Although Tuesdee Milam thought her pregnancy was going well, she became concerned at five months when she wasn't feeling much movement from the baby. She made an appointment with her obstetrician.

"I just wanted to go in and make sure everything was still OK, and they did an ultrasound," says Tuesdee, of Keota, Iowa.

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That's when she learned her unborn son, Bentley, had hydronephrosis, a fairly common condition in which a kidney is swollen because of a buildup of urine. Hydronephrosis affects about 5 percent of pregnancies annually. Tuesdee's doctor referred her to University of Iowa Stead Family Children’s Hospital, home to Iowa's only board-certified pediatric urologists. She met with Douglas Storm, MD, who began working with Tuesdee, before her son was even born, to plan how to monitor Bentley during pregnancy and how to properly evaluate and treat her son after birth.

"Prenatal care of children and their families is one of my favorite parts of my job.  Having the privilege to counsel families and help guide them through pregnancy and care for their child during and after their birth is not something that I take lightly," Dr. Storm says. "However, I think that the level of care necessary for these complex children is only available at a place like University of Iowa Stead Family Children’s Hospital, where you have access to a multitude of pediatric and obstetric specialists who can work as a team and develop the best treatment plan for the family and their child."

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"As a dedicated pediatric urologist, I, along with my partners, offer a level of care that is not available by seeing a urologist who sees mostly adult urology patients," he says. "During my pediatric fellowship training, I quickly learned that children are not just little adults and that their management is completely different from an adult. Kids are the only type of patient that we think about. We see pediatric urologic diseases, like hydronephrosis, on a daily basis, whereas an adult urologist may only see these things on a rare basis. Therefore, we develop a comfort level and expertise with these pediatric diseases that an adult urologist does not have the possibility to develop."

Tuesdee's doctor continued to monitor her pregnancy, and when she was a little past the 34-week mark, Bentley was born during an emergency cesarean section. During newborn testing, doctors learned Bentley's platelet count was low. Concerned the low platelet count might indicate sepsis – a potentially life-threatening complication of infection that can lead to organ failure – doctors immediately sent Bentley to UI Stead Family Children’s Hospital's Neonatology Intensive Care Unit (NICU). The family was in good hands; UI Stead Family Children’s Hospital is home to Iowa's only nationally ranked neonatology program with every possible pediatric specialist available around the clock.

During his first year, Bentley returned regularly to UI Stead Family Children’s Hospital to undergo serial ultrasounds and other specialized testing to monitor the growth of his kidneys and to watch for any signs that might indicate that the enlarged kidney was not draining normally. 

"The first ultrasound came back and everything was good," Tuesdee says. "Then when he was nine months old and we came in for the second ultrasound, Dr. Storm noticed a small blockage was forming. He told us it wasn't life-threatening, but that he didn't want us to wait – he wanted him to grow up with two healthy kidneys."

A few weeks later, when Bentley was 10 months old, he had laparoscopic surgery to alleviate the blockage. Complications required a second procedure later that week.

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"From the imaging that we had performed, it became clear that Bentley had developed a partial obstruction to the drainage system of the right kidney, causing a back up of urine into his right kidney," Storm says. "If this is left in place, over time, it can result in damage to the kidney and loss of kidney function. Bentley had two beautiful, healthy kidneys and I wanted to preserve these for the rest of his life."

Using minimally invasive, laparoscopic techniques, Storm removed the obstructed section of the ureter and sewed the unobstructed ureter back to the drainage system of the kidney."

A stent was removed from Bentley's kidney the day after his first birthday, and Tuesdee says doctors expect him to be released from care in April.

Today Bentley is "just a typical 1-year-old," Tuesdee says. "He likes to play with his toy train, and hide in the curtains, and tease his older brother by tugging on his hair."

Tuesdee said she was worried about her son, but was confident in his medical team.

"I knew he was in good hands at the University of Iowa Stead Family Children’s Hospital," she says. "I was worried, but I know University of Iowa is a great place. Dr. Storm was amazing, and he treated my child like his own."

 

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