GURS International Outreach

GURS International Outreach

In 2009, GURS established the International Outreach Mission program. The mission goals are two fold: 1) to provide expert urologic reconstructive surgical care to indigent people in undeveloped countries where this type of care is either non-existent or extremely limited and 2) to be a teaching and learning experience for local urologists in the surgical treatment of men and women with stress incontinence and lower urinary tract obstruction.

These missions would be greatly limited without the support GURS receives in charitable grants from varies pharmaceutical companies. To date we have received charitable grants American Medical Systems; Coloplast Corporation; and Cook Group Incorporated. These funds are used solely for our International Outreach Mission.

Since establishing the GURS International Outreach Mission, we have sent urological teams to three countries: Honduras in 2010; Brazil in 2011; and Haiti in 2012. Trip reports for each of these locations are listed below.


GURS International Outreach Mission Pune, India
July 14 – 22, 2013

This International Outreach Mission was funded, in part, by charitable grants from American Medical Systems (AMS) and Coloplast Corporation.

Setting:

India is a large country with a diverse population of 1.2 billion people that are served by 3,000 urologists; however, most are experts in Endo-Urology and only a few o f these urologists are skilled and experiencedreconstructiveurologists. Our host in Pune, India was the Kullcami Center for Reconstructive Urology. Our host provided GURS with 2 dedicated operatingrooms, anesthesiologists, and surgical scrub nurses.

In the week prior to the start o f the mission (July 8 —13, 2013), the urology staff at the Kulkami Center for Urology screened 236 patients in the out-patient clinic (these included first time patients, as well as, follow-up patients). From these 236 patients, we preselected 43 patients for surgical treatment duringthe GURS Outreach Mission; however, 1 patient ha d to be cancelled because o flab values.

Surgical Team:

Dr. Sanjay B. Kulkami
Director, Kulkami Center for Reconstructive Urology, Pune, India

Dr. Guido Barbagli
Head o f the Center for Reconstructive Urethral Surgery, Arezzo, Italy

Dr. Allen R Morey
Professor, University of Texas Southwestem Medical Center, Dallas, Texas

Dr. Paul C. Peters
Chair in Urology, University of Texas Southwestem Medical Center, Dallas, Texas

Dr. Justin Chee
Edgewater Urology, Melbourne, Australia

Dr. Anna Lawrence 
Aucldand,New Zealand

Dr. Shilo Rosenberg
Fellow, Kulkami Center for Reconstructive Surgery, Pune, India

Narrative Summary:

Over the course of 5 surgical days, we did 42 surgical interventions. The following surgeries were performed:

Type of Surgery (Number of Cases):

  • Anastomotic Urethroplasty for Bulbar Urethra Stricture (2)
  • Anastomotic Urethroplasty for Primary Posterior Urethral Trauma (5)
  • Redo Anastomotic Urethroplasty Posterior Urethral Trauma (4)
  • Transpubic Urethroplasty for a 4 year old girl with Posterior Urethral Trauma (1)

We definitely thank AMS, Coloplast Corporation, Eagle Medical Services, Ranbzxy Laboratories, Dr. Reddys Lab, and Intas Phannaceuticals for their outstanding support of GURS and its International Outreach Mission. This mission has served both faculty and the patients extremely well.

Sincerely,

Sanjay B. Kulkami, MD, MS, FRCS (UK)
GURS President Team Leader

Sean P. Elliott, MD, MS
GURS Secretary/Treasurer


GURS International Outreach Mission Port Au-Prince, Haiti
August 30 – September 5, 2012

This International Outreach Mission was funded, in part, by a $10,000 charitable grant from American Medical Systems and a $2,000 charitable grant from Coloplast Corporation.

Setting:

Our host organization, the Societe Haitienne d'Urologie (SHU), had made arrangements for GURS to use two hospitals facilities: Hospital de Universite D'Etat D'Haiti — a public hospital and Hospital Bernard Mevs, Port-au-Prince — a semi-private'semi-sponsored hospital by a Non-Governmental Organization.

