The generous support of the New York Section of the AUA made possible Dr. Daniel Lee’s recent IVUmed Traveling Resident Scholar experience in Ulaanbaatar, Mongolia. Dr. Joseph Smith from Vanderbilt graciously acted as Dr. Lee’s mentor during the workshop.
Dr. Lee reported, “Access to quality urologic care and management is a large issue in Mongolia; there are only eleven trained urologists in a country of 3 million people, with all 11 urologists practicing in the capital city of Ulaanbaatar. The goals of this trip were to assess the patient needs in urologic oncology, educate the surgeons in evidence based management and treatment of oncologic diseases, and establish a system for tracking patient data and outcomes.
Dr. Smith from Vanderbilt served as the supervising surgeon for the urologic-oncology patients. The first day involved a review of approximately 30-35 patients with differing presentations, several incidentally found renal masses, advanced prostate cancer, non-muscle invasive and metastatic urothelial carcinomas, and invasive penile squamous cell carcinomas. After reviewing those initial cases, we prepared about 6-8 cases that the urologists requested Dr. Smith to perform because of their technical difficulty and in order to train the other urologists. It became evident in reviewing the cases that the urologists in Mongolia were very well-trained and were very well acquainted with the standards of care for renal masses and penile cancers. However, there were some inconsistencies noted in the management of prostate and urothelial carcinomas that reflected systems problems, unique to Mongolia, and general lack of access to more recent data and gold standards for treatment.
There were signs of extensive delay from initial diagnosis to definitive treatment; the two radical cystectomies we performed there had an average delay of a year from initial diagnosis to presentation for cystectomy (without any previous intravesical or chemotherapy). When radical cystectomies are performed, patients only receive Mainz II (sigmoidorectal pouch) reconstructions with ureteral tunneling as the surgeons have only been trained in this reconstruction and are not familiar with ileal conduits, neobladder, or other continent diversions. This represents a large area of need that could be easily modified with proper training, as ileal conduits have significantly decreased rates of ureteral stenosis and other complications. There is also a need to develop a system that can update data in real time and can be queried and analyzed.
Urologists in Mongolia are very well trained and technically excellent, however there are certain systems and care management issues that can be easily modified with continued education and easy access to resources. Hopefully, this trip will represent the first step in continuing the IVUmed mission to: ‘Teach one, reach many’.”