Humanitarian Urology in LMIC: Lessons Learned

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The abstract included in this submission, separate from the PDF, has multiple spelling errors.  But the text of the PDF is excellent. 

Author Response

Thank you for your thoughtful review and request.  The request for correcting misspellings in the abstract has been addressed.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper is very informative and reflect the situation in LMIC's in respect to visiting volunteers. The following are my comments:

1.     In some countries like Senegal Urology practice has changed from visiting volunteers Urologists. Endoscopic equipment has been ordered and training done in site. Can you consider this situation where humanitarian actions involve acquisition of ad hoc minimally invasive equipment to inspire substantial practice change?

2.     Is there any variations in experience based on geographic regions, number of urologist ?

3.     Has there been in your experience any need assessment from the target countries ? Uptake might depend more on felt need than external ideas. Lack of use of guidelines can be important to revisit

Author Response

Thank you for your thoughtful review with questions. 

Scores revealed concerns about the research design and description of methods.  This report was stated to be a brief, narrative review with a perspective by the author; this differs from a systematic review or scoping review that requires adherence to PRISMA guidelines or other standards.  Therefore, it is unclear that more presentation should be added.

1. A query was asked as to the impact of acquiring ad hoc minimally invasive urology equipment in Senegal.  In response, my literature review did not reveal a direct study or report that determines this outcome in Senegal.  The article does acknowledge the provision of equipment in LMICs generally among providing supplies and other resources with volunteer efforts..  
2. A query was posed as to geographic variation in visiting urologist experiences.  In response, my literature review did not reveal such a study to inform a useful answer. 
3. A query was posed as to whether a needs assessment in LMICs has been done.  In response, my literature review did not reveal such a study as yet performed in urology. 

Reviewer 3 Report

Comments and Suggestions for Authors

my main issues is that this is a communication expected to explore prior information and it does very little with the literature review. I have attached further comments that are detailed for the author to consider to make this this better for the readers

Comments for author File: Comments.pdf

Author Response

Thank you for your thoughtful review and questions.

1. A main issue was raised as to a limited literature review and a request for improvement in this regard.  In response, the manuscript was revised following suggestions for inclusion of more citations.
2. Concern was also presented as to including a section on Future Directions.  In response, this revision was made. 
3. A query was posed as to describing more detail about single disease groups with a call out regarding bladder exstrophy.  In response, a section was given to the management of sickle cell disease-associate priapism, for which the author has had primary knowledge and interaction with specialists in Nigeria.  The author does not have any direct experience with pediatric urology matters.  Statements were included in the manuscript about a variety of urologic disease subjects broadly.