Endourology in a Resource-Limited Setting: Current Practices and Key Challenges in an Ethiopian Tertiary Hospital

Endourology in a Resource-Limited Setting: Current Practices and Key Challenges in an Ethiopian Tertiary Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Endourology in a Resource-Limited Setting: Current Practices and Key Challenges in an Ethiopian Tertiary Hospital Chalachew Tenna Alemu, Tsiyon Nigusie Alemu, Messay Mekonnen Molla, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6194849/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives Endourology has advanced rapidly in developed countries, offering minimally invasive solutions for complex urological conditions. However, in Ethiopia, the practice of endourology faces enormous challenges and remains limited in tertiary hospitals. This study aims to evaluate the current state of endourology in an Ethiopian public tertiary hospital and identify the challenges hindering its growth. It provides insight into endourological practices within a resource-limited healthcare setting Methods Conducted in the urology unit of a leading tertiary hospital in Ethiopia. A comprehensive retrospective review of medical records was performed for all patients who underwent diagnostic and therapeutic endourological procedures at the hospital between September 2023 and August 2024. Results The results reveal that a total of 2,139 endourological procedures were performed, making up 70.4% of all urological interventions by the unit during this period most being done for diagnostic purposes. Bladder outlet obstruction due to benign prostatic hyperplasia (33.2%) was the most common indication, followed by ureteric DJ stent removal (20.1%) and bladder tumor evaluation (17.3%). Limited availability of essential equipment, including for retrograde intrarenal surgery, restricted the scope of interventions Conclusion Despite the significant advantages of minimally invasive endourological techniques, widespread adoption in Ethiopian public hospitals remains constrained by limited equipment, a shortage of trained personnel, and insufficient funding. Endourology Urinary tract challenges urethrocystoscopy Figures Figure 1 INTRODUCTION Endourology has become a critical component of modern urological practice worldwide, fundamentally shifting how conditions of the urinary tract are diagnosed and treated. In developed countries, the field has advanced rapidly, with minimally invasive procedures now considered the gold standard in urology 1 . Few medical specialties have been transformed as profoundly as urology, where endoscopic techniques have replaced many procedures that once required open surgeries 2 . However, in developing nations such as Ethiopia, Progress in endourology has been slow, despite some encouraging developments in recent years 3 . In Ethiopia, access to endourologic services remains limited, particularly within few tertiary hospitals. This scarcity stems from insufficient equipment, a shortage of trained professionals, and inadequate funding to sustain endourologic programs 4 . While private-sector clinics may offer these services, the high costs often make them inaccessible for the majority of Ethiopian patients 4 . This situation underscores the critical need for accessible, cost-effective endourology in public healthcare settings, where most patients seek care. The urinary tract is often affected by conditions requiring endoscopic intervention, such as urinary obstructions, stones, and benign prostatic hyperplasia 5 . This study aimed to audit endoscopic procedures performed on the urinary tract at a leading public tertiary hospital in Ethiopia, documenting the scope of procedures and the challenges faced in providing endourologic care within a resource-limited setting. By sharing our findings, we seek to shed light on the progress and ongoing obstacles in delivering accessible endourologic services, with insights that could inform efforts to improve urological care in similar environments. Methods A comprehensive retrospective review of medical records was conducted for all patients who underwent urologic endoscopic procedures over a one-year period, from September 2023 to August 2024, at a public tertiary hospital in Ethiopia where most of the endoscopic procedures are performed in the country. The study received ethical approval from the hospital's research committee. Data were extracted from clinical notes and operation theater registers, focusing specifically on patients who had undergone urologic endoscopic procedures. Patients who did not undergo