EAU15: PAUSA addresses ongoing challenges in African urology

The lack of urologists, insufficient proper training, poverty and complications from female genital mutilation, are among the pressing issues in Africa, which were discussed during the Joint Session of the EAU and the Pan-African Urological Surgeons’ Association (PAUSA).

Prof. Mohamed Eissa (EG), chairman of the session, explained there still is a shortage of urologists in Africa and that most urological surgeries are performed by general surgeons. “In the Democratic Republic of Congo, for instance, there are only eight certified urologists in a population of more than four million,” Eissa said.

One of the ways in which PAUSA tries to improve this is by creating training centres throughout the continent, together with large international societies like the EAU, which provide training sessions and offer workshops to encourage young physicians to specialise in urology.

The treatment of complex and recurrent kidney stones was discussed and Prof. Christian Türk (AT) explained that stone treatment can be complex due to their size, location, or quantity. They can be managed by open surgery, laparoscopic surgery, percutaneous nephrolithotomy (PNL), and ureteroscopy (URS).

PNL is the first choice for complex stones, possibly in combination with flexible URS, but actual management depends on many factors including availability of instruments. In the African setting in particular, this can be a complex issue. Prof. Andreas Skolarikos (GR) also examined this problem when he discussed metabolic evaluation in patients with stone recurrence. Especially in high-risk patients, who need detailed metabolic evaluations, shortage of resources can be problematic.

In response to a question from the audience regarding the gap between guidelines recommendations and availability of medical equipment in Africa, Skolarikos replied: “Availability of instruments or other equipment is a real issue and it is not limited to Africa because I experience it in Greece as well. Nonetheless, it is important for all urologists to know what the latest scientific evidence shows and to try to offer it to patients.”

Prof. Hassan Abolella Abdelkhalek (EG) addressed the major problem of a widespread tradition of female genital mutilation (FGM) in Africa. FGM is deeply rooted in African cultural history and is believed to have been practiced by various ethnic groups. It mostly affects girls up to 15 years of age and over 101 million girls and women suffer from the long-lasting physical and psychological consequences of FGM.

“We can end this human tragedy by collaborating with local organisations. Legislation alone is not enough to solve this problem because it requires a huge change of mentality and it needs to come from the people. By talking to families and spreading the message, we can all contribute to end FGM,” said Abdelkhalek.