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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...

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Vessel-sparing Excision and Primary Anastomosis
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Adaptations for Urogynecologic Surgery in Limited-Resource Settings: How to Do More with Less.

Hnin Yee Kyaw1,2, Catherine Matthews3, Hannah G Krause4,5,6

  • 1Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia. hninyk13@gmail.com.

International Urogynecology Journal
|May 8, 2025
PubMed
Summary

Pelvic floor disorders like pelvic organ prolapse (POP) are common and undertreated in limited-resource settings (LRS). This guide offers practical, adaptable surgical and diagnostic strategies for managing these conditions effectively despite resource limitations.

Keywords:
Chronic perineal tearGlobal healthLimited-resource settingPelvic floor surgeryVesicovaginal fistula

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Area of Science:

  • Urogynecology
  • Global Health
  • Surgical Management

Background:

  • Pelvic floor disorders (PFDs) impact up to 50% of women in limited-resource settings (LRS), with pelvic organ prolapse (POP) increasingly recognized.
  • Under-treatment is driven by social stigma, mental health impacts, and healthcare access barriers in LRS.
  • Existing urogynecological services in LRS face challenges due to limited surgical tools and equipment.

Purpose of the Study:

  • To provide a practical guide for managing vesicovaginal fistulae, chronic fourth-degree tears, and POP in LRS.
  • To outline diagnostic tools, surgical techniques, and case management strategies tailored to resource-scarce environments.
  • To address challenges including resource scarcity and patient follow-up in LRS.

Main Methods:

  • The article presents a guide based on limited evidence and expert experience in LRS.
  • It outlines key diagnostic tools, adaptable surgical techniques, and case management strategies.
  • Case examples illustrate practical diagnostic and surgical approaches for urinary leakage, fecal incontinence, and POP.

Main Results:

  • Emphasizes precise diagnosis with limited diagnostic testing access.
  • Highlights adaptable surgical interventions and postoperative care for optimal outcomes.
  • Presents sustainable solutions maximizing patient results despite equipment restrictions.

Conclusions:

  • An adaptable care model is crucial for managing PFDs in LRS.
  • Prioritizes cost-effective and reproducible methods.
  • Considers patients' long-term health and social well-being.