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The Year Was 1995…Look How Far We’ve Come!

Twenty years ago, IVUmed was incorporated by its award-winning founder, Catherine deVries, MD, to address the enormous need for patient care and professional training in urology in resource-poor areas of the world. From common congenital malformations to pelvic floor injuries, various cancers and other diseases, urology represents a vastly underserved area of global health.Vol. 1 Issue 1 Newsletter

Initially established to help meet the staggering need for pediatric urology in developing countries, IVUmed has grown to include virtually all areas of urology and incorporates education for nurses, anesthesiologists, radiologists, pathologists and other related areas of medical and surgical care. IVUmed’s services have been requested in over 30 countries in Africa, Asia, Central America and South America. With a proven model that has helped to successfully build surgical training programs in countries as diverse as Honduras, Vietnam, Senegal and Mongolia, IVUmed tailors its efforts to the needs of each of its many partner hospitals and communities.  Our partners in these sites have demonstrated strong long-term commitments to IVUmed’s work and mission and will ultimately serve as a bridge between today’s investment of resources and our shared vision for access to quality healthcare in the future.

Our success is based on uniting peers and strengthening relationships among medical providers with a common shared purpose of ensuring access to quality urological care.

* We connect physicians and nurses in low-resource settings with experienced colleagues for peer to peer interaction.
* We provide hands-on education through ongoing on-site surgical workshops.
* We build self-reliant surgical teaching programs capable of providing local and regional education.
* We are the chosen provider of care and education in partnership with multiple global urological organizations.
* We identify, support, and develop future generations of IVUmed volunteers and host colleagues.

We have refined our capacity-building model over two decades and have become the go-to organization for urology training in developing parts of the world. Our intensive, onsite hands-on workshops equip physicians and nurses throughout the world with the skills they need to serve their communities. Meanwhile, the greater objective of IVUmed training is to develop future generations of medical personnel by building lasting surgical teaching programs. Your support helps ensure that children and adults in resource-poor areas of the world will no longer have to suffer for years with treatable conditions that greatly affect their quality of life.

Our surgical workshops are complemented by distance consultation and other means of instruction and support to help ensure that our partners progress toward their training goals. We also utilize telehealth technology for distance education and are collaborating on educational modules comprised of surgical video, lectures, medical animation, and testing.

Please join us this 20th anniversary year, on Facebook, Twitter, Instagram and Pinterest.  Together, we will make a difference!

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IVUmed – Helping Children Around the World

IVUmed Rwanda

IVUmed in Rwanda

IVUmed’s Pediatric Urology Capacity Building Program makes quality surgical care available to children around the world – especially in low-resource areas. We accomplish this by building a global network of train-the-trainer centers of excellence. There are no pediatric urologists in sub-Saharan Africa, Haiti, and many places in India, leaving millions of children without access to care for debilitating urological conditions.

Pediatric urology diseases, malformations and injuries are among the most common conditions affecting children worldwide, and are up to 10 times more common than cleft lip and palate. In the US, when a baby boy is born with a condition such as hypospadias (a congenital condition in which the opening of the urethra is situated on the underside of the penis instead of at its tip), surgery can be performed before the child is even out of diapers, and there are few to no lasting effects. In countries where this type of surgery is not available however, shame, poor self-esteem and secrecy surround this condition, which often results in adult infertility if left unrepaired.

IVUmed’s teams of volunteer physicians, nurses, and anesthesiologists provide hands-on surgical workshops, lectures, online educational materials, telehealth consultation, and impact measures to equip doctors and nurses with the skills they need to care for children in their communities. In turn, these newly trained medical professionals build future capacity for care by passing along IVUmed training to their colleagues, fulfilling IVUmed’s motto, “Teach One, Reach Many”.

