Pediatric Urology Midwest Alliance (PUMA)

When it comes to rare urological conditions, there is strength in numbers.

That’s why leading surgeons at five of the region’s premier children’s hospitals have formed the Pediatric Urology Midwest Alliance (PUMA). PUMA gives urologists the opportunity to learn from each other in order to improve patient outcomes for the field’s most complicated and rare conditions, such as bladder exstrophy and posterior urethral valves.

PUMA strives to serve patients through three primary activities:

• Continuous surgical education via mentorship, coaching and regular training opportunities
• International missions and intensive surgical immersion experiences
• Collaborative research efforts and data analysis

Improving Patient Care for Complex Urological Conditions

Although many urologists have the experience required to safely and effectively treat rare conditions, the members of PUMA believe that getting more experience is always better. That’s why they travel to each other’s institutions to observe and mentor each other during complex operations.

Not only does this mean that children with rare urologic conditions may have multiple experts involved their surgery but also it means that these surgeons get to participate in far more of these challenging operations than they would on their own. Rather than taking part in just one or two bladder exstrophy operations per year, for example, many PUMA surgeons take part in more than a dozen. This helps increase their knowledge and comfort level working with patients who have rare conditions requiring difficult procedures — so that all patients get a more experienced surgeon for their complex care.

Member Institutions

Deliberately founded as a small, regional group of urologists, member hospitals include:

• Ann & Robert H. Lurie Children’s Hospital of Chicago
• Cincinnati Children’s Hospital Medical Center
• Mayo Eugenio Litta Children’s Hospital
• Nationwide Children’s Hospital
• Riley Hospital for Children

Making Research More Meaningful

It’s hard for individual hospitals to make meaningful advancements in research and clinical care for certain rare pediatric urologic conditions — some of which affect less than 1 in every 50,000 births. By joining forces, PUMA physician-scientists at the five member hospitals can pool their data and study larger groups of patients. They can draw stronger conclusions and learn more about these rare conditions than they would be able to by working alone.

PUMA also holds biannual research meetings, during which they share the latest in their own work on rare urology conditions, talk about exciting new research underway and brainstorm ways to collaborate.

Two joint research initiatives currently underway include:

• A short- and long-term follow-up study to examine patient outcomes for bladder exstrophy
• A clinical algorithm that all five hospitals will use in the pre- and post-operative management of posterior urethral valves; once in use, PUMA can study whether it improves care and patient outcomes and share their findings with the broader urology community