The impact of a continuing international partnership and multiple intensive hands-on workshops on the success rate of bulbar EPA urethroplasty in a low-middle income country: an early experience

Abstract

Background: Thailand has one of the 10 highest national rates of traffic accidents, leading to a high incidence of urethral stricture from bulbar straddle and pelvic fracture urethral injuries. Various treatment options are offered including urethroplasty; however, failure rates are high leading to a significant societal burden. Outreach relationships were established between the United States of America (USA), Vietnam, and Thailand by creating an intensive hands-on workshop and mentorship model to improve urethroplasty success. We aim to report the impact of this partnership and hands-on training on bulbar excision and primary anastomosis (EPA) success rates.

Methods: The University of California, Irvine Medical Center (UC Irvine), USA, Binh Dan Hospital, Vietnam, and Thammasat University Hospital (TUH), Thailand developed partnerships in urethroplasty training since 2020. Urologists from Thailand seeking expertise in urethroplasty joined intensive hands-on workshops for two 2-week periods. An ongoing mentorship relationship subsequently developed. Important infrastructure similar to that at UC Irvine, a urethroplasty Center of Excellence, was established at TUH to include the purchase of identical urethroplasty and urethral imaging-specific equipment and supplies. Subsequent workshops were attended and hosted at TUH. A database was created to compare success rates before and 12 months after completing the workshops and establishing infrastructure. Cystoscopy 4 months after surgery was performed to assess anatomical success.

Results: The study included 29 patients with bulbar urethral stricture who underwent bulbar EPA. There were 19 patients from before the establishment of the partnership that included workshops and infrastructure development. The overall success rate was 57.14%, whereas in comparison, success rates of over 98% were published at Centers of Excellence. After establishing the partnership, bulbar EPA was performed in 10 cases. The success rate increased to 90% (P=0.001) which included anatomical success defined as wide patency on cystoscopy 4 months after surgery and a subsequent absence of recurrent voiding symptoms. The patients who underwent urethroplasty during the workshop and learning period were excluded from this study.

Conclusions: Developing and continuing international partnerships with a mentorship model and multiple intensive hands-on workshops, including established appropriate hospital infrastructure could improve the success rate of bulbar urethroplasty in countries seeking to develop a urethroplasty Center of Excellence.

Keywords: Urethral stricture; bulbar stricture; international partnership; urethroplasty; urethroplasty outcome.