IVUmed’s focus on education stands out among global health organizations, as does our focus on urology. Another unique element to IVUmed is our collaborative model. While IVUmed is guided by a dedicated board and staff, leadership of our programs stems from the dynamic doctors and administrators at our many partner hospitals around the world. Their priorities lead our efforts, which are put into action by our volunteer doctors and nurses. Together, and with the generous donations of many benefactors, we are building a worldwide system of pediatric training programs, ensuring that children everywhere will have access to the care they need.

With the help of supporters like the Ronald McDonald House Charities, the Societe Internationale d’Urologie (SIU), the American Urological Association (AUA), the Pan-African Urological Surgeons Association (PAUSA), and regional surgical associations, IVUmed is building a strong global network. Teaching hospitals throughout the world, skilled medical volunteers, ministries of health, local community leaders, international medical societies, regional colleges of surgeons, and charitable foundations combine strengths to give children everywhere the opportunity to lead the healthy, productive lives they deserve.

You can be involved too, whether a physician, engineer, photographer, philanthropist, medical student, etc.  We invite you to explore our volunteer opportunities here.  http://www.ivumed.org/how-you-can-help/

IVUmed patient in Vietnam

IVUmed in Vietnam

 

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Notes from the Field: Hue, Vietnam

Lawrence Jenkins, II, M.D.  Dr. Jenkins, an IVUmed resident scholar, volunteered with our general urology workshop in Hue, Vietnam on March 10-22, 2014. These are selections from his field notes:

 

Notes from the Field

Lawrence Jenkins, II, M.D.:

Day 1

I arrived in Hue after 23 hours of flight time. I really did not know what to expect, so everything was new. The first thing that was very apparent was that I was at least six inches taller than everybody else and people would often stare at me. I arrived just before noon and we traveled to meet up with the rest of the American group, Drs. Lance Hampton and Albert Petrossian from Virginia Commonwealth University, who were already at the hospital. There were no surgeries scheduled for the afternoon when I arrived so we decided to do some sightseeing. We went to see the Citadel and Imperial palace.

 

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Day 2

We went to the morning conference where there were approximately 6 Vietnamese attendings and residents but 10-30 medical students. The small room rarely made use of the air conditioning unit so it was often very hot and humid. We went to surgery that day… That was my first time seeing open surgery to remove large kidney stones. I was more accustomed to seeing this performed through percutaneous methods. It was very interesting to see this performed, especially through the small incision that they used. The operating rooms did not come with many extra features but luckily they did have air conditioning. Sadly, the scrub uniforms only came in one size and did not come close to fitting me but I luckily brought my own scrubs to wear. It was also interesting to see that most people wore sandals in the operating room and were otherwise barefoot. After the day of surgeries, we went exploring in the neighborhood by the hospital. We found a market which sold everything you could possibly need, from meat and spices to clothing and shoes. The merchants were very ambitious to make sales and negotiate over prices.

 

Day 3

We prepared for a laparoscopic cystectomy, a procedure which none of us had a great amount of experience with. We knew it would be challenging without the equipment we were used to in our institutions. The Vietnamese team was able to guide us through the procedure while utilizing multiple brands and types of tools to make up for what we were used to. The biggest difference was not having an energy-based device for vessel sealing i.e. Ligasure or Harmonic scalpel…  That evening we met up with some international medical students (one from New Zealand, two from Germany, and one from Belgium) and talked about medical training in the different parts of the world. One does not often hear what happens elsewhere.

 

Day 4

We went to morning conference and Dr. Petrossian gave a talk to the urology staff and medical students. After, they gave us a tour of the inpatient ward where they also housed preoperative patients. It was not the most comfortable establishment. There were at least 4 patients to a room and often of mixed gender. The beds were wooden cots with a half inch cloth pad on top. Some people looked worse than others but many were chatting with their roommates. Later in the day, we walked around the city and went to a traditional Vietnamese water puppet show which was entertaining.

 

Enjoy the second section of Dr. Lawrence’s field notes in our next blog post!

