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A global view of pediatric urology
1University of Utah School of Medicine, Center for Global Surgery, 30 N. 1900 E RM 3B110 SOM, Salt Lake City, UT 84132, USA.
Journal of Pediatric Urology
|April 18, 2022
Summary
Pediatric urology faces a global workforce imbalance, with shortages in low-income countries and surpluses in high-income nations. Addressing these gaps is crucial for equitable children
Area of Science:
- Pediatric urology as a surgical subspecialty.
- Global surgery and health systems analysis.
- Congenital anomalies of the genitourinary tract.
Background:
- Pediatric urology has evolved over 60 years, integrating pediatric surgery, urology, and plastic surgery.
- Training guidelines are tightening in high-income countries (HICs) amidst declining fertility and decreasing prevalence of complex genitourinary (GU) conditions.
- Health systems in low- and middle-income countries (LMICs) face significant stress.
Purpose of the Study:
- To review the history of pediatric urology as a surgical subspecialty.
- To identify unmet needs, particularly in LMICs.
- To contextualize pediatric urology within the global surgical ecosystem.
Main Methods:
- Review of English language literature on workforce trends in pediatric urology, pediatric surgery, and urology.
- Analysis of the development of global surgery, considering social, economic, and political factors.
- Examination of global fertility rate trends to identify workforce supply and demand.
Main Results:
- High-income countries experience specialist saturation and declining caseloads due to increased training programs and lower birth rates.
- Surgical specialization has lagged in LMICs despite declining birth rates; training in pediatric surgical specialties and urology is scarce in the lowest-income countries.
- Weaknesses exist in the broader surgical workforce (anesthesia, nursing, radiology) and supply chains for specialized pediatric urological surgery in LMICs.
Conclusions:
- An evolving global maldistribution of pediatric surgical and urological workforce exists, with deficits in LMICs and surpluses in HICs.
- High costs of equipment, patchy supply chains, and inadequate basic health infrastructure (e.g., electricity) in LICs hinder access to quality care.
- Recent global events highlight the vulnerability of surgical systems, presenting an opportunity to build resilience in children's urological care by addressing identified strengths and gaps.
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