Unique Collaboration Leads to First Multicenter Study for Posterior Urethral Valves
Published May 2019 | Pediatrics
In 2016, a group of pediatric urologists from five hospitals in the Midwest made a momentous decision. Rather than working independently, they would collaborate, with the goal of conducting large-scale clinical studies to improve care for children with urologic diseases.
Calling themselves the Pediatric Urology Midwest Alliance (PUMA), they designed two multisite studies to examine long-term outcomes in rare pediatric urology conditions. One study focused on posterior urethral valves (PUV), and the other on bladder exstrophy. In May 2019, they published the first-ever multisite pediatric urology study focusing on PUV. Brian VanderBrink, MD, a pediatric urologist at Cincinnati Children’s, was the study’s senior author.
The researchers reviewed medical records from 274 infants who were diagnosed with PUV and treated at any of the five participating hospitals over a 20-year period. They aimed to identify clinical variables associated with the risk of renal replacement therapy and clean intermittent catheterization. Their results showed that the risk of both outcomes increased with age, and that serum nadir creatinine (SNC1) levels in the first year of life strongly predicted the need for renal replacement therapy.
These results provide the foundation for future PUMA initiatives to stratify risk in patients with PUV, report outcomes and implement interventions early in life to positively affect patient outcomes, VanderBrink says. “The study’s results created baseline values for PUMA, and served as a springboard to establish consensus on a treatment algorithm for newborns diagnosed with PUV treated at PUMA institutions,” he explains. “This type of collaboration will help us improve family counseling and provide more risk-based screening and intervention strategies for higher-risk patients."
The study was presented at the 66th Annual Meeting of the Societies for Pediatric Urology in San Francisco and was recognized as a finalist for the best clinical abstract.