Andrew L. Freedman, M.D., newly appointed director of pediatric urology at Cedars-Sinai Medical Center's Endourology Institute, specializes in minimally invasive techniques to correct a wide range of conditions impacting the urinary tract of infants and children. Before joining Cedars-Sinai, Dr. Freedman completed a fellowship in pediatric urology and a year of practice at Wayne State University and Children's Hospital in Detroit, which at the time was one of the leading centers nationwide specializing in fetal diagnosis and treatment.
"We had a very large program for detecting and treating obstructive uropathy -- damage to the urinary tract or to the kidneys caused by an obstruction," says Dr. Freedman. "With ultrasound, you can see very early in fetal development dilation of the kidneys or dilation of the bladder, and you can see low or falling amniotic fluid levels. Our center was one of very few in the world that regularly treated these children in utero by placing a shunt to channel fluid from the bladder into the amniotic space."
Surgeons insert the shunt into the baby's bladder using a scope and tubes inserted through small incisions in the mother's abdomen. Although many pediatric urologists have the technical skill to perform these procedures, not many have the need or opportunity to do more than a few in a career. Even a major referral center may perform only about 10 such operations a year. Therefore, the combination of Dr. Freedman's experience and Cedars-Sinai's already established prenatal diagnostic capabilities provide a specialty referral service for physicians and moms-to-be when a urologic problem is suspected.
"Perinatologists, neonatologists, pediatric surgeons and a variety of other specialists collaborate to take care of these babies' pre- and postnatal needs," Dr. Freedman says. "When prenatal testing reveals a potential problem, we work together to determine the best approach for the baby and family. We may need to intervene prenatally or we may try to wait until the baby is born. In any case, prenatal detection gives us an opportunity to intervene early, before greater injury occurs."
Attempts at prenatal intervention for obstructive uropathies began a couple of decades ago, with mixed results in the early years. "The specialists at Children's Hospital in Detroit and in a half-dozen other centers in North America continued to refine the techniques," says Dr. Freedman. "During my fellowship, I reviewed the cases performed at Children's Hospital, followed up with the kids, and looked at their outcomes. By understanding their outcomes, particularly their long-term outcomes, we could make several inferences. We were able to assess the accuracy of the prognostic tests we were doing before treatment, and we were able to develop standard protocols. Then we looked at innovative, newer ways of doing it."
Dr. Freedman also has a special interest in treating older children who suffer from incontinence. Kids who wet their pants usually have to deal with shame, embarrassment and the taunting of other kids. Parents often dismiss the problem as "a phase" the child is going through.
"We treat childhood incontinence seriously now. We don't just ignore these kids anymore," Dr. Freedman says. "There are things we can do to make this better, and a lot of them are relatively simple." Specialists in several fields diagnose the cause of the problem and provide treatment, which may range from behavior modification techniques to medication to surgery for correction of an anatomic or neurologic abnormality.
Dr. Freedman received his medical degree from Northwestern University Medical School. He completed his residency at the University of California, Los Angeles Center for the Health Sciences, where he served as chief resident in urology. Cedars-Sinai established the Endourology Institute in 2000 under the direction of Gerhard J. Fuchs, M.D., FACS, one of the world's pioneers in endourology. Specialists in endourology use slender scopes and instruments to perform surgical procedures on organs and structures accessible through the urinary tract, without making an incision in a patient's skin. In situations that do not permit the use of endourologic procedures, the least invasive approach -- such as laparoscopic techniques that are accomplished with thin instruments inserted through tiny incisions -- are employed.
With his expertise in pediatric urology, Dr. Freedman participates in pediatric kidney transplants and he works in cooperation with kidney specialists to correct anatomic abnormalities that cause renal insufficiency or renal disease. Using minimally invasive techniques, he also performs reconstructive surgery of the bladder, valves and other structures of the urinary tract, and genitals.
Thanks to improvements in surgical procedures, equipment and supplies, as well as anesthesia and pain management techniques, pediatric operations that used to require open surgery and hospital stays are now being done on an outpatient basis, especially in centers that focus on these types of cases. "Kids are going home very quickly and the quality of life issues regarding surgery have dramatically improved," according to Dr. Freedman.
"I enjoy the reconstructive nature of this specialty. The surgery is challenging, but we can fix most of the things we deal with," says Dr. Freedman. "It has an impact on people's lives, which makes it a very rewarding field. I love working with kids and I love working with babies. It's a great patient population."
Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. It is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
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