The Current Status of Global Urology

Anatomy and lessons of partnerships in global pediatric surgery

Partnerships in Global Surgery have evolved over several decades and continue to do so based on reports from different experiences and collaborations. These should be characterised by their objectives, leadership and "championship," communication, ethics and equity. Partnerships take the form of academic collaborations or clinical support whose details vary with the different stakeholders involved. Over time, these have evolved based on challenges, successes, and failures. Recently, quality improvement activities have been increasingly initiated with locally derived information. This has come from local databases in low and middle income country (LMIC) settings whose maintenance and analysis have been done through academic collaborations. For many sites in LMICs, there would be very little advance in paediatric surgery without collaborations. Despite this, problems still arise from collaborations due to failure to learn from past problems, lack of local championship, poor communication, and externally driven objectives. For success and longevity, the collaboration must pay attention to unique the needs of the site, champions and equity.

Urologist Workforce and Services in Ethiopia

BACKGROUND

Urological conditions are a cause of diminishing quality of life, hence affecting productivity. Despite the need for urological treatment, it was excluded from receiving priority in both United Nation and Lancet commission. Most of the surgeries in sub-Saharan Africa are open surgeries. The lack of basic endourology equipment and a shortage of experts have limited Africans from receiving the privileges of minimally invasive surgeries, especially in urology. This study describes the socio demographics of the urologists in Ethiopia, the field of services they provide and their access to endourology equipment.

METHODS

This study presents data from a survey of urologists in Ethiopia who are members of Urology Society of Ethiopia (USE).

RESULTS

Thirty-three urologists of the 43 responded, making the response rate 76.5%. Qualification by urology residency in Ethiopia accounted for 66.7% of participants, followed by 21.2% by fellowship training abroad after general surgery training. All respondents practice open surgeries and 75.8% perform endourology. Video endoscope and cystoscopy sets were available to all those practicing endourology, with Direct Visual Internal Urethrotomy (DVIU) sets having the next highest availability and Flexible UreteroRenoScope(URS) and laser lithotripters the least accessible.

CONCLUSIONS

Urology in Ethiopia is in its infancy, where the lack of advanced medical equipment combined with a paucity of qualified urologists have created a huge challenge for the provision of these services.

The feasibility of endourological surgery in low-resource settings

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically, or restricted by the abilities of the surgeons in sub-Saharan Africa. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. They are, however, largely dependent upon the supply of equipment from non-governmental organisations in high income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.