Global Surgery - How Much of the Burden is Urological?

Updated: Dec 19, 2020

Written by: Matthew Denton

Warwick Medical School

Following 25 years since its inception Campain et al. (2015) aimed to assess on behalf of Urolink, a sub committee of the British Association of Urological Surgeons (BAUS), the impact of urological cases on areas with particularly large health disparities. In this article the team focussed on surgical interventions to urological health conditions in Sub-Saharan Africa, an area containing countries such as Zambia which only has 1 urologist per 2.3 million people compared to the UK’s 1 urologist per 72,189.


Campain et al. (2015) used the urological rights charter (Harrison, 2002), a standard set of treatments that should be available to all patients who present with common urological conditions as the basis for their study (Table 1). This allowed them to gauge access to urological healthcare across the globe.


Table 1. The basic urological rights charter (Harrison, 2002).


During the study, Campain et al. identified a number of challenges with data collection in regions with limited public health data. The traditional use of DALYS (disability‐adjusted life years) was shelved in favour of more novel techniques. The team instead looked at reviewing community surveys of unmet surgical needs, cross-sectional household surveys to estimate period prevalence, and the examination of surgical records to assess surgical burden of urological conditions across Sub-Saharan Africa. A number of sources were assessed due to the associated limitations of many survey techniques. This allowed a representative view to be achieved without typical biases. For instance, the bias of only using surgical representations would result in an under-estimate of the prevalence of in-operable conditions (Campain et al. 2015).


One particular study highlighted by Campain et al. estimates that on a global scale Africa will see the highest regional burden increase for lower urinary tract symptoms (LUTS), estimated to be an increase between 30.1% and 31.1%. A combination of the region’s increasing life expectancy and rapid population growth is predicted to result in not only more disability from prostatic cancer, but also a higher prevalence and incidence of bladder cancer (Campain et al. 2015).


In a recent study by Juvet et al. the 5 most common diagnoses for surgical patients presenting with urological conditions at one tertiary care centre in Malawi reflected the 5 most common conditions seen by Campain et al. in 2015. Urethral stricture proved to be the most common surgical diagnosis (21.98% of conditions) followed by: bladder masses (17%), benign prostatic hyperplasia (14.8%), hydrocele (9.3%) and prostatic cancer (5.5%) (Juvet et al. 2020).


Surgical conditions account for between 11 and 30% of the global burden of disease and as both the prevalence and incidence of urological conditions increase, access to sufficient urological interventions will be key across the world (Campain et al. 2015). Urolink’s vision of a standardised global access to healthcare becomes ever more important today with the added pressure of Covid-19 on healthcare systems; the development of robust urological care within surgical communities across the world will no doubt be an exciting time for all within the evolving field of urology.

References

  • Campain, N., MacDonagh, R., Mteta, K. and McGrath, J. (2015) Global surgery - how much of the burden is urological? BJU International, 116(3) 314-316.

  • Harrison, N. (2002) UROLINK a method for working together in a changing world. BJU International, 89(1) 1-5.

  • Juvet, T., Hayes, J., Ferrara, S., Goche, D., Macmillan, R. and Singal, R. (2020) The burden of urological disease in Zomba, Malawi: A needs assessment in a sub-Saharan tertiary care center. Canadian Urological Association Journal, 14(1) E6-E12.

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