotic Prophylaxis in Children with Vesicoureteral Reflux: Systematic Review and Meta-Analysis. Journal of Urology. 193(3):963-936, Mar. 2015. https://pubmed.ncbi.nlm.nih.gov/25196653/
  4. Wang HH, Tejwani R, Cannon GM, Gargollo PC, Wiener JS, Routh JC: Open versus minimally-invasive ureteroneocystostomy: a national population-level database analysis. J Pediatr Urol. 2016 Apr 16. pii: S1477-5131(16)30023-7. doi: 10.1016/j.jpurol.2016.03.014. [Epub ahead of print]
  5. Lloyd JC, Yen T, Ross SS, Wiener JS, Nelson C, Pietrobon R, Routh JC: Estimating Utility Values for Vesicoureteral Reflux in the General Public using an Online Tool. Journal of Pediatric Urology. 10(6):1026-31, Dec 2014. https://pubmed.ncbi.nlm.nih.gov/24766856/
  6. Routh JC, Bogaert GA, Kaefer M, Manzoni G, Park JM, Retik AB, Rushton HG, Snodgrass WT, Wilcox DT. Vesicoureteral Reflux: Current Trends in Diagnosis, Screening, and Treatment. European Urology. 61(4):773-82, 2012. 

Improving clinical management of children with urologic cancer

  1. Routh JC, Grundy PE, Anderson JR, Retik AB, Kurek KC. B7-H1 as a Biomarker for Therapy Failure in Favorable Histology Wilms Tumor.  Journal of Urology. 189(4):1487-92, 2013.
  2. Wang HH, Abern MR, Cost NG, Chu DI, Ross SS, Wiener JS, Routh JC. Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis. Journal of Urology. 192(4):1196-202, 2014.
  3. Rialon KL, Gulack BC, Englum BR, Routh JC, Rice HE.  Factors Impacting Survival in Children with Renal Cell Carcinoma. Journal of Pediatric Surgery.  50(6):1014-8, June 2015.
  4. Rice HE, Englum BR, Gulack BC, Adibe OO, Tracy ET, Kreissman SG, Routh JC. Use of patient registries and administrative datasets for the study of pediatric cancer. Pediatric Blood and Cancer.  62(9):1495-500, September 2015.
  5. Wilcox Vanden Berg RN, Bierman EN, Van Noord M, Rice HE, Routh JC. Nephron-Sparing Surgery for Wilms Tumor: a Systematic Review. Urologic Oncology. 34(1):24-32, January 2016.

Health services research on urologic management of pediatric stone disease

  1. Tejwani R, Wang HH, Wolf S, Wiener JS, Routh JC: Outcomes of shock wave lithotripsy versus ureteroscopy for treatment of pediatric urolithiasis.  Journal of Urology. 2016 Mar 17. pii: S0022-5347(16)03463-7. doi: 10.1016/j.juro.2016.02.2975. [Epub ahead of print] https://pubmed.ncbi.nlm.nih.gov/27208819/
  2. Velaquez  N, Zapata D, Wang HH, Wiener JS, Routh JC: Medical Expulsive Therapy for Pediatric Urolithiasis: Systematic Review and Meta-Analysis. Journal of Pediatric Urology 11(6): 321-7. Dec. 2015. https://pubmed.ncbi.nlm.nih.gov/26165192/
  3. Wang HH, Wiener JS, Lipkin ME, Scales CD, Routh JC: Estimating the nationwide hospital-based economic impact of pediatric urolithiasis. Journal of Urology 193: 1855-59. Suppl 5. May 2015. https://pubmed.ncbi.nlm.nih.gov/25305358/
  4. Young B, Wang HH, Wolf S, Purves JT, Wiener JS, Routh JC: Is the economic impact and utilization of imaging studies for pediatric urolithiasis across the United States increasing? Urology. ePub ahead of print, Jun 2016. https://pubmed.ncbi.nlm.nih.gov/27208819/

Other Health Services Research

  1. Jiang R, Wolf S, Purves JT, Wiener JS, Routh JC: The evaluation of three comorbidity indices in predicting post-operative complications and readmissions in pediatric urology. Journal of Pediatric Urology. 14: 244, June 2018.
  2. Tejwani R, Jiang R, Wolf S, Adkins DW, Young BJ, Alkazemi M, Wiener JS, Pomann GM, Purves JT, Routh JC: Contemporary demographic, treatment, and geographic distribution patterns for disorders of sexual development. Clinical Pediatrics. 57(3):311-318. March 2018.
  3. Tejwani R, Wang HH, Young BJ, Green NH, Wolf S, Wiener JS, Routh JC: Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures. Journal of Pediatric Urology. 12: 388: e1-7, December 2016.
  4. Taicher BM, Routh JC, Eck JC, Ross SS, Wiener JS, Ross AK: The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Pediatric Anesthesia. 27 (7): 688-94, July 2017

Ongoing Collaborations

  • Composition of the urinary microbiome in children – a collaboration with Tatyana Sysoeva PhD at the University of Alabama at Huntsville
  • Defining lower urinary tract symptoms in pediatric patients with and without diabetes- a collaboration with University of Virginia, Children’s Hospital of British Columbia, University of Michigan at Ann Arbor, and Children’s Mercy Hospital
  • Defining molecular biology of inheritance of vesicoureteral reflux – collaboration with laboratory of Rasheed Gbadegesin, MD, Pediatric Nephrology at Duke
  • Immune Expression in Children with Wilms Tumor – collaboration with Smita Nair, PhD, Surgical Sciences at Duke

Advanced Training

Dr. Routh leads an active training program in pediatric urology health services research and is the Co-Director of the Urology Resident & Fellow Research Course. Over the past 5 years, Dr. Routh has served as the primary mentor for 4 urology residents, 1 post-doctoral research fellow, and 4 medical students.  Opportunities for training exist both within the Pediatric Urology group and in conjunction with other Duke groups, notably including the Duke Surgical Center for Outcomes RESearch (SCORES). Dr. Routh’s research group primarily focuses on children with vesicoureteral reflux, spina bifida, kidney stones, differences of sex development, and kidney/bladder cancers; trainees are taught methodological issues in systematic review, decision analysis, comparative effectiveness research, utility estimation, and administrative database analysis.

Drs. Purves and Hughes provide basic science mentorship to residents and fellows in the Urology residency and fellowship programs as well as to Duke undergraduate and graduate science and engineering students.  Dr. Purves serves as a mentor in the K12-KURe fellowship program to provide guidance in the development of basic and translational science projects while also exposing the fellows to the clinical side of their work. A highlight for our lab in 2016 was the awarding of the 2016 Russell Scott Jr., MD, Urology Research Award to Brian Inouye, PGY-3 Urology Resident, for his project on diabetic bladder dysfunction.     

Collaborate with Us

The pediatric urology team is always interested in collaboration and mentoring opportunities.  If interested, please contact any of the pediatric urology faculty (Drs. Wiener, Routh, or Purves). 

 

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