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

Male urethral stricture disease. Why management guidelines are challenging in low-income countries

Urethral stricture disease is one of the commonest urological pathologies in adult men in low or low-middle income countries, providing a significant work burden for the small number of specialist surgeons who are able to provide appropriate treatment. The underlying causes of anterior urethral stricture relate to urethral fibrosis from sexually transmitted infection, with posterior urethral disruption secondary to pelvic trauma being an equally common cause of stricture disease in many countries in sub-Saharan Africa. Anterior urethral strictures are often long, and multifocal, and bulbo-prostatic disruptions are usually due to relatively low-velocity pelvic trauma. The management options available in resource poor settings are often severely limited by the individual's ability to pay for care, the availability of a specialist surgeon and, importantly, a shortage of functioning endoscopic equipment for less-invasive treatments. Consequently, reconstructive surgery is often regarded by the patient, and surgeon, as the most cost-effective and, therefore, primary means of treating a urethral stricture once urethral dilatation has failed. Regional anaesthetic techniques have limited the adoption of free graft augmentation as an alternative to pedicled flaps of locally available skin for reconstruction, whilst an inability to provide tension-free bulbo-prostatic anastomoses has negatively impacted the outcome from the treatment of pelvic fracture disruption injuries in much of sub-Saharan Africa. Urolink has, however, found that local surgeons can be taught sustainable skills required for successful complex urethroplasty when supported by longitudinal mentorship in the management of difficult clinical issues. Evidence-based practice is known to improve the standard of care in specific conditions in high-income countries, including the management of male urethral stricture disease. However, guidelines developed in high-income countries aren't necessarily appropriate for stricture management in less well-resourced healthcare environments, but could be adapted to help improve the delivery of stricture care for men in low- or low-middle income countries.

Global Surgery Education and Training Programmes-a Scoping Review and Taxonomy

Global surgery is an emerging field of study and practice, aiming to respond to the worldwide unmet need for surgical care. As a relatively new concept, it is not clear that there is a common understanding of what constitutes "global surgery education and training". This study examines the forms that global surgery education and training programmes and interventions take in practice, and proposes a classification scheme for such activities. A scoping review of published journal articles and internet websites was performed according to the PRISMA Extension for Scoping Review guidelines. PubMed MEDLINE, EMBASE and Google were searched for sources that described global surgery education and training programme. Only sources that explicitly referenced a named education programme, were surgical in nature, were international in nature, were self-described as "global surgery" and presented new information were included. Three hundred twenty-seven records were identified and 67 were ultimately included in the review. "Global surgery education and training" interventions described in the literature most commonly involved both a High-Income Country (HIC) institution and a Low- and Middle-Income Country (LMIC) institution. The literature suggests that significant current effort is directed towards academic global surgery programmes in HIC institutions and HIC surgical trainee placements in LMICs. Four categories and ten subcategories of global surgery education and training were identified. This paper provides a framework from which to study global surgery education and training. A clearer understanding of the forms that such interventions take may allow for more strategic decision making by actors in this field.

Pediatric Urology and International Medical Volunteerism: Where Are We? Where Are We Going?

OBJECTIVE

To determine the current landscape of international medical volunteerism (IMV) in pediatric urology.

METHODS

A questionnaire regarding IMV participation was distributed to Societies for Pediatric Urology members (SPU), pediatric urology fellows (PUFs), and pediatric urology fellowship program directors (PDs). Questions related to IMV interest, experience, and perceived barriers, as well as the importance of trainee participation.

RESULTS

98 of 733 SPU members queried responded; 62/98 (63%) having volunteered. There was no difference in gender, age, or years in practice between volunteers and non-volunteers (P >.05). Non-volunteers were generally interested in participating (26/36; 72%), with lack of time and knowledge of opportunities cited as limitations. 27/46 PUFs and 16/27 PDs submitted responses. 10/27 (37%) of PUFs have participated in IMV. The main perceived barrier to their participation was lack of protected time off. While 2 PUFs (7%) stated IMV was a mandatory component of fellowship, 11/27 (41%) of PUFs vs 2/16 (13%) of PDs believe IMV should be part of the curriculum (P = .11). PUFs and PDs similarly ranked importance of trainee IMV participation on Likert scale (median 73 vs 70, P = 0.67). Volunteering SPU respondents ranked trainee participation higher than non-volunteers (median 80 vs 50, P = 0.0004).

CONCLUSION

While pediatric urology IMV opportunities exist, disseminating this information to interested parties and lack of time are barriers to participation. Amongst SPU members, there is a divide in attitudes regarding the importance of trainee participation. Trainees, however, strongly support IMV participation.