patient Cynthia and Dr. AuA little over seven years ago, when Cynthia Medina was in fourth grade, she was an active little girl who loved her family and her life in Houston. But, her parents began noticing that she fell while walking for no apparent reason. It began to happen with increasing frequency, and each time, her parents would ask her if she felt okay.

“She always said she felt fine,” said her mother, Marina Rojas Medina. “She was such a strong girl; any time she was sick or hurt she would always say she was fine.”

But, after a particularly bad fall, her mother took Cynthia to the hospital to get examined.

“Before we knew it, they told us she had to be admitted, and that she would need surgery as soon as possible,” Marina said.

An MRI revealed a tumor on Cynthia’s spine. The pressure was affecting her nerves, causing numbness in her legs. Because of the location of the tumor, it was critical that it be removed as quickly as possible before causing further damage to the nerves in her spinal cord.

In August 2015, Dr. Manish N. Shah, associate professor in the Pediatric Neurosurgery division at McGovern Medical School at UTHealth Houston and a pediatric neurosurgeon affiliated with Children’s Memorial Hermann Hospital, the home to the Children’s Neuroscience Center, performed a series of two surgeries to remove as much of the tumor as possible. The surgeries were successful, however, Cynthia developed neurogenic bladder and bowel, which is common among patients who undergo spinal tumor surgeries. This condition is characterized by a dysfunction and loss of sensation in the two organs, and so Cynthia required a catheter to empty her bladder four times a day.

In the following months, Cynthia recovered in the hospital and then went on to receive intensive physical therapy to help her relearn to walk. She also completed chemotherapy, and although she became extremely weak, her inherent determination helped carry her through.

“She really is such a strong girl,” Marina said. “We were all in awe of her throughout this journey.”

Cynthia finally learned to walk using only crutches but, she continued to have issues related to her neurogenic bladder and bowel, including multiple hospitalizations for urinary tract infections. Additionally, due to multiple kidney infections and her neurogenic bladder, her kidney function deteriorated significantly. During one of these hospitalizations, Cynthia was being evaluated by Dr. Rita Swinford, professor of Pediatric Nephrology at UTHealth Houston and pediatric nephrologist affiliated with Children’s Memorial Hermann Hospital, who referred Cynthia to Dr. Jason Au. Dr. Au is an assistant professor at UTHealth Houston, and a pediatric urologist affiliated with Children’s Memorial Hermann Hospital.

Dr. Au and his team are trained in advanced surgical techniques, including minimally invasive procedures that offer shorter recovery times, smaller incisions, less pain and improved outcomes. The collaboration between Memorial Hermann and McGovern Medical School fosters excellent urologic care utilizing advanced technology. Even more, the Memorial Hermann Surgical Innovation and Robotics Institute is one of the largest training sites for robotic surgery in the nation and the only site in the Southwest, making it a leading destination for advanced surgical techniques, including cutting-edge, minimally invasive surgeries.

Cynthia’s kidney and bladder condition progressed to a point where Dr. Au felt surgery was imperative. Together with her care team, Dr. Au believed Cynthia was a perfect candidate for a minimally invasive bladder augmentation and ureteral reimplant—the first at Children’s Memorial Hermann Hospital using this new robotic technology for such a complex surgery.

“Due to the deterioration of her neurogenic bladder, Cynthia developed worsening hydronephrosis, which is a buildup of urine in the kidney, as well as urine reflux and numerous kidney infections, which had drastically affected her kidney function,” Dr. Au said. “If we didn’t operate urgently, she would have been on the verge of dialysis.”

In January 2022, Cynthia became the first patient to utilize robotic techniques for this complex surgery. Through just a few tiny incisions in her abdomen and the use of new and highly specialized technology, Dr. Au performed a bladder augmentation and ureteral reimplant. The purpose of a bladder augmentation is to increase the size of the bladder and also improve its ability to stretch. A ureteral reimplantation is a surgery that alters the position of the ureters—tubes that carry urine from the kidneys to the bladder—to a different spot in the bladder, to correct reflux of urine.

“She has done amazingly well since the surgery,” Dr. Au said. “She left the hospital in three days with significant improvement of her kidney function and resolution of her urinary reflux.

Typically, this type of procedure is done through an open surgery and patients can stay in the hospital for more than a week, so we are thrilled to be able to offer this type of complex reconstructive robotic surgery for patients like Cynthia—especially when we can see improved outcomes such as hers.”

Cynthia, who recently turned 18, is thankful for the care Dr. Au and his team provided. Her mother said she is hoping to go to school to become a nurse so that one day, she can help others just like her.

“Dr. Au was incredible, and we are so grateful to everyone at Children’s Memorial Hermann Hospital,” Marina said.

Learn more about Pediatric Urology Care at Children’s Memorial Hermann Hospital »

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