 

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In the News: Dr. Steven Kahan in Vietnam

IVUmed board member and long-time volunteer, Steve Kahan, MD, was recently featured by the online media outlet, Seacoastonline.com. Their article covers Dr. Kahan’s work on our recent general urology workshop in Hue, Vietnam, the progress IVUmed has made in providing quality surgical training to our Vietnamese partners, as well as Dr. Kahan’s his service history with IVUmed. We thank Dr. Kahan for his generous service to IVUmed and Seacoastonline.com for covering this story!

 

Enjoy the full article below:

 

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Doctor returns from mission trip to Vietnam

EXETER — Seacoast resident Steven Kahan, MD, recently returned from a surgical mission trip to Vietnam organized through International Volunteers in Urology.

Dr. Kahan, who practices at the Portsmouth location of Core Physicians’ Atlantic Urology Associates, was part of a group that volunteered during a two-week mission to Hue Central Hospital in Hue, Vietnam. During the trip, he educated other doctors, consulted on patient cases and conducted surgical procedures.

Kahan is a board member of IVU Med, a Salt Lake City, Utah-based organization that works to make quality urological care available to people in developing countries. Its services have been requested in more than 30 countries in Africa, Asia, Central America and South America. Kahan has traveled on six mission trips with the group to locations in both Vietnam and India.

“When you go and take part in something like this, it’s the purest form of medicine,” Kahan said. “This is the reason I went to medical school. This was about working one on one with students, caring directly for patients and teaching other doctors new techniques so that they can in turn treat patients on their own when we leave.”

The hospital in Hue where Kahan spent his time has 2,030 beds and serves as the main referral hospital in the central region. Kahan assisted with an average of six to 10 general adult urology patient cases per day. The Hue Central Hospital is also the key practical hospital for the Hue Medical College and University, the primary medical school in the region. During his trip, Kahan gave a handful of lectures on general urology and medicine to medical students from the university.

“Those of us on the trip were ambassadors for American medicine and the United States,” Kahan said.

There are only 1.2 doctors per 1,000 people in Vietnam, according to IVU Med. When the organization first began its volunteer missions to Vietnam in 1994, fewer than 100 pediatric urology patients were treated annually. Today, thanks to ongoing training from volunteers with IVU Med, Vietnamese partner surgeons now run their own training programs and treat more than 1,000 patients each year.

Kahan said he is considering a future mission trip to a hospital in Laos. However, he is also eager to return to Hue, where he has formed relationships with the Vietnamese doctors, some of whom have even consulted with him on cases after his return to the United States.

Core Physicians’ Atlantic Urology Associates has locations in Exeter and Portsmouth, offering patients state-of-the-art diagnosis and treatment of disorders of the male and female urinary tract. The practice treats patients with benign prostatic hyperplasia, hematuria, kidney cancer, incontinence, voiding dysfunction, prostate cancer, bladder cancer, testicular cancer and kidney stones.

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Quotes from the Field: Kumasi, Ghana

March was our busiest month yet at IVUmed – including five workshops across the globe! We’re highlighting this excellent work with quotes from IVUmed volunteer medical providers on those trips and photographs from the regions served.

 

Today’s Highlight: Kumasi, Ghana

 

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“This was my first international trip. The lack of medical supplies and general knowledge was striking to me. Key is to working with what they have and building on basics to help create lasting education and change in practice. I left feeling like we made a difference in caring for these patients and teaching nursing staff how to care for our patients as well. I felt humbled and lucky to have the kind of medical care we have in the US. One of the most memorable things I saw in Ghana was how loving the families were– all of the children had parents there who loved them and were there taking care of them. On rounds in the ward, they all supported each other and it was one big community. I was so happy they were welcoming and were appreciative of what we were there to do.”  (Shared Anonymously)

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“It was fantastic. I really want to get heavily involved with IVUmed in the future! Let me help!!! Most memorable experience was how grateful the patients are. I work a lot with inner city patients who have no insurance, and I used to think that they would be grateful to have any medical care. I found this to not be the case, so it was just so nice to be able to operate and have patients just be so very grateful and to try to do exactly what the doctors said (even though in some cases there was a language barrier.)” Janae Preece, MD

