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Urologic Disease in a Resource Poor Country
Marc D. Manganiello, MD1, Christopher D. Hughes, MD, MPH2, Lars Hagander, MD3, David Bayne, BA4, Jean Hamiltong Pierre, MD5, Jill C. Buckley, MD1, John G. Meara, MD, DMD, MBA6.
1Institute of Urology Lahey Clinic, Burlington, MA, USA, 2Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA, USA, 3Department of Plastic and Oral Surgery, Children's Hospital, Boston, MA, USA, 4Harvard Medical School, Boston, MA, USA, 5Zanmi Lasante, Cange, Haiti, 6Program in Global Surgery and Social Change, Children's Hospital Boston, Boston, MA, USA.
Introduction: Establishing a baseline for understanding the role that urologic disease plays within central Haiti could lead to the development of sustainable and regionally appropriate urologic care. The aim of this study is to document the prevalence of urologic surgical disease presenting for treatment in this resource poor country.
Methods: We conducted a retrospective review of surgical case logs at five Partners in Health (PIH) and Zanmi Lasante (ZL) hospitals in central Haiti. Data were collected from July 2009 through July 2010 and included patient demographics, disease processes, interventions required, surgeon name, and surgeon training information (urologic versus non-urologic trained).
Results: Urologic surgical disease comprised 498/5539 (9.0%) total surgical cases in central Haiti from July 2009-July 2010. A total of 492 diagnoses and 498 urologic procedures on 469 patients were recorded. The most common diagnoses included hydrocele (33.3%), phimosis (23.0%), benign prostatic hyperplasia (BPH)(10.8%), and cryptorchidism (7.3%). Hydrocelectomy was the most commonly performed procedure (160/498, 32.1%), followed by circumcision (117/498, 23.4%) and open prostatectomy (38/498, 7.6%). Surgeon training information (urologic trained versus non-urologic trained) was determined for 360/498 (72.3%) of surgical cases. Urologic trained surgeons performed 55/360 (15.3%) of all surgical procedures. Among patients who underwent prostatectomy for BPH, there was no statistically significant difference for rate of open prostatectomy between urologic trained (14/31(45.2%)) and non-urologic trained surgeons (17/31 (54.8%)), p=0.86. Urologists performed all transurethral resections of the prostate (TURP), 9 versus 0, p=0.007.
Conclusions: Urologic surgical diseases comprise a substantial source of morbidity for patients in central Haiti. Understanding the scale and scope of urologic disease is important in developing health systems to adequately address the regional burden of surgical disease in limited resource settings.
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