Ten-year-old Josiah Lee is a typical kid growing up in Tracy, Calif., but his life has been anything but typical.
By age 4, Josiah was having severe health issues. Incontinent of urine and stool, he had a history of imperforate anus, a malformation of the rectum, with associated neurogenic bladder, in which the bladder does not empty properly due to dysfunction of the nerves controlling it. His kidneys also were starting to deteriorate.
But Bernice and Young Lee - Josiah’s parents - heard about Children’s Hospital Central California’s urology team. Fortunately, Dr. Devonna Kaji who is part of that team sees patients at Children’s Pediatric Subspecialty Center in Modesto. The center provides patients in Stanislaus, San Joaquin and Merced counties access to pediatric subspecialty services close to home.
“When Josiah first came to us his kidneys were in really bad shape,” said Dr. Kaji.
Josiah had developed high grade bilateral vesicoureteral reflux in which urine washes backward from the bladder to the kidneys. He was suffering recurring kidney infections along with enlarged kidneys, early kidney failure and high blood pressure.
“With these complex issues you need a pediatric urologist with the experience to take this on,” said Dr. Kaji. “Children’s Hospital has physicians here who can handle these complex cases.”
A pediatric urologist since 1991, Dr. Kaji has expertise in the surgical repair of bladder augmentation, neuro-genic bladder and other complex genitourinary reconstruction. “This is a common congenital abnormality,” said Dr. Kaji. “If we get them when they’re babies with this condition, we’re very aggressive in our treatment.”
Although Josiah was not a baby when Dr. Kaji first saw him, she caught him before it was too late to save his kidneys.
To improve his condition, she performed a urinary reconstruction. This includes a bladder augmentation, which consists of making the bladder larger using a patch of bowel, and reimplanting the ureters (two tubes which carry urine from the kidneys to the bladder), to stop the urine reflux. She also performed a Malone procedure, creating a channel between the belly button and the bowel using his appendix to flush out stool daily.
Josiah now has stable renal function with no kidney infections and the severe dilatation of his kidneys has resolved. He is able to empty his bladder and flush his bowels and is continent of urine and stool.
“These procedures led to better independence and improved self image for him,” said Dr. Kaji. “He can do most of the same activities as his peers, like swimming and riding a bicycle. He’s done incredibly well – I’m
Josiah’s family agrees. “He’s a very tough guy, the toughest I know,” said Young, who owns a computer liquidation corporation in Stockton. “He never complains, he just does what has to be done.”
Josiah continues to see Dr. Kaji for follow-up care once a year at the Subspecialty Center in Modesto. His prognosis looks good.
“He’s going into adulthood without having dialysis – that’s significant,” said Dr. Kaji.
Given Josiah’s improved health, Young said, “life is more back to normal” for him, his wife, and their four girls and two boys, all of whom Bernice homeschools.
“We look at the bright side,” said Bernice. “Josiah is happy and healthy.”