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

Screening for colorectal cancer spares male patients from intense treatments

November 21, 2018
While screening for colorectal cancer does not reduce mortality, it does reduce the need for chemotherapy and emergency surgeries among male patients, according to a recent Finnish study.

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

Surgery, not antibiotics, should remain first-line treatment for appendicitis: study

November 14, 2018
Treating appendicitis with antibiotics as an alternative to surgical removal of the inflamed organ was found to be more costly in the long term and result in higher rates of hospital readmissions, according to a study by ...

Study finds that in treating obesity, one size does not fit all

November 13, 2018
Analyzing data from more than 2,400 obese patients who underwent bariatric weight-loss surgery, researchers identified at least four different patient subgroups that diverge significantly in eating behaviors and rate of diabetes, ...

Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

November 7, 2018
Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

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.