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Notes from the Field: Reconstruction in Rwanda

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Jeremy Myers, MD, of the Department of Genitourinary Injury and Reconstructive Urology at University of Utah School of Medicine, recently returned from an IVUmed reconstructive urology workshop trip to Rwanda. Upon returning to the United States, Dr. Myers recorded his thoughts on working with IVUmed and his experience in Rwanda. He has kindly allowed us to share his thoughts here:

 

Jeremy Myers 3/17/2014 – University of Utah and IVUmed:Rwanda_countryside

“I am just returning from a 2 week trip from Rwanda, Africa with IVUmed.  The focus of this group, headed by Catherine DeVries MD, is on increasing global urologic access through education of local surgeons.  The motto of the organization is “Teach One, Reach Many.”  This philosophy differs substantially from many relief organizations or mission trips.  Most often these trips seek to give aid and provide surgical care in resource poor countries.  While this is a noble sentiment, the impact of these trips may not be very great when they are viewed in the context of a country’s overall population and needs.  How much impact can a single trip have, with 20-40 operations performed in a country with a population of millions?

“This is why IVUmed’s mission and guiding principles are so important.  As opposed to impacting a few patients, surgeons can impact a population by identifying sites where surgeons are wanting to increase the level of care they provide and have the basic resources needed to create this change.

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“In Rwanda, there are 2 urologists for a population of 12 million people!  They are talented surgeons that are concentrated on providing quality care and also upon training more urologists.  They are now training 2 other urologists and anticipate a residency in urology in the future.

“Our trip was the first adult reconstructive urology workshop in Rwanda.  We found that the surgeons there were very talented.  They had excellent fine dissection and made the most of the resources they had.  They perform about 50-60 urethroplasties a year.

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We were able to demonstrate new techniques [that will enhance the local care of severe pelvic injuries].  The [local surgeons] should be able to incorporate [them] into their skill set with their already impressive urethroplasty experience.  These were challenging cases, but not something the Rwandan surgeons had had much exposure to.

“Our team consisted of 2 adult reconstructive urologists, a urology resident, a radiologist who was married to one of the reconstructive urologists, and an anesthesiologist.  We performed about 26 operations in 2 weeks.

 

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“We were able to have the weekend in Kigali, which is the main city in Rwanda.  Our weekend was spent visiting the markets in the city and relaxing.  We also made a visit to the genocide museum.  While this was a difficult visit to make, we felt this was something important to do in order to understand how the genocide has affected all of Rwanda and shaped its current government and culture.

“This was a fantastic trip and our team felt we were able to educate and show the Rwandan surgeons some advanced techniques that they can incorporate very readily into their practice.  I am looking forward to returning and reinforcing these techniques and observing what progress the urologist have made in shaping their urology training programs.  They were inspiring surgeons and individuals and very gracious hosts for our trip.  While it takes a while to get to Rwanda, the experience was worth it.”

 

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Women’s Month Feature: Kristin Chrouser

 

IVUmed Board Member and Volunteer:  Kristin Chrouser, MD

 

Dr. Kristin Chrouser was IVUmed’s first fellow and has been an IVUmed board member since 2004.

 

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Dr. Kristin Chrouser has trained and assisted doctors in Nigeria, Namibia, South Africa, India, and elsewhere. Of her reconstructive urology work for women of Namibia, Dr. Chrouser stated, “the smiles and often spontaneous dances of joy that erupt when a woman leaves the hospital cured and dry make it all worthwhile”.

She became involved with IVUmed when she traveled to India as a Traveling Resident Scholar. She spent two weeks at a urology camp in Bhopal, India organized by local Hindu charity Jeev Sewa Sansthan (JSS), which translates as “Service to the Living”. The organization, founded on the principle that God is seen in all people, has founded several schools, an eye hospital, and provides several short-term urology and general surgery “camps” each year. IVUmed partners with JSS to provide US urologists and resident volunteers for JSS camps.

