HJNO Jan/Feb 2025

HEALTHCARE JOURNAL OF NEW ORLEANS  I  JAN / FEB 2025 55 for treating bladder exstrophy involves formally reconstructing the bones of the pelvis such that it maintains a more nor- mal alignment and allows her reconstruct- ed bladder and abdominal wall to be free of tension while healing. For this reason, we aim to wait until the bony pelvis is more fully formed, which usually happens around six months of age. This complex reconstruction relies heavily on pediatric orthopedic expertise, andWilliamAccous- ti, MD, with Children’s Hospital New Orle- ans Pediatric Orthopedics has partnered with the urology team for the last 15 years in care of bladder exstrophy patients. After her initial hospital stay, Lydia was discharged at just six days old. Her par- ents were instructed to keep the bladder area covered and protected until she was old enough for surgery, which required a bit of ingenuity. Over the next seven months, Lydia was at Children’s Hospital every month for careful monitoring and assessment. She developed polyps on her exposed bladder, which would potential- ly take up much needed space inside the reconstructed bladder. For her bladder to be as healthy as possible at the time of clo- sure, we excised these polyps and allowed the bladder to completely heal before pro- ceeding with complete reconstruction. At seven and a half months, it was time for her big surgical procedure, which would involve more than ten hours in the operating room. The surgery went well, Christopher Roth, MD Service Line Chief, Pediatric Urology Children’s Hospital New Orleans genital conditions, often have a long first chapter to their life story. Lydia’s first chapter has gone as well as we could have predicted, though we recognize the next chapter has already started. Will she be able to toilet train? Will she have UTIs? Will her orthopedic condition allow her to play sports and dance to the level that she desires? The answers to these questions aren’t known, but the relationship and medical foundation have been set such that the subsequent chapters can end on high notes as well. To be successful in caring for children like Lydia, you need a facility that has a team of pediatric specialists with many different perspectives and ideas. However, for the Lounsberrys, it wasn’t just about the technical expertise, but also the care and compassion of the entire team. This level of care, offered in their home state, helped them overcome an incredibly chal- lenging time. The current star of this story is a daughter and sister who is thriving as a happy toddler. n Christopher Roth, MD, specializes in pediatric urol- ogy at Children’s Hospital New Orleans, where he serves as service line chief for the division of urolo- gy. He received a medical degree from LSU Health Shreveport and completed residency training at LSU Health NewOrleans.Roth then completed fellowship training in pediatric urology at the University of Okla- homa Health Sciences Center in Oklahoma City.Roth is certified by the American Board of Urology and serves on the faculty at LSU Health New Orleans as a professor of urology. with all the reconstructive goals being achieved. Specific to the orthopedic re- construction, an external support system, termed a fixator, was left in place. To keep her urine draining well while her recon- structed bladder and urethra healed, four urinary drains were left in place. All of these devices were needed for her recov- ery, though they make it hard for a fami- ly to get close to their child. For this and many reasons, recovery is a long and hard process, and the Lounsberrys leaned into their support system and made the best of this challenging time. Initially in the hospital and later as out- patient visits, the drains and external fixa- tor were removed as her progress allowed. Each milestone represented its own small victory, though in a bit of irony, the hap- piest moment was a wet diaper. Prior to reconstruction, the urine simply dribbles out of the open bladder and onto the ab- dominal wall. For Lydia, a period of dry- ness followed by a wet diaper meant that her reconstruction was successful! Her orthopedic reconstruction was also a success. The Lounsberrys were warned that Lydia might not hit her developmental milestones on time, and even though she wasn’t expected to stand up until she was 16months old, she was walking well before that. If she stays on track, there may not be a need for subsequent surgeries for her hips and pelvis. Children like Lydia, with complex con-