Urology in India: Numbers and practice

Surgical Advances in Treating Benign Prostatic Hyperplasia in Africa: What About the Endoscopic Approach?

OBJECTIVE

To assess the practices, trends, and challenges associated with the use of endoscopic techniques in Africa related to the surgical treatment of benign prostatic hyperplasia METHODS: The questionnaire, which was based on Google Forms, assessed several points related to the surgical management of benign prostatic hyperplasia.

RESULTS

In 67.4% of the centers, BPH was the primary pathology requiring surgical management. In all 43 centers, approximately 1/3 of the urologists (n = 41) are able to perform an endoscopic procedure for the management of prostatic hypertrophy. Of the 43 centers, 30 had a block equipped with endourology equipment, and 56.6% (n = 17) performed endourological surgery exclusively for the surgical management of BPH. TURP is the most widely used endoscopic technique. Open prostatectomy was the only surgical technique used in 14 centers (32.5%). In the remaining centers, both procedures (endoscopy and open surgery) were used depending on the surgeon's skills. Twenty-six (60.5%) centers expressed the need for training in endoscopic management of BPH.

CONCLUSION

The main challenges encountered relate to the lack of competent personnel, the unavailability of equipment and materials, and the high cost to patients. It is essential to develop modern urology in Africa, particularly in terms of endourological practices.

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 rising worldwide impact of benign prostatic hyperplasia

OBJECTIVES

To describe the trend in the impact of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH) on a global scale using the Global Burden of Disease (GBD) database.

MATERIALS AND METHODS

Using the GBD database, worldwide data aggregated from registries and health systems from 1990 to 2017 were filtered for LUTS/BPH diagnoses. Calculation of years lived with disability (YLD) were compared with other urological diseases. YLD were calculated by a standardized method using assigned disability weights. The GBD-defined sociodemographic index (SDI) was used to assess impact of LUTS/BPH by global SDI quintile.

RESULTS

Global Burden of Disease data over the 1990-2017 study period were summarized and global numbers and trends noted with other urological diseases for comparison. A total of 2 427 334 YLD were attributed to BPH in 2017 alone, almost three times more than those attributed to the next highest urological disease, prostate cancer (843 227 YLD). When stratified by SDI quintile, a much lower impact of BPH was found in the bottom three quintiles, despite this subset representing 66.9% of the 2017 world population.

CONCLUSIONS

Lower urinary tract symptoms attributed to benign prostatic hyperplasia exert a rapidly rising human burden far exceeding other urological diseases. As the population ages and men in a lower SDI enjoy increased life expectancy and decreased competing mortalities, a continually accelerating wave of LUTS/BPH can be forecast. These epidemiological trends have serious implications for the future allocation of resources and the global urological workforce.