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Dr. Chrouser and mentor Dr Sakti Das, a veteran IVUmed mentor and long-time India camp participant, scrubbed in together on dozens of cases.

About her experience in India, Dr Chrouser reflected:

“Surgically, I had an amazing experience. There were moments of frustration—language barriers, incorrect suture, no sterile forceps with teeth, scissors that refused to cut, inadequate anesthesia, but overall, given the environment, things ran very smoothly… I learned that a dorsal lumbotomy incision can be used to access the collecting system in an adult (with minimal need for post-operative analgesia), as long as you’re willing to work in a hole! I found that almost anything can be done under spinal anesthesia—as long as you don’t mind your patient watching you operate…Despite my inability to speak Hindi, I saw in the eyes of my patients a message of hope. It made me forget the small inconveniences of working in India and remember the real reason for service to others.”

 

 

Read more about Dr. Chrouser’s work on her website: www.freewebs.com/chrouser.

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Thank You for Supporting IVUmed in 2013

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We offer our thanks and appreciation to all IVUmed volunteers and donors of 2013! Your volunteer hours and generous contributions make possible our efforts to improve patient care and provide quality medical training worldwide. We look forward to a fantastic 2014!

 

Matching Gift Opportunity

Donors may still maximize their gifts by using participating employers’ Matching Gift programs. Check with your employer’s human resources or payroll department to verify participation. You may also refer to this partial list of U.S. corporate matching gift programs:> Read More 

 

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Urology and Children: A Nurse’s Perspective

The continued account of IVUmed volunteer recovery nurse, Michael Felber, regarding his recent IVUmed humanitarian service in Zambia, shared from his travel journal:

 

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IVUmed missions have a focus on education. There is very little fanfare and the only visitors to the hospital are other doctors and medical students. The operating rooms are usually full of observers and IVUmed surgeons and anesthesiologists work together.

 

Many of the surgeries this week have been revisions of previous surgeries. Pediatric urology as a specialty doesn’t exist as a standalone specialty in most of the developing world. Children need different techniques and different care than adults do though, so specialized training is needed. It’s a dilemma for IVU. The best way to teach doctors surgical techniques is with primary surgeries, allowing them to learn how to do surgeries that won’t require a redo. At the same time, you can’t ignore the needs of children who are living with bad outcomes from previous surgeries.

 

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One of the common procedures is a hypospadias repair, a relatively common birth defect where the opening of the urethra is on the shaft or base of the penis instead of the tip. It is typically treated in infancy in the developed world. The implications depend on where the hypospadias is. If the urethra empties on the distal (tip) end the child may not be able to urinate straight, but otherwise function normally. If it is proximal (base of the penis), the penis will not be able to straighten. The child may not be able to urinate while standing, and eventually will not have normal fertility. The surgery to repair a hypospadias takes a couple of hours. The urethra is reconstructed to the tip of the penis, and the skin is closed with a graft, usually from the foreskin. The child has a catheter in place while healing. Probably the most common complication that occurs after surgery is the formation of a fistula. Instead of healing completely along the suture line, a second opening forms from the urethra to the shaft of the penis. The child will not urinate in a normal single stream and may “leak” urine after emptying his bladder. Repairing is complicated by excessive scar tissue or a shortage of soft, healthy skin available for grafting.

