title: Establishment of a urology service in a developing country: an observational study of outcomes in transurethral prostate resection procedures in Vanuatu.
abstract: BACKGROUND
  The Royal Australasian College of Surgeons (RACS) via the Pacific Island Program (PIP) administer yearly urology visits to Vanuatu to perform surgery and deliver training in the management of urological conditions. In conjunction with the Vanuatu Ministry of Health a self-sufficient urology service has developed, specifically performing transurethral resection of the prostate (TURP) procedures. We review the TURP outcomes for the PIP and detail the development and outcomes of the first independent TURP service in the Pacific.
  
  
  METHODS
  With retrospective local and RACS medical records, an observational study was performed of TURP procedures undertaken in Port Vila Central Hospital, Vanuatu over 6 years. Outcome measures comprised significant morbidity, prolonged post-operative admission, blood transfusion, TUR syndrome, successful trial of void, postoperative urinary incontinence, and perioperative mortality. Comparisons were made with univariate analysis between the RACS, local team, and international standardised values, with t-tests for continuous variables, and with Fisher's exact test for binary variables.
  
  
  RESULTS
  Since 2009, a total of 117 TURP procedures were performed. 84 by the PIP team and following training both in Vanuatu and Australia; the local team independently performed 33 TURPs. Comparisons of all outcomes measured between the local and PIP teams showed no statistically significant differences (appendix). 29 patients overall (22 in the PIP group and seven in the local group) required blood transfusions, eight (seven and one) failed their trial of void, 10 (seven and three) had a prolonged post-operative admission (>7 days); two patients died in the post-operative period both in the PIP group). 10 (seven and three) had postoperative urinary incontinence. There was no difference between mean length of stay (4·07 days vs 4·7 days; p=0·2081) and haemaglobin loss with no cases of TUR syndrome. Only the rate of transfusion was statistically significantly higher in the Vanuatu cohorts when compared with international standards (appendix).
  
  
  CONCLUSIONS
  The development of a local urological service and in particular a TURP service is a first for a Pacific Island Nation. Baseline data were obtained with encouraging outcomes reflecting careful patient selection, cautious management, and expertise accumulation. Planned prospective audit should overcome some of the difficulties encountered in performing a longitudinal study in a developing nation with suboptimum follow-up and challenging medical records. Through linkage between the PIP and the Vanuatu Ministry of Health capacity building an independent service provision can be achieved. This model could be replicated to establish a sustainable and self-sufficient surgical service in a developing country.
  
  
  BACKGROUND
  None.
authors: Urology Department, Barwon Health, Geelong, VIC, Australia.
authors: Ben
authors: B
authors: Namdarian
authors: Western District Health Service, Hamilton, VIC, Australia.
authors: Stuart
authors: S
authors: Willder
authors: Austin Health, Melbourne, VIC, Australia.
authors: Geoff
authors: G
authors: Steele
authors: Department of Surgery, Vila Central Hospital, Port Vila, Vanuatu.
authors: Richard
authors: R
authors: Leona
authors: Urology Department, Barwon Health, Deakin University, Geelong, VIC, Australia. Electronic address: rgrills@westcoasturology.com.au.
authors: Richard
authors: R
authors: Grills