John S. Wiener1, Carina Zhang2
1 Section of Pediatric Urology, Duke University, Durham, NC, USA.
2 TAU Editorial Office, AME Publishing Company.
Correspondence to: Carina Zhang. TAU Editorial Office, AME Publishing Company. Email: tau@amepc.org.
Editor’s note
Translational Andrology and Urology (TAU) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year TAU launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Pediatric Urologic Malignancies”(1) led by Dr. John S. Wiener (Figure 1), Dr. Jonathan C. Routh, and Dr. Nicholas G. Cost has attracted many readers since its publication. This special series was devoted to the contemporary practice of pediatric urologic oncology. At this moment, we are honored to have an interview with Dr. Wiener to share his scientific career experience and insights on this special series.
Figure 1 Prof. Marco Scarci
Expert introduction
Dr. John S. Wiener serves as Professor of Urology & Pediatric and Head of the Section of Pediatric Urology at Duke University in Durham, North Carolina USA where the team has grown from a single surgeon to adding a fourth this fall. Duke has provided a collaborative environment for research and state-of-the-art clinical care that improves the lives of children with genitourinary disorders. This has allowed him to be involved in all aspects of pediatric urology including oncology, neurourology, reconstructive surgery, and stone disease. The urologic management of spina bifida has been his primary research focus of late due to a robust all-ages robust clinic and fortuitous timing with sponsored research opportunities with the U.S. Centers for Disease Control and Prevention (CDC).
Interview
TAU: What motivated you to specialize in the field of pediatric urology?
Dr. Wiener: Pediatric urology is the best field in urology! We get to partake in all of the best parts of urology – oncology, reconstructive surgery, stone management, neurourology – all in one age group, rather than subspecialize in only one discipline. I was blessed to begin working in operating rooms at only 17 years of age and was awe-struck by the art of surgery. This drew me to pediatric urology which incorporates some of the most intricate and demanding surgeries in urology. Additionally, the anatomy and relatively clean surgical planes make these operations such beautiful journeys. Much of pediatric urology involves the correction of congenital deformities, so it is a natural choice for anyone who has a passion for embryology. Finally, who could not love spending every day around children?
TAU: Could you briefly introduce how the progress in the field of anesthesia has contributed to the development of pediatric urologic oncology？
Dr. Wiener: Back in mid-twentieth century, anesthesia in children was a risky endeavor. Without safe and consistent anesthesia, major operations in pediatric urologic oncology, such as resection of a large Wilms’ tumor or radical cystectomy for rhabdomyosarcoma, were very morbid and potentially fatal. Maintaining homeostasis of fluids and temperature are keys to successful outcomes. Refinements in anesthesia have allowed for better post-operative pain control as well as development of newer surgical approaches such as partial nephrectomy or minimally invasive approaches using robotic-assisted laparoscopy.
TAU: What do you think are the biggest challenges that researchers face when studying pediatric urology, and how do you think these challenges can be overcome?
Dr. Wiener: The biggest obstacle for pediatric urology researchers is securing consistent funding. Even the common entities in pediatric urology, such as vesicoureteral reflux or hypospadias, are relatively rare compared to adult urologic issues like prostate or bladder cancer, female stress urinary incontinence, or adult stone disease. Governmental agencies and private industry both see a greater return on their investments by funding research involving these more common urologic disorders of adults. Despite these challenges, pediatric urology research is growing by leaps and bounds. Pooling resources in collaborative and multi-institutional research endeavors, such as the Children’s Oncology Group (COG), International Society of Pediatric Oncology (SIOP), and the CDC’s Spina Bifida Program, can help overcome these challenges and have raised the quality of ongoing research.
TAU: How do you see the future of pediatric urology?
Dr. Wiener: Looking at the whole world on a macro level, we currently have an imbalance. Traditionally, pediatric urologists has been concentrated in high income countries which are seeing declining birth rates and incidences of many congenital disorders. This has translated to fewer index cases for a growing number of surgeons. As we, our patients, and their families increasingly demand superior outcomes, there has been a growing trend to concentration of complex cases to centers of excellence where teams of experienced pediatric urologists work together. Conversely, low and middle income countries have a greater pediatric urology disease burden with their younger and growing populations, but many lack the adequate surgical expertise and capacity. Pediatric urologist Catherine deVries, an expert in global surgery, has highlighted this issue and is leading the charge to have pediatric urologists from more developed countries work with colleagues in less developed countries to address this care gap and disseminate both knowledge and expertise.
On a micro level, technology will continue to drive changes in pediatric urology. Artificial intelligence may aid in better diagnosis and standardization of urodynamic and imaging evaluation for children with uropathies and, ideally, improve treatments. Miniaturization will make it easier to incorporate more and better minimally invasive techniques of laparoscopy and endourology to the smallest of children.
TAU: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more comprehensive series?
Dr. Wiener: One of the most gratifying aspects in pediatric urologic oncology has been the dramatic advances in survival over the past 75 years. As the field has advanced from focusing merely on curing cancers, we have gained a greater appreciation of the lifelong morbidity and disabilities left in the wake of that success. I am impressed by the many researchers working on ways to reduce the morbidity of cancer treatments without compromising efficacy. There has been progress on many fronts from reducing the systemic toxicity of anti-neoplastic agents, applying new biologics to target specific malignancies, and incorporating minimally invasive surgical techniques to make big operations not so big.
Reference
1. Pediatric Urologic Malignancies. Available online: https://tau.amegroups.com/post/view/pediatric-urologic-malignancies