Pd15-09 Assessing the Transfer of Surgical Expertise in Urethral Injury Repair: From International Volunteers to Local Urologists in Rwanda

You have accessJournal of UrologyGlobal Health/Humanitarian (PD15)1 May 2024PD15-09 ASSESSING THE TRANSFER OF SURGICAL EXPERTISE IN URETHRAL INJURY REPAIR: FROM INTERNATIONAL VOLUNTEERS TO LOCAL UROLOGISTS IN RWANDA Theophile Ndayishimye, Jane T. Kurtzman, J. M. V. Niyonkuru, Edmond Nkubiri, Edouard Ngendahayo, Emmanuel Muhawenimana, Kevin Hebert, Jeremy Myers, and Emile Rwamasirabo Theophile NdayishimyeTheophile Ndayishimye , Jane T. KurtzmanJane T. Kurtzman , J. M. V. NiyonkuruJ. M. V. Niyonkuru , Edmond NkubiriEdmond Nkubiri , Edouard NgendahayoEdouard Ngendahayo , Emmanuel MuhawenimanaEmmanuel Muhawenimana , Kevin HebertKevin Hebert , Jeremy MyersJeremy Myers , and Emile RwamasiraboEmile Rwamasirabo View All Author Informationhttps://doi.org/10.1097/01.JU.0001008648.33830.32.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Repairing pelvic fracture urethral distraction defects (PFUDD) in Rwanda has historically been a challenge, due to the scarcity of resources and surgeons with expertise in these complex cases. International volunteers (IVs) in reconstructive urology have participated in PFUDD surgical education in Rwanda since 2012. This study compares outcomes of PFUDD repairs performed over the last 3 years by local surgeons alone, after receiving intermittent training from IVs over time, and repairs performed in conjunction with expert IVs during trips. METHODS: We reviewed all males who underwent excision and primary anastomosis for a PFUDD at 3 Rwandan hospitals (2020-2023). Primary outcomes: 3-month stricture recurrence stenosis on imaging or cystoscopy+symptoms, change in urinary quality of life (QoL) score AUASS and change in erectile function IIEF5. Univariable logistic regressions assessed for associations between surgeon type (alone v. with IV) and primary outcomes. Differences in characteristics and means were compared using X2 tests and t-tests. RESULTS: 43 patients were included: mean age: 35 years SD 13; mean time to repair: 3.2 years (median: 1.3; IQR: 0.5-3.4); mean defect length: 2.8cm. 53% (n=23) of cases were performed by a Rwandan surgeon alone and 47% (n=20) with an IV. Mean patient age, time to surgery, defect length, and need for crural splitting did not significantly differ based on surgeon type (all p-values > 0.1), however mean number of pelvic fractures was significantly higher (1.6 v. 1.2, p=0.03) and mean postoperative catheter duration was significantly longer (39 days v. 27 days, p<0.01) in cases done with IVs. Overall stricture recurrence rate was 14% (alone: 22%, with IVs: 5%) and mean postoperative IIEF-5 score: 16.3 SD: 7.2. Urinary QoL scores improved in 100% of patients postoperatively. There was no statistically significant association between surgeon type and stricture recurrence (p=0.15), worsened erectile function postoperatively (p=0.64) or total postoperative IIEF5 score (p=0.64). Mean improvement in urinary QoL score was 4.4 points SD 1.5 for local cases and 5.0 SD 1.3 for volunteer cases. This difference was also not statistically significant (p=0.19). CONCLUSIONS: Local Rwandan urologists who received intermittent training from IVs in PFUDD repairs, are achieving relatively comparable outcomes to visiting international experts. Our data suggest that surgical skills transfer is possible through volunteer efforts and that such work can help surgeons treat complex cases like PFUDDs. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e362 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Theophile Ndayishimye More articles by this author Jane T. Kurtzman More articles by this author J. M. V. Niyonkuru More articles by this author Edmond Nkubiri More articles by this author Edouard Ngendahayo More articles by this author Emmanuel Muhawenimana More articles by this author Kevin Hebert More articles by this author Jeremy Myers More articles by this author Emile Rwamasirabo More articles by this author Expand All Advertisement PDF downloadLoading ...