these procedures were excluded from the analysis. The collected data included demographic parameters, indications for the procedures, types of endoscopic interventions performed, whether the surgeries were day cases or inpatient admissions, types of anesthesia utilized, and the purpose of each surgery, whether diagnostic or therapeutic. The data analysis was performed and presented in detail. The endoscopic procedures employed a range of specialized instruments, including rigid cystoscope sets, 0-degree and 30-degree telescopes, semirigid ureteroscopes, and a flexible ureteroscope used exclusively for diagnostic purposes. Additional equipment included stone punches, biopsy forceps, monopolar resectoscope sets, and percutaneous nephrolithotomy sets, which comprised puncture needles, both plastic and metallic dilators, and rigid nephroscopes. Imaging support was provided by gray-scale ultrasound. pneumatic lithotripsy connected to oxygen cylinders for compressed air was used for intracorporial lithotripsy. Most procedures utilized normal saline and 5% dextrose in water as irrigation fluids. There was a lack of operational equipment essential for performing vital minimally invasive urologic procedures, such as retrograde intrarenal surgery and extracorporeal shock wave lithotripsy. Some equipment was entirely absent, while others were unavailable due to inadequate maintenance. The urology unit consists of 9 urologists, 3 urology fellows, and 17 urology residents in training. RESULTS In this study, we analyzed data from 2,139 patients who underwent endourologic procedures for urinary tract issues at Tikur Anbessa Specialized Hospital, a tertiary facility in Ethiopia, over a one-year period. The cohort comprised 1,692 males (79.1%) and 447 females (20.9%). The age of the patients ranged from 12 to 88 years, with a mean age of 48.9 years. The median age group was between 50 and 59 years, as displayed in Table 1 . Table 1 Frequency distribution of the age range Age range(years) Frequency Percentage 10–19 182 8.5 20–29 221 10.3 30–39 211 9.7 40–49 321 15 50–59 556 26 60–69 363 17 70–79 199 9.3 80–89 86 4.2 Total 2139 100.0 Notably, 55.5% of all procedures were performed for diagnostic purposes, with nearly all utilizing rigid cystourethroscopy. The most common indication for these procedures was the evaluation of bladder outlet obstruction due to benign prostatic hyperplasia, which accounted for one-third of the cases. This was followed by procedures for ureteric DJ stent removal and evaluations for bladder tumors, as shown in Table 2 . Table 2 Indications for urinary tract endoscopic procedures Indications for endourology Frequency Percentage Benign prostatic enlargement (BPE) 712 33.2 Ureteric DJ stent removal 430 20.1 Bladder tumor with or without hematuria 369 17.3 Ureteral stone 295 13.8 Renal stone 135 6.3 Urethral strictures 126 5.9 Ureteric DJ stents Insertion 48 2.24 Bladder neck stenosis 8 0.4 Bladder stone 5 0.23 Ureteric stricture 8 0.37 Urethral diverticula with stone 1 0.05 Posterior urethral valve 1 0.05 Prostatic abscess 1 0.05 Almost two-thirds of the procedures were performed using rigid cystourethroscopy, followed by semirigid ureteroscopy, monopolar transurethral resection and percutaneous endoscopy using Rigid Nephroscope. This distribution is illustrated in Table 3 . Table 3 Frequency Distribution of types of endoscopic procedures performed Procedures performed Frequency Percentage Cystourethroscopy (rigid) 1402 65.6 Ureteroscopy (semirigid) 303 14.2 Trans-urethral resection of bladder tumor (TURBT) 142 6.65 Percutaneous Nephrolithotomy (PCNL) 135 6.3 Monopolar trans-urethral resection of prostate (M-TURP) 74 3.46 Cystodilation of urethral strictures 48 2.25 Transurethral resection of prostate ca (channeling) 12 0.57 Transurethral deroofing of prostatic abscess 1 0.047 Bladder Neck Incision 8 0.38 DVIU 8 0.37 Transurethral ablation of PUV 1 0.048 Cystolitholapaxy 5 0.23 Local anesthesia with lidocaine was the most commonly used type of anesthesia, as shown in Fig. 1 . The majority of procedures (67.8%) were carried out as day cases, while the remainder were performed on admitted patients DISCUSSION Urinary tract endoscopy is a vital component of urologic patient management, routinely performed by urologists 6 . In our study conducted in Ethiopia, the mean age of patients was 48.9 years, which is notably lower than the mean ages reported in earlier studies that typically correspond to the sixth decade of life. Consistent with previous reports, our cohort was predominantly male, reflecting the gender