We continue our Medical Student Column interview series highlighting urologists who have unique accomplishments outside traditional patient care. We met with Dr Aseem Shukla, a pediatric urologist at the Children’s Hospital of Philadelphia (CHOP). Dr Shukla led the International Bladder Exstrophy Collaborative at Civil Hospital, Ahmedabad, India, for 16 years. This surgical mission has treated nearly 200 children with primary or previously failed bladder exstrophy repairs, significantly improved outcomes for this rare condition, and accelerated training for pediatric urologists around the world.¹

Tell Us a Little Bit About Yourself.

Dr Shukla: I grew up in South Florida and did my undergraduate, medical school, and residency there. Fellowship in pediatric urology at CHOP led me out of my home state! My work now involves clinical practice, teaching, and research. I specialize in pediatric urology, particularly minimally invasive surgery and complex congenital conditions like bladder exstrophy. After working in Florida and Minnesota, I was recruited back to CHOP by my mentor, the late Dr Doug Canning, to lead the minimally invasive surgery program, continue my global work, and build the bladder and cloacal exstrophy program here.

How Did You First Get Involved in Your Global Service Work?

Dr Shukla: My global service journey began during residency when I realized the vast disparities in access. When I was trained, few people worldwide were specially trained in pediatric urology. I had amazing mentors active in India, and as an Indian American, that was important to me. My initial foray into global health was through short-term medical missions, most memorably one in Vellore, India, in 2002. Over time, I saw the need for sustainable, long-term solutions.

Can You Tell Us More About the International Bladder Exstrophy Collaborative?

Dr Shukla: Bladder exstrophy is a condition where the lower abdominal wall, genitalia, and pelvis do not form properly and the bladder is open and exposed. This condition requires highly specialized surgery not available in many parts of the world. We work with local hospitals to bring together global experts to operate, train local teams, and provide ongoing care. We prioritize sustainability, ensuring that children receive comprehensive care even after our team has left.

Dr Canning always reminded me that we must provide care that parallels the world-class facilities at CHOP, no matter how far we are from Philadelphia. In Dr Rakesh Joshi and Jaishri Ramji’s team at the Civil Hospital in Ahmedabad, India, we found a host institution committed to that vision of excellence. It is critical that we do not become itinerant surgeons. I emphasize follow-up on our patients’ long-term outcomes and working with our host team to address postoperative complications and care for patients well after their repair. Typical global health projects have less than 30% yearly follow-up rates. With the Ahmedabad team, we have ~80% follow up over 16 years.

How Do You Get Such a Complex Initiative Off the Ground?

Dr Shukla: There was a meeting in 2006 where Indian urologists were trying to work with pediatric surgeons to bring those 2 specialties together; I became involved with that. In 2009, I had my first opportunity to go to Ahmedabad. I got a humble outreach from a doctor who told me they had lots of exstrophy and were getting bad results. On our first trip, I saw a public hospital with dedicated staff, exceptional surgeons, and all the elements to do something special.

Launching such an initiative involves extensive coordination. We start by forming strong partnerships with local providers to understand the needs and capabilities of the region. Our team of experts, now comprised of my partners in this work—Dr Pramod Reddy (Cincinnati Children’s), Pippi Salle (Toronto Sick Kids), and Paul Merguerian (Seattle Children’s)—is carefully selected for their skills and commitment. We develop detailed protocols for patient care, from selection through surgery to postoperative follow-up. Cultural sensitivity is key, as we work within the local context to provide the best possible care.

What Surprised You Most Once You Started These Annual Trips?

Dr Shukla: The determination and collaborative spirit of the local teams. Their willingness to adapt to new techniques was truly inspiring. This humility went both ways, and I was amazed to see how much we learned from each other. It’s easy when you have a shared goal. Dr Canning always said, “start from the kid, and work your way out from there.”

Additionally, I was struck by the profound impact on the lives of the children and their families. Witnessing the immediate and long-term benefits of our work reinforced our collaborative efforts.

How Do You Prepare and Train Your Team for the Unique Elements of Working in Ahmedabad?

Dr. Shukla: We were still in the old building in Ahmedabad 8 to 9 years ago. Two surgeons operate on 2 operating room tables next to each other with extensive staff. It’s noisy, chaotic. People are yelling, there’s music in the background. Your sleep cycle is off. You cannot use your normal operating room shoes, half your instruments get mixed up. The ability to adjust without compromising the outcome is key.

Preparation is vital. Continuous communication within the team and with local partners helps us refine our approach. This work is not for everyone, but over 16 years, fortunately, I’ve met very few that didn’t have an amazing, life-changing experience.

How Do You Perceive the Opportunities and Needs for This Type of Work Within Urology?

Dr Shukla: In India, you can see world-class surgeries—we can learn so much from their stone surgeries, robotic transplants, and more. At the same time, there are other areas more limited in capabilities. There are still opportunities there—and all over the world. We have found interest from pediatric surgeons and urologists in West Africa about developing partnerships. When I presented our work in India, other surgeons came up to discuss partnership in their countries, from Jakarta to Vietnam and beyond.

I think the opportunities are boundless if you have the right spirit. Being a global surgeon is not about going in and doing a bunch of cases. That mindset is long discarded. You must be committed to return. You must put down the foundation to deliver the same quality results, no matter where you are.

What Recommendations Do You Have for Medical Students Who Are Interested in Urologic Global Health?

Dr Shukla: I think that global health in urology will grow as more of us become involved. When I started, there was little support. Now, we have AUA sessions on it. I’ve taken many medical students on our workshops. We get patients from all over India and collect data on quality of life, genetics, long-term surgical outcomes—students can be involved in that.

If global work is not only exciting for you, but something that you can learn from and care deeply about, you will have opportunities, especially as you progress through training. I feel like it was just yesterday that I was just sitting where you are, thinking this is what I’d like to do.

Do You Have Any Final Thoughts or Reflections to Share?

Dr Shukla: In global situations, you will encounter many opportunities—hernias and hypospadias, stones, and urethral strictures. I used to find this disconcerting because nobody’s great at everything. We decided to exclusively focus on bladder exstrophy. I think that’s important to focus on these global missions and assess the needs carefully. We focused on a rare disease—bladder exstrophy. One might ask if that is really the best way to make a major impact. However, we really believe that exstrophy is a fundamental problem—and if you get good at treating a complex disease, the skills will translate to other procedures such as hypospadias and other genital surgery, right up to augmentation and even cloacal malformation. We are able to serve more patients in 1 week in India than we would see here in 3 years, and so India remains an incredible place to partner.

Plus, the world’s interest always amazes me. Each year, we have about 25 surgeons who come to learn with us. Global surgery is not for your practice. That’s not the spirit of global work. The right spirit is to observe, learn, and think about how you can substantively contribute. And then down the line, you can become part of a core team operating on the ground. But, you first have to gain the trust of the host surgeons wherever you choose to partner.

Ultimately, I hope this excites students. Our field improves as more sharp minds bring different ideas. Stay passionate, stay hungry, and stay committed. There’s a lot we can do to improve urology everywhere.