HJAR Mar/Apr 2026

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2026 39 Ashay Patel, DO Pediatric Urologist and Chief of Urology Arkansas Children’s precisely. As a surgeon breaks the stones, aspiration devices use suction to vacuum small fragments, helping minimize residual pieces left in the kidney, which can help prevent reoperation for leftover stones in children. Traditionally, passive gravity removes the fragmented stone debris, in which the irrigation fluid slowly drains during surgery, clearing the fragments. With an aspiration system, a surgeon can move through the kidney with both passive and active suction, allowing small fragments to be pulled out of the sheath and collected in a container. It enables quicker surgeries, better visualization, lower intrarenal pressure, and less basketing. These techniques and approaches help minimize the need for narcotics post-surgery. Leading Change in Pediatric Pain Management There is a nationwide focus on reducing narcotics use, and one way to achieve this is to reduce opioid prescriptions. An Arkansas Children’s quality improvement project explored reducing prescriptions in urological surgeries. The project revealed that longer-lasting regional anesthetic injection, such as a pudendal block, could be used for all circumcisions rather than relying on prescription narcotics for care at home. It also revealed that for orchiopexy, a surgery to fix undescended testicles, experts can use a caudal block in the operating room for children under 5 years old. Older patients receive local medicine to the surgical area. At Arkansas Children’s, the percentage of pediatric patients prescribed narcotics for orchiopexy has decreased each fiscal year since 2023, from 99.9% in FY2023 to 82% in FY2024 to 39.7% in FY2025. For FY2026, the percentage dropped to 11.5% as of September 2025. Most children do well with non-opioid pain medications after surgery, alternating acetaminophen and ibuprofen, and parents report that their children feel normal again the day following surgery. Providing parents with this assurance goes a long way toward reducing prescriptions for narcotics for post-surgery pain management, which also aids in reducing the opportunity for misuse of prescriptions by non-patients that may occur when a provider gives two or three doses of a narcotic to a pediatric patient who may not use it. We, as pediatric providers, are doing our part to help the state reduce narcotics abuse and prevent downstream effects. While many urologists still prescribe narcotics for some inpatient abdominal surgeries, we are also looking for ways to reduce their usage. For example, there’s a nationwide trend to reduce narcotics for hypospadias surgeries, and urology providers and nurses lead the quality improvement project mentioned earlier, where the team collaborates with anesthesiologists for nerve blockers. The driving force for all these efforts must be a willingness to change our practice patterns so they are better for our patients and our communities. n Ashay Patel, DO, is a pediatric urologist and chief of urology at Arkansas Children’s, an associate pro- fessor of urology at the University of Arkansas for Medical Sciences in Little Rock, and an Arkansas Children’s Hospital Auxiliary and John F. Redman, M.D. Endowed Chair in Pediatric Urology. TREATMENT for urological conditions must consider how environmental factors and society affect pediatric patients. For urology cases in Arkansas, this is evident in two separate areas: kidney stones and prescription narcotics. Experts have developed effective ways to handle these unique patient experiences by revolutionizing medical approaches. Advancing Pediatric Kidney Stone Surgery The southeastern United States is known as the “kidney stone belt” due to the higher prevalence of kidney stones among adults — and, more recently, children. A common cause of kidney stones is an imbalance of minerals and fluids in the urine, but pediatric patients are more likely to have kidney stones caused by underlying metabolic disorders or urinary tract abnormalities that require a specialized pediatric approach. There are nonsurgical and surgical options for kidney stone removal. Comprehensive counseling on all treatment and prevention methods can help determine the best approach for each patient. For nonsurgical options, a clinical dietitian can help families adjust their child’s diet to prevent kidney stones. Surgical stone removal options include ureteroscopy with laser lithotripsy, extracorporeal shockwave lithotripsy, and a percutaneous nephrolithotomy. Not all centers are equipped or have clinicians trained to perform ureteroscopy in children. Historically the use of aspiration devices is less common in pediatric surgery, but they can remove kidney stones faster and more