WCHOB Outpatient Clinics
Pediatric Urology of Western New York PC
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Buffalo, NY 14222
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Leading a major NIH-funded clinical trial, RIVUR
Dr. Saul Greenfield
Dr. Greenfield has authored and co-authored over 100 scientific articles and book chapters. He has been a Visiting Professor at numerous institutions, invited lecturer at the Society of Genitourinary Reconstructive Surgeons, Program Chair at national pediatric urology meetings, current President of the Society
for Pediatric Urology (SPU), past President of the American Association of Pediatric Urologists, and member of the Executive Committee of the Urology Section of the American Academy of Pediatrics. He is Director of Pediatric Urology, Women & Children's Hospital of Buffalo and Clinical Professor of Urology, University at Buffalo School of Medicine and Biomedical Sciences. Dr. Greenfield is a graduate of the University of Pennsylvania School of Medicine;
he trained in Urology at Columbia-Presbyterian Medical Center and Pediatric Urology at the Children's Hospital of Buffalo.
The Department of Pediatric Urology at Women & Children’s Hospital of Buffalo has long been a leader, both nationally and internationally, in research of urological disorders in children, contributing to advancements in treatment aimed at improving the lives of children affected by these disorders.
As evidence of the Department’s unique place among pediatric urology centers, since 2000, Dr. Saul Greenfield, Director of Pediatric Urology, has been awarded grants totaling over $5,000,000 by the National Institutes of Health (NIH) to study pediatric urology issues. Heading the only major NIH-funded clinical trial on pediatric urology in the country, Dr. Greenfield is a principal investigator of a five-center study comparing medical and surgical treatments of vesicoureteral reflux in children. Vesicoureteral reflux causes an abnormal backward flow of urine from the bladder to the kidneys, which can lead to persistent urinary infections and renal damage. It is a relatively common condition, diagnosed in 50,000 children in the United States annually. In this article, Dr. Greenfield speaks about the work carried out by the Department of Pediatric Urology.
Q: You are leading an NIH-funded study regarding vesicoureteral reflux. Please elaborate.
A: First off, we are extremely proud of the grants we’ve received from the NIH and NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases). It’s quite unusual to have an NIH-funded pediatric urology study, even for basic research, let alone clinical research. We are the only major NIH-funded clinical trial in pediatric urology in the nation, and are one of just five clinical centers involved in the study. The name of the study is RIVUR, which stands for Randomized Intervention for children with VesicoUreteral Reflux. I am a principal investigator for the study, which evaluates medical treatments of reflux. Vesicoureteral reflux is most often a congenital condition, and it can cause recurrent urinary tract infections and kidney damage, which may lead to hypertension and kidney failure in children and young adults.
The study is multi-faceted: an ancillary part of the RIVUR study is CUTIE, or Careful Urinary Tract Infection Evaluation. This project assesses the risk of the development of renal scarring in children who have urinary tract infections and do not have vesico-ureteral reflux or any other underlying urologic abnormalities.
Q: How were you uniquely placed to qualify for these grants?
A: Women & Children’s Hospital of Buffalo has been a leader nationally and internationally in the reflux field. We have reported the largest single institution series of children with reflux, in addition to numerous other surgical, clinical, and basic science investigations in this area. This project is a continuation of our previously published work—we have been investigating and publishing in this area for the better part of 20 years—and it also reflects the national recognition that our work has received. To be awarded NIH funding, it’s very helpful to have a track record, particularly in terms of publications and investigations in your field. Also, when pursuing additional funding after the initial grant, we were ranked according to our performance, and our score was very high. The NIH was very pleased with how we were conducting our research.
Q: What makes this research so timely?
A: Reflux is one of the most common problems we deal with in pediatric urology. In this study, we accept patients from one month to 71 months, but many of our patients are infants. It’s a very controversial area because there are lots of arguments about what to do with medications and surgery. This project is intended to answer some of those questions.
Q: In terms of treatment, please discuss your urology program and the team in place at the hospital.
A: Another program we have initiated is called CUPID, which stands for the Center for Urinary Pediatric Incontinence Disorders. Within the center, we have an interdisciplinary team dealing with urinary incontinence disorders in children. The team consists of physicians, nurse practitioners, and a nurse specialist, who performs urodynamics testing and biofeedback therapy. With biofeedback therapy, we work with children who have abnormal voiding function, so that they learn to void normally. We also have an on-site lab that allows us to assess the innervation of the bladder and to assess bladder function, which is particularly useful for children born with neurologic problems like spina bifida. We also use the lab to diagnose and treat otherwise healthy children who have abnormalities that affect nerve control of the bladder.
Q: The Department performs over 1,000 surgical procedures per year, encompassing all aspects of reconstructive pediatric urological surgery, from the very commonplace to the tertiary. Your facility is particularly well regarded for certain surgical procedures.
A: We have had great success with hypospadias repair (reconstruction of an incompletely formed urethra). Hypospadias occurs in one of 200 live births, and only pediatric urologists perform this type of surgery. Here in Buffalo, we have published extensively on the subject and demonstrated superior surgical outcomes. We do long-term follow-up with our patients, tracking them into young adulthood, and they have shown excellent results with minimal complications.
We are also innovators when it comes to treating patients with ambiguous genitalia or intersex patients. Women & Children’s Hospital of Buffalo is one of the few hospitals employing an intersex team, which consists of urology, endocrinology, and psychology specialists who take an integrated approach to working with children born with ambiguous genitalia. Very few children’s hospitals have a program like ours.