Re: The Role of International Partnerships in Improving Urethral Reconstruction in Low- and Middle-Income Countries
Abstract
available at http://www.ncbi.nlm.nih.gov/pubmed/31177304 Editorial Comment: The authors describe their experience with urethroplasty performed in Senegal before and after mentorship in reconstructive urology through the American nonprofit organization IVUMed. Success rates of urethroplasty improved with the training intervention as would be expected but overall success remained surprisingly low. The authors review many possible reasons for this finding, including highly complex strictures at presentation, inadequate preoperative characterization of stricture complexity through available imaging, suboptimal sterilization techniques and surgical instruments that are in poor condition. Success rates of 29% beg a couple of questions. How low a success rate is too low before the risks of surgery outweigh the benefits? Are low success rates acceptable when the rate of improvement is encouraging (eg doubled over a short period)? Regarding the first question, urethroplasty is generally a low risk operation, and as long as the patients are aware of the success rate it seems acceptable to proceed. Concerning the second question, a doubling of success rate is encouraging, and we know from prior studies that the learning curve for urethroplasty after completion of training is about 100 cases. Given that the reported reconstructive urologist had performed 75 cases since initiation of IVUMed training, we can expect to see continued improvement. While some ongoing mentorship is desirable,…
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