distribution commonly observed in urologic cases 7 . The most frequent diagnostic indication for lower urinary tract endoscopy in our study was the presence of bladder outlet obstruction, accounting for 33.3% of cases followed by evaluation for bladder tumor consistent with high prevalence of this conditions 8 . Usman M. Tela reported in Borno State, Nigeria the commonest diagnostic indication for LUT endoscopy as bladder tumor presenting (31.3%) 9 . Other common indication for endoscopic procedure in our study was the insertion and removal of double-J stents via urethrocystoscopy. Percutaneous nephrolithotomy (PCNL) and semirigid ureteroscopy (URS) are the main endoscopic procedures used for treating upper urinary tract stones 10 .In our study they accounted accounting for 6.3% and 14.1% of cases, respectively. However, the unavailability of advanced options like retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESWL) leaves most intrarenal stones to be managed conservatively. This limitation significantly affects urology services, leading to increased patient morbidity and a higher burden on healthcare resources. we employed rigid cysto-urethroscopes for all the diagnostic and therapeutic procedures including removal of DJ stent.In contrast, the availability of flexible provides for a more thorough yet less morbid and less expensive examination 11 . Monopolar transurethral resection of the prostate (TURP) and transurethral resection of bladder tumor (TURBT ) are among the other commonly performed procedures, collectively accounting for 10.7% of cases—a figure that is relatively low compared to the disease burden 12 . The lack of advanced equipment such as bipolar TURP or laser technology necessitates that most procedures are still performed via open surgery, contributing to increased surgical morbidity and resource demands. The other less common procedures reported are transurethral resection of ureterocele and posterior urethral valve, bladder neck incision, cystolithotripsy, direct vision internal urethrotomy Almost all urethrocystoscopies and urethroscopies in this study were conveniently performed under local anesthesia. This approach was effective even for procedures requiring double-J stent insertions and the majority of direct vision internal urethrotomies (DVIU). These findings are consistent with previous studies, which have highlighted the safety, practicality, and cost-effectiveness of local anesthesia in minimally invasive urological procedures 13 . For major procedures, such as transurethral resection of the prostate (TURP), transurethral resection of bladder tumors (TURBT), cystolitholapaxy, and semirigid ureteroscopy, spinal anesthesia was predominantly used, reflecting standard practice in similar healthcare settings. In contrast, all reported percutaneous nephrolithotomy (PCNL) procedures were performed under general anesthesia Normal saline at room temperature, elevated to a height of 60 centimeters, was used as the standard irrigation fluid in the majority of procedures, as normal saline is isotonic and minimizes the risk of complications such as electrolyte imbalance during endoscopic procedures. However, for procedures involving monopolar resection, 5% glucose in water was used as the irrigation fluid due to its non-conductive properties. This approach yielded good procedural outcomes with minimal complications, aligning with evidence from previous studies that highlight it’s efficacy and safety 14 . In conclusion, Urinary tract endoscopy is a critical aspect of standard urological practice. In this study, urethrocystoscopy was the most frequently performed procedure, alongside other common interventions. However, despite the high prevalence of urologic diseases, the limited availability of advanced urological equipment presents significant challenges. These limitations restrict treatment options, delay care, and negatively affect patient outcomes. Bridging these gaps through investment in diverse, modern urologic tools and comprehensive training for healthcare providers is essential to enhancing the quality of care and improving patient outcomes in Ethiopia. STRENGTH: A robust retrospective review of 2,139 cases provides a significant sample size, ensuring that the findings are statistically meaningful and representative of the hospital's patient population. The study provides a foundation for future research aimed at improving endourological care in Ethiopia and similar settings. It provides valuable information on the prevalence of urological conditions requiring endoscopic interventions, contributing