Leaders in Pediatric Urological Care

A fellowship with the founder of pediatric urology played an important role in the creation of the pediatric urology practice at the University of Rochester Medical Center (URMC) — the largest, most experienced pediatric urology practice in Upstate New York.

In 1975, the Hospital for Sick Children in Toronto had two fellowship openings: one in pediatric urology research, another in clinical pediatric urology. Ronald Rabinowitz, M.D., accepted the clinical fellowship and was preparing to leave for Toronto from his hometown of Pittsburgh. One month before his fellowship was to start, the person who was going to be the research fellow chose to accept a fellowship in England with David Innes Williams, the world’s first full-time pediatric urologist. Rabinowitz could have both fellowship positions if he wanted them.

As a result of accepting both research and clinical positions, Rabinowitz was able to conduct research after spending his first two months in the hospital’s record room collecting data in addition to his clinical work. This resulted in the publication of 15 clinical research papers. It was a “right place at the right time” defining moment in his academic career.

“Whenever I have seen my British colleague at conferences through the years, I always thank him for choosing London over Toronto,” Rabinowitz said.

Rabinowitz’s career had another strong connection to David Williams. As Sir David served as the only pediatric urologist in England for about a decade in the 1950s and 1960s, he trained many other first-generation, North American pediatric urologists. The urologist Rabinowitz trained under at the Hospital for Sick Children was also trained by Williams.

A perfect match

Growing up near Pittsburgh’s steel mills, Rabinowitz suffered from severe asthma. Spending time in the children’s hospital as a young boy led to his decision to become a doctor. While in medical school, Rabinowitz spent time in pediatric offices. He decided that, rather than become a primary care physician, he wanted to specialize.

Originally, he thought he would become a pediatric general surgeon. But, while rotating in pediatric urology, he became interested in the prospect of treating children with birth defects through reconstructive procedures. He completed his residency in Pittsburgh, including a year at the Children's Hospital of Pittsburgh, before taking on the fellowships in Toronto.

A tennis match is responsible for bringing Rabinowitz to Rochester 45 years ago. While attending the match, he met the then-chair of URMC’s Urology Department, who was looking for someone to handle pediatric urology. Rabinowitz’s expertise was a perfect match for the needs of children in the region, and a new practice was born.

Since then, URMC’s practice has become the largest pediatric urology practice in Upstate New York.

Specialized care for children

Understanding that young people require very different care than adults, the practice’s urologists treat children exclusively and provide comprehensive care for a broad spectrum of urologic diseases.

“Abnormal organs and congenital deformities have a significant impact on young people so reconstructive procedures and specialized treatments are so important to their growth,” said Jean Joseph, M.D., M.B.A., chair of URMC’s Department of Urology. “We focus on giving children the best possible urological care as part and parcel of our medical center and department’s overall mission.”

Conditions and treatments range from neurogenic bladder, voiding dysfunction and vesicoureteral reflux, to prenatal hydronephrosis, testicular torsion, varicoceles, hypospadias, meatal stenosis, penile deformities, kidney stones, kidney abnormalities and urinary tract infections. Experts in pediatric urologic cancer, they also work closely with physicians at the Wilmot Cancer Center, the area's most respected cancer center.

Utilizing video urodynamics, the practice looks at how a child’s bladder functions and provides better treatment. Videogame-like biofeedback therapy teaches children how to relax pelvic muscles to void more effectively. Through animation, patients can see their pelvic muscles on a video screen to see if they are using them correctly.

Recently, the urology practice expanded in-office circumcisions, so infants from newborns to age 5 or 6 months can have the procedure without going to the operating room or needing general anesthesia.

URMC’s practice also boasts Jimena Cubillos, M.D., an expert in minimally invasive, laparoscopic and robotic pediatric urology. A former University of Rochester medical student, Cubillos completed her surgery and urology residencies at Mount Sinai School of Medicine in New York City, and a two-year fellowship in pediatric urology at Long Island Jewish/Schneider Children's Hospital.

With robotic surgery, the practice can treat kidney blockage by accessing kidneys through the belly as opposed to traditional surgery requiring access through layers of muscle. Patients benefit from faster recovery time due to the use of small incisions.

Because of Cubillos’ leadership in robotic pediatric urologic surgery, URMC’s practice receives numerous referrals from the surrounding area, such as Buffalo, Syracuse, Watertown, Ithaca and northern Pennsylvania.

Teaching the next generation

Following the model of Sir David, Ron Rabinowitz has trained a hundred or so urology residents and medical students. He also has authored or co-authored more than 200 scientific articles and textbook chapters.

Passionate about the history of urology, he currently serves as historian for the American Urological Association. He has also served on the AUA board of directors and as chair of the American Academy of Pediatrics Section on Urology. This year, Rabinowitz was honored with the AUA’s Lifetime Achievement Award.

Rabinowitz continues to train and educate the next generation of urologists. “Teaching is not just sharing techniques because I believe that appreciating where we came from makes us better educated,” he said. “My philosophy is that residents are extremely intelligent. My job is to make them smarter and more educated about the history of where our specialty came from.”

Through teaching, advanced clinical care and research, the upstate New York region’s largest pediatric urology practice will continue leading the way in specialized care for children.