With a population of close to 9 million, Haiti is the poorest country in the Western Hemisphere; as is their health care. The Urologic care in Haiti is very rudimentary, particularly in the area of reconstruction. Haiti has approximately 24 active urologists for a population of 9 million. No urologist in Haiti specializes or has formal training in reconstructive Urology.

Port-au-Prince, the capital city of Haiti, has a population of 1.2 million with only one major public hospital, the Hospital de Universite D'Etat D'Haiti. As a University Hospital, it is staffed with both attending and resident physicians. The Section of Urology has 2 operating rooms (only one of them is functional), no cystoscopy suite, one open ward and nursing staff.

Goals:

1. To deliver surgical care to indigent patients in need of expert genitourinary reconstructive surgery. 2. To train native Haitian Urologists and residents in genitourinary reconstructive surgical techniques.

Participants:

Dr. Angelo E. Gousse
Clinical Professor, Florida International University,
Bladder Health and Reconstructive Urology Institute, Miami, Florida.

Dr. Christopher Gomez 
Assistant Professor of Urology, University of Miami,
Miller School of Medicine, Miami, Florida.

Dr. Steven B. Brandes
Director of Reconstructive Urology and Urology Residency, Washington University in St. Louis, St. Louis, Missouri

Dr. Andrew Chang
Fellow in Urologic Reconstructive Surgery, Department of Urology, Washington University in St. Louis, St. Louis, Missouri.

Dr. Andrew C. Peterson
Associate Professor of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.

Dr. Erin McNamara
Fellow in Urologic Reconstructive Surgery, Department of Urology, Duke University Medical Center, Durham, North Carolina.

Dr. Danielle Stackhouse
Fellow in Urologic Reconstructive Surgery, Department of Urology, Duke University Medical Center, Durham, North Carolina.

Mr. Frank Salazar
Retired U.S. Army LVN, Department of Urology, Joint Base San Antonio Medical Center, San Antonio, Texas.

Narrative Summary of Experience:

Over the course of 5 clinical days, we examined approximately 20 possible surgical candidates (male and female) and completed 16 surgical interventions. Visiting faculty arrived on August 30, 2012. On the day of arrival, we had a pre-operative conference, reviewed all available imaging studies, and conducted a teaching session with local urologists and residents. On August 31st, we separated into two surgical teams. One team going to the Hospital Bernard Mevs and the other team going to the Hospital de Universite D'Etat D'Haiti. The teams remained separated for the remainder of the mission in an attempt to perform an average of 2 surgical cases per hospital per day (4 cases day). On September 3rd, we also conducted a formal teaching session with the attending and residents to review surgical techniques and discuss operative approaches. The lectures were on urethral reconstruction and female pelvic reconstructive surgery.

All surgeries were highly complex and performed under suboptimal conditions. Only one urethroplasty was a redo-operation. We performed 12 urethral reconstruction cases (excision and primary anastomosis and buccal mucosa onlay graft). Two cases were treated by cystoscopy and dilation, with no critical stricture identified. We performed two complex redo-transvaginal vesico-vaginal fistula repairs. We had one dedicated operating room running at each hospital at all times. All cases were performed by visiting faculty, a visiting fellow, and a local urology resident or junior faculty (scrubbed or operating).

All urethral strictures were related to trauma: motorcycle accident, fall, or earthquake related blunt pelvic trauma, etc.

Sixteen adult surgical cases included:

  • Excision and Primary Anastomosis Urethroplasty — 7
  • Buccal Mucosa Graft Onlay Urethroplasty — 5
  • Cysto and Urethral Calibration — 2
  • Transvaginal Vesico-Vaginal Fistulas — 2

All goals of the visit were accomplished. All patients were indigent. None of the patients would have had access to the technical expertise of advanced reconstructive surgeons without the completion of this medical volunteer trip.

More importantly, the trip incorporated two 3-hour well attended didactic sessions with powerpoint presentations in a designated conference room at the hotel. Dr. Pierre-Mix Nazon (Secretary General of SHU) and Dr. Claude Paultre (President of SHU) were excellent host and provided excellent coordination.

