Early Interventions Best for Peds With Congenital Kidney and Urinary Tract Anomalies
When a child is born with urologic organs outside his or her body or with a serious urologic condition, parents call Shumyle Alam, MD, Director of Pediatric Urologic Reconstruction and Medical Director of Urodynamics, NewYork-Presbyterian/Morgan Stanley Children's Hospital. Dr. Alam and his team take on some of the country's most complicated, maximally invasive urologic surgeries and kidney transplants.
"We take special care to deliver the best possible outcomes," said Dr. Alam, who is Assistant Professor of Urology at Columbia University Medical Center. "When we build a bladder from scratch or we reconstruct a urinary tract, parents should expect the child to be healthy, dry and free from complications. Additionally, since we're talking about children, there should be an 80-year warranty on our work."
Having operated on patients from nearly every state in the U.S., and several other countries, Dr. Alam has become the go-to surgeon and advisor for parents whose children suffer from urinary tract issues and renal disease.
Dr. Alam's surgeries demand time, precision and patience. A routine surgery typically lasts eight to 10 hours, but his longest went over 23. "I'm very pleased that in two years and over 65 urinary tract reconstructions, we've had only one surgical site infection," he said. "And that was a long time ago. Our commitment to safety guides my work.
"We have a world-class center right here in New York with unparalleled energy and excitement," he said. "We're delivering high-complexity quality care while also trying to change the face of pediatric urology."
'Put Myself Out of Business'
Many of the patients Dr. Alam sees have varying degrees of kidney and bladder ailments resulting from medical and anatomic complications that need to be addressed. "Most of the kidney transplants we perform are for patients in the 15 to 25 age bracket who have had persistent problems with the urinary tract, which ended up attacking their kidneys," he said. "Somewhere along the line, my patients saw a series of experts who did the best they could but didn't treat the child holistically or see the long-term outcomes caused by their course of treatment."
Dr. Alam hopes to put an end to this type of practice. "My biggest goal is to put myself out of business," he said.
To that end, he analyzes large data sets to identify patterns in stages of renal diseases, transplant patients and outcomes, and neurogenic diseases. Patterns that emerge in the North American Pediatric Renal Trials and Collaborative Studies database, the Pediatric Health Information System database and the U.S. Renal Data System shed light on what leads patients with congenital anomalies of the kidney and urinary tract (CAKUT) down the path of severely invasive treatment.
"We're looking at how to standardize care and catch things early, so kids don't end up needing major urologic reconstruction or a kidney transplant," Dr. Alam said. "Right now, there's a lot of opinion and pomp about how things should be done, but that's offered without concrete long-term evidence."
The burgeoning evidence Dr. Alam sees suggests early, effective interventions could save kidneys and urinary tracts in patients with CAKUT and decrease long-term treatment.
"By taking a more holistic approach and standardizing care, we can decrease costs drastically," he said. "Right now, we spend several hundred million dollars a year for CAKUT patients who progress to end-stage renal disease. We cannot only decrease that cost, but we can also relieve patients and parents from years of physical and emotional anguish."
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