Establishing a sustainable urology program in northern Guatemala: an implementation report from El Petén (2024-2025)

Subspecialty surgical care is limited in low- and middle-income countries (LMICs). Nongovernmental organizations (NGOs) attempt to bridge this gap through short-term medical trips (SMTs), but sustainability remains challenging. This report describes establishing a urology program in El Petén, Guatemala's largest region, as a model for sustainable subspecialty surgical care in LMICs.

This retrospective, single-institution review evaluated the Aid Via Action Inc. (AVA) urology program at Hospital Nacional de San Benito (HNSB), a departmental public hospital in El Petén, Guatemala, from June 2024 to June 2025. All AVA cases were reviewed, with a descriptive analysis of program development and implementation. Institutional approval was obtained from the hospital ethics committee and director. Patient selection included medical, anesthesia, and urologic evaluation. Equipment was obtained through donations and partnerships. Sterilization used a 2% glutaraldehyde (Cydex®) protocol. Data were analyzed descriptively in Microsoft Excel, complications categorized by the Clavien-Dindo system, and follow-up conducted through clinic visits, phone calls, and coordination with local physicians.

During this period, a total of 37 urologic procedures were performed: 31 TURPs, 2 cystolithotomies, 2 vesicovaginal fistula repairs, 1 cystoscopy, and 1 circumcision. There were three complications-two cases of urinary retention following TURP and one surgical-site infection (all Clavien-Dindo Class II) following a cystolithotomy. The median follow-up was 88 days (IQR 73-98 days). There were no mortalities.

Early outcomes demonstrate the feasibility of implementing a urology program in a resource-limited setting. Long-term success depends on local engagement and sustained urology staffing at HNSB.