The Hospital Bernard Mevs was well equipped with a good support staff. The Hospital de Universite D'Etat D'Haiti Urology operating room was very poorly equipped with very poor support staff. For future trips to Haiti, we would recommend bringing an anesthesiologist.

Total expenses for this mission were $15,692.93. This included roundtrip airfare, hotel, food, incidental expenses such as airport parking fees, rental of small bus and driver for transportation needs in Port-au-Prince, and airport departure fees in Haiti.

We thank American Medical Systems and Coloplast Corporation for their support of OURS and our International Outreach Mission. This trip has served both the participants and the patients well. We look forward to working with American Medical Systems and Coloplast Corporation again in the future.

Sincerely,

Angelo E. Gousse, MD, OURS
Executive Board member Team Leader

Sean P. Elliott, MD 
Secretary Treasurer


GURS International Outreach Mission Sao Luis, Brazil
October 23 – 29, 2011

This International Outreach Mission was funded, in part, through a $10,000 charitable grant from American Medical Systems, a $3,000 charitable grant from Coloplast Corporation, and a $3,000 charitable grant from Cook Group Incorporated.

Setting:

Hospital Universitario, Universidade Federal do Maranhao, Sao Luis, Brazil. Maranhao is the poorest state in Brazil. It is located a few hundred kilometers south of the Amazon delta. Sao Luis is the largest city in Maranhao and the University Hospital supplies all hospital-based care for indigent patients throughout the entire state of Maranhao. As a university hospital, it is staffed with attending physicians and residents.

Goals:

  1. To deliver surgical care to indigent patients in need of expert genitourinary reconstructive surgery.
  2. To train native urologists in advanced genitourinary reconstructive techniques.

Participants:

Dr. Andre G. Cavalcanti (chief organizer)
Chief of Urology Department, Hospital Municipal Souza Aguiar, Rio de Janeiro, Brazil.

Dr. Jose de Ribamar Rodrigues Calixto (local host),
Chief of Urology, Hospital Universitario, Universidade Federal do Maranhao, Sao Luis, Brazil.

Dr. Gustavo C. Wanderley
Hospital Esperanca, Recife, Brazil.

Dr. Sergio F. Ximenes
Universidade Federal de Sao Paulo, Sao Paulo, Brazil.

Dr. Sean P. Elliott
Director Reconstructive Urology, Associate Professor of Urology, University of Minnesota, Minneapolis, Minnesota.

Dr. Daniel D. Dugi III
Assistant Professor Surgery, Division of Urology, Oregon Health Sciences University, Portland, Oregon.

Narrative Summary of Experience:

Over the course of 5 clinical days we examined over 20 possible candidates for surgery and completed surgery on 18. Visiting faculty arrived on October 23m. Examinations were completed on October 24th and surgeries were completed October 25th — 28th. Departure was on October 29th. Following the patient examinations on October 24th, the afternoon was spent in conference with the urology residents and medical students. They gave case presentations which were then discussed with the visiting faculty. Each of the visiting faculty then gave lectures on topics including urethral reconstruction and female pelvic surgery

All surgeries were high complexity cases. Many of them were re-do reconstructive surgeries after failure of the primary surgery. We had 2 operating rooms running at all times. All cases were performed with residents and 2 visiting faculty. Specifically, surgeries included:

Urethral Stricture (14):

  • Urethroplasty after a trans-sexual surgery (1)
  • Primary anterior Urethroplasty (5)
  • Re-do anterior Urethroplasty (2)
  • Posterior Urethroplasty for urethral distraction defect after pelvic fracture (3, including 2 re-do's)
  • Posterior Urethroplasty for bladder neck contracture (1) and bladder neck contracture plus recto-urethral fistula (1) occurring as a complication of prior radical prostatectomy
  • Posterior Urethroplasty for membranous urethral stricture after TURP for BPH (1)

