Presentation Authors: Ian Metzler*, David Bayne, San Francisco, CA, Helena Chang, Santa Clara, CA, Mohamed Jalloh, Dakar, Senegal, Ira Sharlip, San Francisco, CA
Introduction: International volunteer organizations foster collaboration between urologists across borders, but the variance of and challenges to providing urologic care in resource-constrained settings is not well characterized, leading to scattered and misdirected aid.
Methods: An online survey was developed in RedCapTM with 70 distinct questions written in English. The surveys were distributed to urologists who had practiced in countries outside of the United States and Europe through personal contact, social networking sites and letters to regional urologic societies. Response countries of practice were categorized by World Bank income groups: high income countries (HICs) and low and middle income countries (LMICs).
Results: 114 urologists from 27 countries completed the survey; 35 (39%) practiced in HICs while 54 (61%) practiced in LMICs. The mean age was 46 years, 11% were female and 43% percent of urologists received training outside their home country. The most common conditions treated were urolithiasis (30%), BPH (15%) and prostate cancer (13%) which did not vary by income group. Only 19% of urologists in LMICs reported sufficient urologists in their country compared to 68% of urologists in HICs. Patients in LMICs are less likely to get urgent drainage for infected obstructing kidney stones or endoscopic treatment for a painful kidney stone (p=0.009). Local LMIC urologists were more likely to cite financial challenges, access to diagnostics, support staff and surgical training as major barriers to care whereas urologists visiting LMICs were more likely to cite knowledge, operative facilities and access to disposables as the major challenges.
Conclusions: LMICs are lacking enough urologists to care for their population and nearly half of all urologists surveyed received urologic training outside their home country suggesting that access to urologic education is limited. There is disconnect between the needs identified by local and visiting urologists. International collaborations need to target broader interventions in LMICs to address local priorities such as diagnostic studies, support staff and financial support.