The 2-year-old Israeli boy had already been through two surgeries in the Middle East when pediatric urologic surgeon John P. Gearhart began a 10-hour operation last April. Looking at his young patient with bladder exstrophy, a major birth defect in which the bladder develops inside out, Gearhart knew he was faced with the daunting task of building the boy an entirely new bladder.

“The state of his bladder was so bad, and it was just so small,” Gearhart explains, “that we had to make him a new one.”

To do that, Gearhart borrowed about 10 inches of tissue from the boy’s large intestine. He then connected ureters from the kidneys into the new bladder so that urine could drain properly. Finally, he attached one end of the boy’s appendix into the new bladder and the other side into the base of the navel. By passing a catheter into his navel, the boy will now be able to empty his urine properly.

Hopkins Children’s surgeons, led by Gearhart, perform these man-made bladder procedures about 20 times a year. Since they began operating to correct these abnormalities more than 30 years ago, they’ve tracked 973 cases—and still counting. They successfully repair about 98 percent, and about 75 percent are done at an early enough age so that the child can live without a catheter. Most of the patients referred to Gearhart (who alone has done 223 surgeries) need repair of operations performed at other hospitals that have failed.

“Most surgeons,” Gearhart says, “just haven’t seen very many bladder exstrophies. Our team treats more cases than any center in the world.”