Department of Urology, University of Washington, Seattle, USA.
Department of Urology, Parnassus Campus, University of California San Francisco, 400 Parnassus Avenue, UCSF Box 0738, San Francisco, CA, 94143-073, USA.
World J Urol. 2020 Nov;38(11):2987-2994. doi: 10.1007/s00345-020-03101-6. Epub 2020 Feb 7.
The challenges in providing urologic care across borders and in resource-constrained settings are poorly understood. We sought to better characterize the impediments to the delivery of urological care in low- and middle-income countries (LMICs) compared to high-income countries (HICs).
A 70 question online survey in RedCap™ was distributed to urologists who had practiced in countries outside of the United States and Europe categorized by World Bank income groups.
114 urologists from 27 countries completed the survey; 35 (39%) practiced in HICs while 54 (61%) practiced in LMICs. Forty-three percent of urologists received training outside their home country. Most commonly treated conditions were urolithiasis (30%), BPH (15%) and prostate cancer (13%) which did not vary by group. Only 19% of urologists in LMICs reported sufficient urologists in their country. Patients in LMICs were less likely to get urgent drainage for infected obstructing kidney stones or endoscopic treatment for a painful kidney stone or obstructing prostate. Urologists visiting LMICs were more likely to cite deficits in knowledge, inadequate operative facilities and limited access to disposables as the major challenges whereas local LMIC urologists were more likely to cite financial challenges, limited access to diagnostics and support staff as the barriers to care.
LMICs lack enough training opportunities and urologists to care for their population. There is disconnect between the needs identified by local and visiting urologists. International collaborations should target broader interventions in LMICs to address local priorities such as diagnostic studies, support staff and financial support.
跨境和资源有限环境下提供泌尿科医疗服务所面临的挑战尚未被充分了解。我们试图更好地描述与高收入国家（HIC）相比，中低收入国家（LMIC）在提供泌尿科医疗服务方面的障碍。
通过 RedCapTM 在线调查向曾在美国和欧洲以外国家行医的泌尿科医生分发了 70 个问题，这些医生按世界银行收入分组。
来自 27 个国家的 114 名泌尿科医生完成了调查；35 名（39%）医生在 HIC 工作，54 名（61%）医生在 LMIC 工作。43%的泌尿科医生在其祖国以外接受过培训。最常见的治疗病症是尿路结石（30%）、良性前列腺增生（15%）和前列腺癌（13%），但各组之间没有差异。只有 19%的 LMIC 泌尿科医生报告称，他们所在国家有足够数量的泌尿科医生。LMIC 国家的患者获得感染性梗阻性肾结石紧急引流或内镜治疗疼痛性肾结石或梗阻性前列腺的可能性较小。访问 LMIC 的泌尿科医生更可能将知识不足、手术设施不足和一次性用品获取受限视为主要挑战，而当地 LMIC 泌尿科医生更可能将财政挑战、诊断和支持人员有限作为护理障碍。
LMIC 缺乏足够的培训机会和泌尿科医生来满足其人口需求。当地和访问泌尿科医生之间存在需求脱节。国际合作应针对 LMIC 开展更广泛的干预措施，以解决当地的优先事项，如诊断研究、支持人员和财政支持。
