Juvet Tristan, Hayes James R, Ferrara Sarah, Goche Duncan, Macmillan Robert D, Singal Rajiv K
Division of Urology, University of Toronto, Toronto, ON, Canada.
Division of Urology, University of Ottawa, Ottawa, ON, Canada.
Can Urol Assoc J. 2020 Jan;14(1):E6-E12. doi: 10.5489/cuaj.5837. Epub 2019 Jun 17.
A large part of the developing world continues to lack access to surgical care. Urology remains one of the least represented surgical subspecialties in global health. To begin understanding the burden of urological illness in sub-Saharan Africa, we sought to characterize all patients presenting to a tertiary care hospital in Malawi with a urological diagnosis or related complaint in the past year.
Retrospective review of the surgical clinic and surgical theater record books at Zomba Central Hospital (ZCH) was performed over a one-year time span. Patients presenting with urological diagnoses or undergoing a urological procedure under local or general anesthetic in the operating theater were identified and entered into a database.
We reviewed 440 clinical patients. The most common clinical presentations were for urinary retention (34.7%) and lower urinary tract symptoms (15.5%). A total of 182 surgical cases were reviewed. The most common diagnoses for surgical patients were urethral stricture disease (22%), bladder masses (17%), and benign prostatic hyperplasia (BPH) symptoms (14.8%). Urethral stricture-related procedures, including direct visual internal urethrotomy and urethral dilatation, were the most common (14.2% and 7.7%, respectively). BPH-related procedures, including simple prostatectomy and transurethral resection of the prostate were the second most common (6.7% and 8.2%, respectively).
Urethral stricture disease, BPH, and urinary retention represent the clinical diagnoses with the highest burden of visits. Despite these numbers, few definitive procedures are performed annually. Further focus on urological training in sub-Saharan Africa should focus on these conditions and their surgical management.
世界上很大一部分发展中地区仍然无法获得外科治疗。在全球卫生领域，泌尿外科仍然是代表性最少的外科亚专业之一。为了开始了解撒哈拉以南非洲地区泌尿系统疾病的负担，我们试图对过去一年中在马拉维一家三级医院就诊并被诊断为泌尿系统疾病或有相关主诉的所有患者进行特征描述。
对宗巴中央医院（ZCH）外科诊所和手术室记录簿进行了为期一年的回顾性研究。确定在手术室接受局部或全身麻醉下进行泌尿系统诊断或接受泌尿系统手术的患者，并将其录入数据库。
我们回顾了440例临床患者。最常见的临床表现是尿潴留（34.7%）和下尿路症状（15.5%）。共回顾了182例外科病例。外科患者最常见的诊断是尿道狭窄疾病（22%）、膀胱肿块（17%）和良性前列腺增生（BPH）症状（14.8%）。与尿道狭窄相关的手术，包括直视下尿道内切开术和尿道扩张术，最为常见（分别为14.2%和7.7%）。与BPH相关的手术，包括单纯前列腺切除术和经尿道前列腺切除术，是第二常见的（分别为6.7%和8.2%）。
尿道狭窄疾病、BPH和尿潴留是就诊负担最高的临床诊断。尽管有这些数字，但每年进行的确定性手术很少。撒哈拉以南非洲地区应进一步关注泌尿外科培训，重点关注这些疾病及其外科治疗。
