Soc. Int. Urol. J., Volume 5, Issue 5 (October 2024) – 10 articles

Background: Nephrolithiasis, or kidney stone disease, presents a significant global health burden, with global incidence rates and treatment practices varying widely. This study aims to discuss the epidemiology, risk factors, treatment modalities, and challenges for nephrolithiasis in the lower half of the World Bank rankings; that is, in low- and lower-middle-income countries. Methods: A comprehensive literature review was conducted using PubMed for each country on the list, focusing on studies published from January 2000 onwards and reporting data on prevalence, risk factors, treatment practices, and economic implications. Results: Nephrolithiasis represents a significant burden for healthcare systems, with noteworthy geographical variability in prevalence possibly dependent on socioeconomic status and gender. Risk factors include dietary habits, climate, pollution, and infectious diseases. Treatment practices in some regions still rely on open surgery due to limited access to advanced endourological techniques, while other regions demonstrate high proactivity in research. The burden is exacerbated by inadequate healthcare infrastructure and training. Conclusions: Addressing nephrolithiasis in challenging economic circumstances requires targeted interventions, including improved access to modern treatment methods, enhanced training for healthcare professionals, and better socioeconomic and environmental conditions. Future research should focus on region-specific strategies and the development of sustainable healthcare solutions. Full article

Kidney transplantation (KT) is a preferred treatment for end-stage renal disease (ESRD) because it offers better long-term survival and cost-effectiveness compared to dialysis. Significant global disparities persist in access to KT, particularly in low- and middle-income countries (LMICs). This study aims to assess the epidemiology and outcomes of KT in LMICs while examining the relationship between a country’s income level and its KT prevalence. A systematic review of the literature was conducted, with searches of PubMed, Scopus, and Web of Science from inception to 31 May 2024. Relevant articles reporting on the epidemiology and outcomes of KT or ESRD patients undergoing kidney replacement therapy (KRT) in LMICs were included. A total of 8054 articles were identified, with 972 articles selected for full-text screening after initial title and abstract review. Following full-text screening, 35 articles met the inclusion criteria. The data showed significant variation in KRT and KT prevalence across different geographical locations. Higher-income countries within LMICs tended to have higher KT prevalence rates. Barriers such as inadequate healthcare infrastructure, limited financial resources, and insufficient organ donation frameworks were identified as contributing factors to the low KT rates in these regions. The study highlights the disparities in KT access and prevalence in LMICs, underscoring the need for targeted interventions and international collaboration to address these gaps. Efforts to increase both living and deceased donor transplants, expand health system capacity, and incorporate KT in healthcare planning are needed to close this gap. Global partnerships spearheaded by organizations such as The Transplantation Society (TTS) and the International Society of Nephrology (ISN) are crucial for improving KT rates and outcomes in LMICs. Full article

Introduction: Urological conditions significantly impact global health, with increasing demand for urologists in both developed and developing countries. Disparities in access to surgical care between high-income countries (HICs) and low- and middle-income countries (LMICs) are evident. Despite advancements in urology, LMIC training programs often follow outdated curricula and traditional methods. Methodology: A comprehensive search strategy identified urology training programs in LMICs using the EduRank website, Google searches, and PubMed. Data were collected from the literature, official documents, and online resources, focusing on variables such as program duration, research requirements, and resident salaries. Results: The analysis revealed significant variability in program structures and requirements across LMICs. Residency training durations ranged from 4 to 6 years, with inconsistent research obligations and resident salaries averaging USD 12,857 annually, with a range from USD 5412 to USD 18,174. Fellowship opportunities were limited, with only a small number of programs achieving international accreditation. Conclusions: This study reveals disparities among urology training programs in LMICs, emphasizing the challenges faced by LMICs in providing comprehensive education. Outdated curricula, limited faculty, and insufficient resources contribute to the variability in training quality within LMICs. To bridge these gaps, there is a pressing need for standardized and locally tailored educational frameworks. Future research should focus on direct comparisons with programs in HICs to develop strategies that improve training opportunities and ensure equitable access to advanced urological education and care worldwide. Full article

Despite the considerable global burden of urologic malignancies, Low- and middle-income countries (LMICs) often encounter significant challenges in caring for patients with urologic malignancies. Several interrelated factors impact cancer care in LMICs, which face significant challenges that hinder effective diagnosis, treatment, and management of disease. Socioeconomic and healthcare infrastructure limitations are fundamental issues leading to the disparity observed in cancer care across the globe. This review aims to evaluate the challenges and disparities in access to comprehensive urologic care in LMICs, emphasizing the impact of such global disparities on incidence rates, timely diagnoses, and access to comprehensive care as it relates to prostate, kidney, and bladder cancers. Full article

