Global surgery – how much of the burden is urological?

Campain, Nicholas; MacDonagh, R.; Mteta, Kien; McGrath, John

doi:10.1111/bju.13170

Cited by 19 publications

(17 citation statements)

References 10 publications

(10 reference statements)

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“…Provision of urological care and services is limited in Ethiopia, where there are currently 15 urologists for a population of >120 million people. Urological disease typically presents at an advanced stage and treatment is predominantly provided by general surgeons with limited urological expertise .…”

Section: Timeline Of Urolink Activitiesmentioning

confidence: 99%

Urolink supporting the development of urological services in Hawassa, Ethiopia

et al. 2019

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Section: Timeline Of Urolink Activitiesmentioning

confidence: 99%

Urolink supporting the development of urological services in Hawassa, Ethiopia

et al. 2019

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“…In stark contrast, IVUmed, an organization that sends urologic volunteers all over the world, reports that there are less than 30 urologists for the entire population of Kenya, a country of greater than 41 million individuals ( 9 ). Additionally, the British Association of Urological Surgeons (BAUS) estimates that there is one urologist per 2.3 million people in Zambia while in the UK they estimate one urologist per 72,189 individuals ( 7 ). With such steep disparities in healthcare workforce, it is no surprise that there is a substantial unmet need in middle and lower-income countries.…”

Section: State Of Urologic Care Worldwidementioning

confidence: 99%

“…Irwin et al estimated the worldwide prevalence of lower urinary tract symptoms at 45.2% in 2008 ( 13 ). According to Campain et al , a survey of 48 urologists working in sub-Saharan Africa ranked the top most commonly encountered urologic conditions as BPH, urethral stricture, prostate cancer, bladder cancer, and urethral/ureteral trauma ( 7 ). Attempts have been made to quantify the prevalence of urethral stricture disease specifically in certain areas of the world.…”

Section: Global Burden Of Urologic and Urethral Stricture Diseasementioning

confidence: 99%

“…Unfortunately, there is limited data on the prevalence of global urologic disease. We do know, however, that a significant portion of undertreated global disease is urologic—urinary retention, urethral stricture, malignancy, and urolithiasis ( 7 ). Much of the effort to improve urologic care worldwide has come in the form of international volunteerism.…”

Section: Introductionmentioning

confidence: 99%

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International volunteerism and urethral stricture disease: a review

Frankel

Murphy

2018

Transl. Androl. Urol.

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Global health is an ever-expanding area of interest for many healthcare workers around the world. In recent years, it has become apparent that much of the global disease burden is surgical. Urologic disease is no exception—many international organizations send volunteers around the world to support Urologic services in countries that lack capacity and resources. Urethral stricture represents a unique opportunity for specialized surgical management that vastly improves long term morbidity. Here we review the prevalence, etiology, and management of urethral stricture from a global perspective while highlighting impact of international urologic volunteer efforts.

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“…As the global burden of disease comprises a growing proportion of cases that require surgical care, the number of surgical mission trips has grown significantly [1]. Urethral strictures comprise one such disease that has been increasing in relation to trauma in low-and middle-income countries (LMICs) and requires dedicated urological care [4,5]. The development of in-country permanent surgical centers in many parts of the world is leading to a paradigm shift where sustainability and local capacity building are increasingly more important than having visiting surgeons perform high-volume, short-duration surgical trips [6].…”

Section: Introductionmentioning

confidence: 99%

The role of international partnerships in improving urethral reconstruction in low- and middle-income countries

et al. 2019

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Purpose To explore the impact of education and training in international surgical partnerships on outcomes of urethral stricture disease in low-and middle-income countries. To encourage data collection and outcomes assessments to promote evidence-based and safe surgical care. Methods Qualitative data were collected through observation of a reconstructive surgical workshop held by IVUmed at a host site in Dakar, Senegal. Quantitative data were collected through a retrospective review of 11 years of hospital data to assess surgical outcomes of urethral stricture disease before and after IVUmed started reconstructive workshops at the site. Results In the 11-year study period, 569 patients underwent 774 surgical procedures for urethral strictures. The numbers and types of urethroplasty techniques increased after IVUmed started its workshops. The average number of urethroplasties increased from 10 to 18.75/year. There was a statistically significant improvement in the mean success rate of urethroplasties from 12.7% before to 29% after the workshops. Anastomotic urethroplasty success rates doubled from 16.7 to 35.1%, but this was not statistically significant (p = 0.07). The improved success rate was sustained in cases performed without an IVUmed provider. Conclusions Urethral stricture disease treatment in low-and middle-income countries is fraught with challenges due to complex presentations and limited subspecialty training. Improper preoperative management, lack of specialty instruments, and suboptimal wound care all contribute to poor outcomes. International surgical groups like IVUmed who employ the "teach-the-teacher" model enhance local practitioner expertise and independence leading to long-term improvements in patient outcomes. Tailoring practice guidelines to the local resource framework and encouraging data collection and outcomes assessment are vital components of providing responsible care and should be encouraged.

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Global surgery – how much of the burden is urological?

Cited by 19 publications

References 10 publications

Urolink supporting the development of urological services in Hawassa, Ethiopia

Urolink supporting the development of urological services in Hawassa, Ethiopia

International volunteerism and urethral stricture disease: a review

The role of international partnerships in improving urethral reconstruction in low- and middle-income countries

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