Female Stress Urinary Incontinence, Pelvic Organ Prolapse, Fistula (4):

  • Sacrocolpopexy for Grade 4 vaginal prolapse after 2 prior mesh repairs (1)
  • Transvaginal mesh repair of Grade 4 vaginal prolapse (1)
  • Re-do repair of vesico-vaginal fistula after failure of 2 prior surgeries (1)
  • Pubo-urethral sling with autologous fascia for stress urinary incontinence (1)

All goals of the visit were accomplished. All patients were indigent. None of the patients would have had access to the advanced reconstructive techniques without the completion of this medical volunteer trip. Furthermore, a significant amount of education was accomplished. The more senior reconstructive urologist (Cavalcanti, Ximenes and Elliott) were able to spend an intense 5 days training the more junior faculty (Dugi and Wanderley). Specifically, Dr. Wanderley who works in Recife, is the only urologist in the state of Pernambuco who is interested in reconstructive urology. He had little previous exposure to reconstructive urology and felt he greatly benefited from the week-long experience. He looks forward to being able to deliver procedures such as Urethroplasty, penile implant and artificial sphincter in a State with no previous access to such expertise.

Total expenses for this mission were $12,717.44. This included roundtrip airfare, hotel, food, incidental expenses for taxis, airport parking fees, airport departure fees in Brazil, and Brazilian visas for Dr. Dugi and Dr. Elliott.

We thank American Medical Systems, Coloplast Corporation, and Cook Group Incorporated for their support of GURS and our international volunteer efforts. This trip has served both the participants and the patients well. We look fonvard to working with American Medical Systems, Coloplast Corporation, and Cook Group Incorporated again in the future.

Sincerely,

Allen F. Morey, MD
Secretary Treasurer Secretary Treasurer Elect

Sean P. Elliott, MD 
Andre G. Cavalcanti, Chief Organizer


GURS International Outreach Mission San Pedro Sula, Honduras
August 21 – 28, 2010

This International Outreach Mission was funded through a $10,000 charitable grant from American Medical Systems.

Our team had six people on it: Dr. Allen F. Morey (University of Texas Southwestern Medical Center, Dallas, Texas; Dr. Steven B. Brandes (Washington University Medical Center, St. Louis, Missouri; Dr. Steven J. Hudak (University of Texas Southwestern Medical Center, Dallas, Texas; Dr. Lawrence L. Yeung (Washington University Medical Center, St. Louis, Missouri; Mr Frank Salazar (LVN – San Antonio, Texas); and Mr. Gene Sloat (Logisticsadmin – San Antonio, Texas).

All team members arrived in San Pedro Sula on Saturday, August 21st. We were met at the airport by our hosts, Dr. Daniel Chinchilla and Dr. Edin Quijada, who took us to our hotel. Immediately after checking into our hotel, Dr. Chinchilla and Dr. Quijada gave us a power point presentation on the patients we would be screening for surgery on Sunday.

On Sunday, August 22nd, our host took us to the Hospital Nacional Nor-Occidental where we screened 48 patients and prioritized them for surgery appointments starting on Monday, August 23rd and ending on Friday, August 27th.

Our host had arranged for us to use two dedicated Operating Rooms at the Hospital Nacional Nor-Occidental, as well as, providing a support staff that included anesthesiologist, scrub nurses,and OR technicians. Although we had some minor scheduling problems and some difficult cases, we managed to do 5 surgeries each day for a total of 25 surgeries.

Overall, we believe this mission was a complete success and definitely a learning experience for our hosts and the hospital OR staff. Our OR's were always filled with physicians, surgical staff, and medical students observing the surgeries. At one time, we counted 17 people in the OR.

Total expenses for this mission were $11,41716. This included roundtrip airfares, hotel, food, and incidental expenses for taxis, airport parking fees, and airport departure fees in Honduras.

GURS is extremely grateful for American Medical Systems support of our International Outreach Mission.

Sincerely,

Allen F. Morey, MD 
GURS Secretary/Team Leader