Background: Benign prostatic hyperplasia (BPH) is the leading cause of lower urinary tract symptoms (LUTSs) in men, with a histological prevalence that increases significantly with age. While extensive research on BPH has been conducted in high-income countries (HICs), limited information exists regarding its burden in low- and middle-income countries (LMICs), especially in Sub-Saharan Africa (SSA). Understanding the prevalence, impact on quality of life, and management practices in these regions is crucial for developing effective healthcare policies and improving patient outcomes. Objectives: This scoping review aims to collate the existing literature on the burden of BPH in LMICs, focusing on prevalence rates, quality-of-life impact, and management practices. The goal is to provide a comprehensive overview that informs healthcare strategies in resource-constrained settings. Methods: A scoping review methodology was employed, following the framework proposed by Arksey and O’Malley. The review encompassed five stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. A comprehensive search of electronic databases, including Google Scholar, PubMed, Scopus, and Embase, was conducted using specific search terms related to BPH and LMICs. The inclusion criteria were studies conducted in LMICs (limited to SSA); reporting on the prevalence, impact, or management of BPH; and published in English. Results: The review included studies that reported the wide-ranging prevalence rates of BPH in LMICs, highlighting significant regional variations. The impact of BPH on quality of life was profound, with many men experiencing significant bother and reduced daily functioning due to LUTSs. The management practices in these regions often differed from those in HICs, with limited access to pharmacological treatments and surgical interventions. The economic burden of BPH in LMICs was also notable, with many patients facing financial barriers to accessing effective care. Conclusions: BPH poses a significant health and economic burden in LMICs, particularly in SSA. The prevalence of the condition is high, and its impact on quality of life is substantial. There is an urgent need for improved diagnostic and management strategies tailored to the resources available in these settings. Policymakers should consider integrating BPH management into broader healthcare initiatives to enhance patient outcomes and reduce the overall burden of the disease. Full article

All 189 World Bank member countries are classified by their capita gross national income into one of four income groups. In this review, we aim to explore the economic burden and management of urologic oncology conditions in low- and middle-income countries (LMICs), emphasizing disparities and challenges in treatment access. The current World Bank classification system highlights economic stratification, showing significant health outcome disparities, particularly in urologic oncology conditions including kidney, bladder, and prostate cancer. First, this review focuses on the management of advanced prostate cancer in Asian LMICs, revealing higher mortality-to-incidence ratios and a greater prevalence of metastatic disease compared to high-income countries (HICs). The prohibitive costs of novel hormonal therapies (NHTs) like abiraterone and enzalutamide limit their use and exacerbate outcome disparities. Second, we review Wilms tumor treatment with chemotherapy in African countries, noting significant price variations for adapted and non-adapted regimens across different economic settings. The cost of chemotherapy agents, particularly dactinomycin, acts as a primary driver of treatment expenses, underscoring the economic challenges in providing high-quality care. Lastly, bladder cancer treatment costs in Brazil and Middle Eastern countries are examined, highlighting how detrimental the economic burden of intravesical therapies, like mitomycin C and Bacillus Calmette–Guérin (BCG), is on treatment accessibility. Overall, this literature review emphasizes the financial strain on healthcare systems and patients, particularly in regions facing economic instability and drug shortages, and underscores the need for international cooperation and effective resource allocation to address the economic barriers to urologic care in LMICs, aiming to improve health outcomes and ensure equitable access to advanced treatments. Full article

We performed a literature review to identify articles regarding the state of urological cancers in low-to-middle-income countries (LMICs). The challenges that LMICs face are multifactorial and can include poor health education, inadequate screening, as well as limited access to treatment options and trained urologists. Many of the gold standard treatments in high-income countries (HICs) are scarce in LMICs due to their poor socioeconomic status, leading to an advanced stage of disease at diagnosis and, ultimately, a higher mortality rate. These standards of care are vital components of oncological disease management; however, the current and sparse literature available from LMICs indicates that there are many obstacles delaying early diagnosis and management options in LMICs. In the era of evolving medical diagnosis and treatments, sufficient data must be gathered and understood in order to provide appropriate diagnostic and treatment options to curtail rising mortality rates and, therefore, help to alleviate the burden in LMICs. Full article