CME

 

Urology pathways for the primary care physician

 

 

J John

FC Urol (SA), MMed; Division of Urology, Department of Surgery, Frere Hospital and Faculty of Medicine and Health Sciences, Walter Sisulu University, East London, South Africa; Division of Urology, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

Correspondence

 

 

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ABSTRACT

Urology provides critical medical treatment that has the potential to save lives and greatly improve quality of life. Although there is a growing need for urological care, South Africa (SA) now faces an unmet need for these services, and junior doctors have limited exposure to urology. SA has a total of 347 urologists who are actively practising and registered with the Health Professions Council of South Africa. This means that there is a ratio of only 0.56 urologists per 100 000 people in the population. The ratio is even more dire if we only include urologists in the public sector. This article offers pragmatic strategies for addressing common urological conditions. These guidelines adhere to international standards and can be adopted at all levels of healthcare, with the exception of a few advanced imaging needs.

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Urology, the oldest of the surgical specialties, delivers care that has the potential to be lifesaving and has the capacity to significantly enhance quality of life. However, there is currently an unmet demand for urological services in South Africa (SA). SA currently has only 347 active urologists registered with the Health Professions Council of South Africa, a dire urologist-to-population ratio of 0.56 per 100 000.^[1] Furthermore, 52 million people who fall outside the medical aid net^[2] are dependent on just 50 full-time urologists in the public sector across the country.^[1] Waiting lists continue to grow, and the status quo is inadequate to meet the demand. However, these issues are not unique to SA. In theory, National Health Insurance aims to provide equitable access to healthcare and general practitioners and primary care physicians, often described as the jewel in the crown of the National Health Service in the UK,^[3] will have an increasing role in managing common urological conditions here. This article provides practical, cost-effective diagnostic pathways, which are in line with international guidelines^[4-7] to approach common urological presentations and, except for a small number of advanced imaging requirements, can be implemented at all levels of care.

Declaration. None.

Acknowledgements. The author gratefully acknowledges comments and suggestions from Kerisha Bhana, Noma Mngqi, Bernard Marais, Kaylyn Stride and Návan van Jaarsveld (Frere Hospital, East London), Ntuthuzelo Lusawana and Lonwabo Gqoli (Walter Sisulu University), John Lazarus and Lisa Kaestner (University of Cape Town), Ahmed Adam (South African Urological Association and University of the Witwatersrand), Shingai Mutambirwa (South African Urological Association and Sefako Makgatho Health Sciences University), Greg Webb, David Smart Karlheinz Jehle, James Urry, Dawid Mouton (South African Urological Association), and Shauli Minkowitz.

Author contributions. Sole author.

Funding: None.

Conflicts of interest: None.

 

References

1. John J, Adam A, Mutambirwa S. Urology care in South Africa: A call for collaboration. S Afr Med J 2024;114(4):eXXXX. https://doi.org/10.7196/SAMJ.2024.v114i4.XXXX_TO_BE_COMPLETED        [ Links ]

2. M'bouaffou F, Buch E, Olorunju S, Thsehla E. Perceived knowledge of scheme members and their satisfaction with their medical schemes: A cross-sectional study in South Africa. BMC Public Health 2022;22(1):1700. https://doi.org/10.1186/s12889-022-14106-8        [ Links ]

3. Marshall M. A precious jewel - the role of general practice in the English NHS. N Engl J Med 2015;372(10):893-897. https://doi.org/10.1056/NEJMp1411429        [ Links ]

4. Prostate Cancer Foundation of South Africa. South African prostate cancer guidelines. 2017. https://prostate-ca.co.za/wp-content/uploads/2017ProstateGuidelinesDraftVersion2016.pdf (accessed 11 February 2024).         [ Links ]

5. National Department of Health, South Africa. Standard treatment guidelines and essential medicines list for South Africa: Primary healthcare level. 2020 edition. Pretoria: NDoH, 2020. https://knowledgehub.health.gov.za/content/standard-treatment-guidelines-and-essential-medicines-list (accessed 28 February 2024).         [ Links ]

6. American Urology Association. Guidelines. https://www.auanet.org/guidelines-and-quality/guidelines (accessed 19 February 2024).         [ Links ]

7. European Association of Urology. Guidelines 2023. https://uroweb.org/guidelines (accessed 22 February 2024).         [ Links ]

 

 

Correspondence:
J John
jeffveenajohn@gmail.com

 

 

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