Gino J. Vricella, MD, is an assistant professor in the division of urologic surgery. He specializes in pediatric urologic surgery and pediatric general surgery. His areas of interest include robotic pediatric urology, adult transitional care for urology, spina bifida, and neurogenic bladder.
Dr. Vricella sees patients at St. Louis Children's Hospital, One Children's Place, 2nd floor, Suite A.
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What happened in the course of schooling to influence you to choose your specialty?
During our medical school clinical rotations, the main choice that a medical student was faced with was whether they wanted to do medicine or surgery. What drew me to surgery was I liked the fact that you can see a patient with a problem, figure it out, and have the ability to surgically fix it.
I became interested in urology during medical school at University of Missouri in Columbia. The urologic surgeons there were a great group and took me under their wing. The more time I spent with them, the more urology interested me.
How did you choose pediatric urology?
Initially, I was interested in minimally invasive urologic oncology (cancer treatment of the urinary tract and male reproductive organs). But it was my rotation on pediatric urology service that changed my mind. The head of pediatric urology at Rainbow Babies in Cleveland was a great mentor and a friend and I learned a lot from him. I found I liked embryology and the congenital aspects of urologic development; plus I’ve always enjoyed treating children. Pediatrics was a good fit for me.
What brought you to Washington University?
You can tell from my training and education that I’m a Missouri guy. I was born and raised in St. Louis, attended St. Louis University for my undergraduate degree, and went to medical school at University of Missouri in Columbia.
During medical school, I met my wife, who is also a native St. Louisan. After medical school we both moved to Cleveland to continue our training. While in Cleveland, we started a family and had two children. We were far from home, with two demanding residencies and two young children – we decided we needed help from our St. Louis families.
Beyond this, I think we always knew we eventually wanted to move back to St. Louis. It was about this time that the pediatric urology fellowship opened at Washington University. After my interview here, I was offered the position. But because my wife was still doing her obstetric fellowship in Cleveland, I wasn’t sure I wanted to accept the job, because that would mean living apart for a year.
My wife convinced me to accept the fellowship. She basically said, “Are you crazy? We’ll be fine – just do it.” So I moved back to St. Louis with our two boys. It was a hard year being apart, but it was worth it. My wife finished her training, joined us in St. Louis and is now a maternal-fetal-medicine specialist in town.
Which aspect of your practice do you find most interesting?
There are not many places in the country doing robotic pediatric surgery, let alone robotic pediatric urology surgery. The opportunity to continue and lead the robotic pediatric surgery program was one of the reasons I stayed here after my fellowship. I like the fact that we can offer the latest technologies and options to our patients, and care for them close to home. It’s a very rewarding experience.
When can you use robotic surgery?
The most common robotic surgery we do is called a pyeloplasty. This procedure is performed to correct a congenital malformation of the ureter tube that drains the kidney -- called a UPJ obstruction. We cut out the obstruction and reconstruct the ureter to a normal size to drain the urine -- this prevents kidney damage.
We also use robotic surgery for more complex reconstruction such as ureteral reimplantation. This procedure is performed when children have reflux disease (a condition in which urine from the bladder is able to flow back up into the kidneys). The ureter is re-implanted so urine is not refluxed backward into the kidneys.
Other cases in which robotic surgery can be utilized are for ureteral duplication anomalies. These occur when children have a duplicated collecting system with two ureters that feed the upper and lower portions of the kidney.
With this condition, it is common that either the upper or lower ureter isn’t inserted correctly, or it is inserted into a different part of the body, or into a part of the bladder that doesn’t drain as well. To correct this, we take the ureter that was inserted incorrectly and plug it into the normal ureter that was inserted correctly, so it can drain normally into the bladder.
We now also have the ability to perform a very complex robotic reconstruction called appendicovesicostomy or Mitrofanoff procedure. During the procedure the appendix is tunneled into one end of the bladder and the other end is connected to the belly button.
This reconstruction can help patients who are wheelchair bound, as a result from various spinal disorders, catheterize themselves more easily. We are very excited to offer this procedure that will give our patients more independence from their families and caregivers in their daily lives.
Besides robotics, what other new developments are important in your field?
Another new development would be our adult transitional clinic. A pediatric urologist would naturally take care of a child with spina bifida, who had a urinary tract reconstruction. But then, what happens to that child when he or she turns 18?
Technically, the patient is now an adult, but transitioning to an adult urologist can be difficult. The adult urologist didn’t do the initial surgery, and isn’t as familiar with pediatric urology and the young patient population. The adult urologist may be reluctant to take the young adult as a patient.
Because today’s care and treatment for conditions like spina bifida has improved over the years, more and more of these patients are now living well into their 50s and 60s. Unfortunately, these adults get abandoned, in a way, by the health care system. Just because they are now over 18 years old, doesn’t mean that they still don’t need long-term care. There needs to be someone to bridge the gap to make sure their health needs are being met.
Whether it was spina bifida or some other major reconstruction, these patients have to live with that for the rest of their lives. They’ve trusted us with their bodies to reconstruct them -- we owe it to them to make sure what we did is working. I’ll follow my patients for as long as they want to see me.
Which particular award or achievement is most gratifying?
This might sound a little strange, but I felt like getting my undergraduate degree in biology was harder than medical school. My parents are both from Salerno, Italy, a little town near Naples, just inland from the Amalfi coast. I am first generation born in the United States and the first one in my family to graduate from college. For that reason, my college degree is my most prized possession.
What is the best advice you’ve received?
My dad always told me, “You can have a lot of degrees, but don’t ever forget your roots.”
When I see patients, that advice is always in the back of my mind. They’re here to see me, but they are also here for my empathy and understanding. They want to have someone who doesn’t just comprehend what it says in the books, they want a relationship. That’s really important.
My younger brother, Tony, showed me how to be a better doctor. Unfortunately, Tony passed away from Hodgkin’s Lymphoma during my first year of residency. He was diagnosed when I was interviewing for medical school.
Hodgkin’s Lymphoma has almost a 95% cure rate, but for whatever reason, it just kept coming back in Tony. He saw so many doctors and was admitted to the hospital many times. I would listen to him for hours on the phone just talking about his doctors – “this doctor was nice, that doctor was excellent”. I went to some of his appointments with him and was able to see how some of his physicians interacted with him. Some were great, some not so great.
I learned a lot from my brother -- more than I could ever learn in a book.
If you weren’t a doctor, what would you like to be doing?
I would like to do something creative in the arts. I enjoyed my creative writing and art classes in high school, so I always wanted to be a great writer – either writing stories or music. I also was in a band in high school, and we were pretty good.
I think why I didn’t ultimately pursue this was that the course was unclear and there was a lot of uncertainty there. But with medicine, you go from point A to point B. It’s a career path that’s a little more straightforward, and perhaps a little more suited to the way that my mind works.