 

Another problem that requires surgical treatment is the formation of posterior urethral valves. Normally urine empties from the bladder through the urethra. Posterior urethral valves are malformed tissues that block this flow of urine, only allowing it to leak out under very high pressure. Children with this condition have chronically full bladders. The pressure forces urine into the ureters, which empty urine from the kidneys to the bladder. The additional pressure restricts blood flow to the kidneys, preventing normal growth and eventually starving the kidneys of oxygenated blood. In the short term children with this condition are incontinent. Over time they develop kidney failure. Surgical repair of post urethral valves requires specialized techniques and equipment. In countries where these are not available, the treatment may involve creating an opening from the abdomen to the bladder and placing a tube attached to a drainage bag. This relieves the pressure on the child’s bladder but greatly increases the risk of bladder infections and bladder cancer. Tubes and drainage bags need to be replaced frequently and urine can leak from the opening, and the associated shame and isolation impedes normal social development. In addition to teaching surgical techniques, IVU donates necessary equipment for this repair and teaches techniques that can be done with local resources and equipment.

 

The most complex treatment is for bladder exstrophy, a condition that results from insufficient room in the pelvis for the bladder. Instead it tries to form outside the abdomen, leaving an opening that drains urine continuously. The implications are complete incontinence, and heightened risk of abdominal cancer and infection. Surgical treatment requires reshaping the pelvis to accommodate the bladder, and reconstructing and reforming the bladder using grafts from other tissue. Because of the complexity, surgical reconstructions are often done in stages.   

 All of these conditions have significant impacts on the lives of children and their families. The suffering they cause is often discreet. Urological defects tend to be hidden behind a wall of shame and often these children are ostracized socially, and are unable to find employment or get married as adults. I think in the end all of these conditions affect people’s most basic sense of dignity.

 The last two patients are in the operating rooms.  One more day left.  It feels like I have been here much longer than a week, though.

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Zambia Blog: A Kind Word and a Smile

The continued account of IVUmed volunteer recovery nurse, Michael Felber, regarding his recent IVUmed humanitarian service in Zambia, shared from his travel journal

 

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We are on the fourth day, a beautiful, warm day. Surgeries are going well.

 

The nurses’ strike is still officially going on, but more nurses are trickling in. This morning there was no running water in the hospital. Luckily the surgical instruments had already been sterilized. There is a large blue tank of water with a spigot for hand washing. By the end of the morning the water was running again. People just sort of go with the flow here.

 

David was a very nice 8 year old boy who had surgery this morning. He was frightened as he went to sleep, but tried mightily not to cry. He held it together until the mask went on, then struggled and cried out “I am dying!”  In recovery he woke up with a smile. He was mildly pleased when we brought him toys, but when I gave him a banana he just about jumped off his cart with excitement.

 

There is the usual big city traffic on the way in to the hospital, but it is quiet. I haven’t heard a car horn since I got here, unlike other countries where the horn is a substitute for a brake. People here are exceedingly polite. Zambia is a poor country, with 50% unemployment. But so far, unlike many other countries I have visited, the people standing in traffic selling newspapers, cell phone minutes, and candy have been adults.

 

The University Teaching Hospital of Zambia, our host, is an 1800 bed facility. When you walk on the wards, you see that all the beds are full, and more patients are sleeping on the floor.

Someone called me Sister yesterday. I guess there aren’t too many men in nursing here. A couple of the surgeons were discussing starting an internet teaching program that would use video to teach urological surgery techniques. You could say live “streaming” video…

In the United Kingdom 10% of available food is wasted. I imagine the figure for the US is the same or worse. It would be enough to feed the entire population of Zambia. Fasting for surgery is tricky here. Kids are often chronically hungry to begin with. After surgeries their blood sugars are low. We had a two year old who was in surgery for 6 hours. We mixed our own intravenous dextrose solution, and when he woke up we fed him orange Fanta with a syringe. Not quite a breast, but he liked it.

I love watching the porters with the patients here. They do all the patient transport. They seem to always have a kind word and a smile, and can often calm a frightened child just with their presence. On Sunday I noticed an iron on one of the stretchers in the recovery room. It seemed out of place, but it isn’t. Nobody is allowed to wear scrubs or shoes that have been outside the operating room area, so they wash and iron their scrubs here.

 

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IVUmed is committed to making quality urological care available to people worldwide.