Urologists address unmet global burden of surgical disease in India

March 7, 2018, Children's Hospital of Philadelphia
Aseem R. Shukla, MD, is a pediatric urologist at Children's Hospital of Philadelphia Credit: Children's Hospital of Philadelphia

Aseem R. Shukla, MD, a pediatric urologist at Children's Hospital of Philadelphia (CHOP), along with several of his colleagues from around the world, have created an innovative program to help address urological needs in India. The team is specifically addressing bladder exstrophy (BE), a complex, rare disorder that occurs during fetal development when the bladder does not form completely and drains onto the surface of the abdomen. If untreated, the disease raises the risk of serious infections and cancer, along with psychosocial complications.

With a population of 1.2 billion, India accounts for 21 percent of the global burden of disease. Approximately 500 babies are born there with BE each year, and the highly-specialized surgical knowledge required to treat BE is limited to a few major medical centers. The consequent lack of access is what prompted Dr. Shukla, along with Douglas Canning, M.D., chief of the Division of Urology at CHOP, and several of their colleagues from around the world, to create a multi-institutional collaborative that leverages capabilities to alleviate the global burden of this surgically treatable disease, as reported today in JAMA Surgery.

The article describes their project at Civil Hospital, a public in Ahmedabad, India, between January 2009 and 2015. In addition to surgeons at Civil Hospital and CHOP, it joined together experts in urology from various other institutions, including Seattle Children's Hospital, Cincinnati Children's Hospital, and Sidra Medical and Research Center, in U.A.E.

"The international collaboration that we forged has transformed the care of children born with bladder exstrophy here in India and together, we are delivering care and surgical outcomes on par with the best hospitals in the world," said Dr. Rakesh Joshi, director of pediatric surgery at the Civil Hospital, and a lead author of the study. "We have seen our own surgical experience and follow-up care improve not only in the management of exstrophy, but for all complex anomalies as a result of the collaboration. This study confirms that ours is a model to emulate in reducing the surgical burden in this part of the world."

The goals of this program were to not only to address the complex surgical challenges associated with BE and deliver outcomes that would be expected in high-income countries, but also to transmit knowledge to provide long-term patient care for the future. The team accomplished this by partnering with Civil Hospital, which served as a location to train and perform surgeries. Surgeons local to India learned and participated in the procedures so that, with time, they are able to perform them on their own.

A contributor to this collaboration's success was rigorous patient follow-up, which resulted in improved patient outcomes and an accelerated surgical learning curve for participating surgeons. The results were impressive: 76 percent of patients who underwent complete primary repair of BE during the study interval returned for annual follow up in 2016. The same team that performed the surgeries was present for follow up, which helped to ensure cohesive care. Additionally, the team shared resources and infrastructure of academic research centers from higher-income countries.

"This was not simply mission work, it was an opportunity to provide long-term sustainability to our mission and deliver the highest levels of treatment," said Dr. Shukla. "I first traveled to India in 2002, and was awed by the volume and diversity of pathology. I was also moved by the massive burden of surgical disease in children. With Dr. Joshi, we resolved to help change the staggering statistics. While the work in India has been inspiring, we hope that this team and our study will inspire others to implement a similar collaboration model in other countries so they can continue transmitting knowledge and delivering care where it is needed most."

Philanthropy greatly helped power this work. Funding was made possible by generous donors and institutional funds.

In addition to Dr. Shukla's work at CHOP, he is also an Associate Professor of Urology in Surgery in the Perelman School of Medicine at the University of Pennsylvania.

"The International Bladder Exstrophy Consortium: A Model for Sustained Collaboration to Address the Unmet Global Burden of Surgical Disease," JAMA Surgery, March 7, 2018

Explore further: Racial disparities found in children's urologic surgery

Related Stories

Racial disparities found in children's urologic surgery

June 17, 2016
Black children who undergo urologic surgery are more likely than white children to have postsurgical complications and hospital-acquired infections 30 days after the surgery. Researchers studying a national database from ...

Could ambulatory surgical centers help bend the cost curve in US health care?

December 1, 2016
U.S. healthcare costs have more than tripled since the 1960s1. Nearly one of every five dollars of national expenses1,2 are spent on health care. The Patient Protection and Affordable Care Act (ACA)—signed into law in 2010—aims ...

Practice makes perfect in cancer surgery

November 7, 2014
In a new, in-depth research project, Queen's professors Rob Siemens (Urology) and Christopher Booth (Cancer Care and Epidemiology) investigated what affect higher volume hospitals and surgeons had on the outcomes of patients ...

Study of thousands of operations finds overlapping surgeries are safe for patients

December 1, 2016
A common way of scheduling surgeries to expand patient access to care and improve hospital efficiency, known as "overlapping surgeries," is as safe and provides the same outcomes for patients as non-overlapping surgeries, ...

Early surgical follow-up with primary care physicians can cut hospital readmissions

June 26, 2014
Patients who have post-operative complications following high-risk surgery have a significantly lower risk of being readmitted to the hospital within 30 days if they go see their primary care physician soon following discharge, ...

In low- to middle-income countries, barriers to cleft lip and palate surgery persist

October 28, 2016
Charitable organizations perform more than 80 percent of cleft lip and cleft palate surgeries in Vietnam—reflecting the complex and persistent barriers to surgical care in low- to middle-income countries (LMICs), according ...

Recommended for you

Muscle relaxants increase risk of respiratory complications

September 18, 2018
Muscle relaxants are a necessary part of anesthesia during certain major operations. However, studies have hinted at respiratory risks connected with these drugs. POPULAR, a major prospective observational European study ...

Liver allocation system disadvantages children awaiting transplants

September 17, 2018
Children are at a considerable disadvantage when competing with adults for livers from deceased organ donors in the U.S. allocation system, a University of Pittsburgh Graduate School of Public Health-led analysis reveals ...

Gunshot victims require much more blood and are more likely to die than other trauma patients

September 17, 2018
In a new analysis of data submitted to Maryland's state trauma registry from 2005 to 2017, Johns Hopkins Medicine researchers found that gunshot victims are approximately five times more likely to require blood transfusions, ...

Taste preferences connected to success of long-term weight loss after bariatric surgery

September 16, 2018
Following Roux-en-Y gastric bypass (RYGB), a type of bariatric surgery, many patients exhibit a reduction in taste preference for sweet and fatty foods, although this effect may only be temporary, according to new research ...

New insights into what drives organ transplant rejection

September 6, 2018
When it comes to transplant rejection, some organs are far trickier than others. Some transplantable organs, such as the liver, are readily accepted by the recipient's immune system, rarely triggering an immune response and ...

Investigators find that bile acids reduce cocaine reward

August 31, 2018
Bile acids—gut compounds that aid in the digestion of dietary fats—reduce the desire for cocaine, according to a new study by researchers at Vanderbilt University Medical Center and the University of Alabama at Birmingham.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.