to a better understanding of disease patterns in Ethiopia. LIMITATION: Data were collected from a single tertiary hospital, which may limit the generalizability of the findings. The retrospective nature of the study relies on existing medical records, which may have incomplete or inconsistent documentation, potentially introducing information bias. Declarations DISCLOSURE: Ethics approval and consent to participate : Approval of the research protocol by the Addis Ababa University College of Health Sciences Institutional Review Board, conducted in accordance with Declaration of Helsinki Funding: No funding available Human Ethics and Consent to Participate declarations : not applicable Registry and the Registration No. of the study: N/A Animal study: N/A References Patel, Hiten D., Adam L. Kushner, and Mohamad E. Allaf. "Waiting for global access to urologic care." European urology 64.2 (2013): 344-345. Miller, R. A. "Endoscopic surgery of the upper urinary tract." British medical bulletin 42.3 (1986): 274-279. Nedjim, Saleh Abdelkerim, et al. "Global viewpoints: proposals for the development of endourology in resource‐limited countries in Africa." BJU international (2024). Kifle, A.T., Biyani, C.S., Bogdanowicz, J. et al. Urologist Workforce and Services in Ethiopia. World J Surg 47, 2628–2634 (2023). https://doi.org/10.1007/s00268-023-07169-0 Mahadevan, Vishy. "Anatomy of the lower urinary tract." Surgery (Oxford) 34.7 (2016): 318-325. Shu'aibu, S. I., et al. "Lower Urinary Tract Endoscopic Procedures in Jos." Journal of Medicine in the Tropics 14.1 (2012): 74-77. Geremew, Lijalem Mekonnen, Samuel Amare Gelaw, and Andualem Deneke Beyene. "Assessing the complications of monopolar transurethral resection of the prostate (M-TURP) using Clavien-Dindo complications grading system." Ethiopian journal of health sciences 32.3 (2022). Kacker, Ravi, and Stephen B. Williams. "Endourologic procedures for benign prostatic hyperplasia: review of indications and outcomes." Urology journal 8.3 (2011): 171-176. Tela, Usman M., et al. "Audit of lower urinary tract endoscopic procedures in Borno, North-Eastern Nigeria." International Journal of Research in Medical Sciences 9.2 (2021): 325. . Payne, S. R., T. F. Ford, and J. E. A. Wickham. "Endoscopic management of upper urinary tract stones." Journal of British Surgery 72.10 (1985): 822-824. Kavoussi, Louis R. "Office flexible cystoscopy." Urologic Clinics of North America 15.4 (1988): 601-608. Awedew, Atalel Fentahun, et al. "The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019." The Lancet Healthy Longevity 3.11 (2022): e754-e776. Ather, M. Hammad, Ammara Mushtaq, and M. Nasir Sulaiman. "Urological surgical procedures under local anesthesia." Clinical Use of Local Anesthetics (2012): p-39. Hahn, R. G. "Fluid absorption in endoscopic surgery." British Journal of Anaesthesia 96.1 (2006): 8-20. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6194849","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":442373721,"identity":"e72cd03f-fc2b-48e5-bedb-6b57f60023ca","order_by":0,"name":"Chalachew Tenna Alemu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Chalachew","middleName":"Tenna","lastName":"Alemu","suffix":""},{"id":442373724,"identity":"3143f6e7-cec3-4d0f-b072-ed87a0b9ce2d","order_by":1,"name":"Tsiyon Nigusie Alemu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYFACxgYQKQNiPUgwkJAD8Q48wKOBB6qFB4iZDT4UWBiDtSTg1YKg2SRnfKhIBJuAT4s9/+E2iY877Hj4xc4YSPMYSKTPDzv8EGiLnZxuAw5bJBLbJGeeSeaRnJ1jYAzUkrvxdpoBUEuysdkBXFoY26R525h5DG7nGCSDtcxOAGk5kLgNlxb+gyAt9Tz2QC2HQQ4znJ3+Ab8WhkSQFqBi6RzDxhkGEgny0jkEbLmR2Gw5s+04j8TttGKGDwYShhukcwoOJBjg9gt7//GHNz62Vcvxz07e/iPhT528/Oz0zR8+VNjJ4dICBCwSKFwDsEoDnMpBgPkDCle+Aa/qUTAKRsEoGIEAAHQGXGDErp6tAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Tsiyon","middleName":"Nigusie","lastName":"Alemu","suffix":""},{"id":442373726,"identity":"7b7a5de7-2c35-4423-baed-cfebeb234fde","order_by":2,"name":"Messay Mekonnen Molla","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Messay","middleName":"Mekonnen","lastName":"Molla","suffix":""},{"id":442373728,"identity":"255f8927-402f-455f-8303-bbd6c4ddd7fa","order_by":3,"name":"Yacob Sheiferawe Seman","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yacob","middleName":"Sheiferawe","lastName":"Seman","suffix":""},{"id":442373730,"identity":"f9d3cb17-0af1-4ec0-a4d8-ab19616af2fd","order_by":4,"name":"Kinfe Tsehaye Gebregziabher","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Kinfe","middleName":"Tsehaye","lastName":"Gebregziabher","suffix":""}],"badges":[],"createdAt":"2025-03-10 11:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6194849/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6194849/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82097707,"identity":"bdd495c9-4139-4665-9f1d-0b8ce3be50bd","added_by":"auto","created_at":"2025-05-06 17:54:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67711,"visible":true,"origin":"","legend":"\u003cp\u003eType of anesthesia used in the endoscopic procedures\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6194849/v1/ec98bd0f2ab5f9886c721b57.png"},{"id":96238991,"identity":"c44ffc2b-91ff-4cce-9f52-130261d4f4c7","added_by":"auto","created_at":"2025-11-19 06:59:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":535655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6194849/v1/eb33ab5d-92ab-48e6-8d47-348856735354.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Endourology in a Resource-Limited Setting: Current Practices and Key Challenges in an Ethiopian Tertiary Hospital","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndourology has become a critical component of modern urological practice worldwide, fundamentally shifting how conditions of the urinary tract are diagnosed and treated. In developed countries, the field has advanced rapidly, with minimally invasive procedures now considered the gold standard in urology\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Few medical specialties have been transformed as profoundly as urology, where endoscopic techniques have replaced many procedures that once required open surgeries\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. However, in developing nations such as Ethiopia, Progress in endourology has been slow, despite some encouraging developments in recent years\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn Ethiopia, access to endourologic services remains limited, particularly within few tertiary hospitals. This scarcity stems from insufficient equipment, a shortage of trained professionals, and inadequate funding to sustain endourologic programs\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. While private-sector clinics may offer these services, the high costs often make them inaccessible for the majority of Ethiopian patients\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. This situation underscores the critical need for accessible, cost-effective endourology in public healthcare settings, where most patients seek care.\u003c/p\u003e \u003cp\u003eThe urinary tract is often affected by conditions requiring endoscopic intervention, such as urinary obstructions, stones, and benign prostatic hyperplasia\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study aimed to audit endoscopic procedures performed on the urinary tract at a leading public tertiary hospital in Ethiopia, documenting the scope of procedures and the challenges faced in providing endourologic care within a resource-limited setting. By sharing our findings, we seek to shed light on the progress and ongoing obstacles in delivering accessible endourologic services, with insights that could inform efforts to improve urological care in similar environments.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA comprehensive retrospective review of medical records was conducted for all patients who underwent urologic endoscopic procedures over a one-year period, from September 2023 to August 2024, at a public tertiary hospital in Ethiopia where most of the endoscopic procedures are performed in the country.\u003c/p\u003e \u003cp\u003e The study received ethical approval from the hospital's research committee.\u003c/p\u003e \u003cp\u003eData were extracted from clinical notes and operation theater registers, focusing specifically on patients who had undergone urologic endoscopic procedures. Patients who did not undergo these procedures were excluded from the analysis. The collected data included demographic parameters, indications for the procedures, types of endoscopic interventions performed, whether the surgeries were day cases or inpatient admissions, types of anesthesia utilized, and the purpose of each surgery, whether diagnostic or therapeutic. The data analysis was performed and presented in detail.\u003c/p\u003e \u003cp\u003eThe endoscopic procedures employed a range of specialized instruments, including rigid cystoscope sets, 0-degree and 30-degree telescopes, semirigid ureteroscopes, and a flexible ureteroscope used exclusively for diagnostic purposes. Additional equipment included stone punches, biopsy forceps, monopolar resectoscope sets, and percutaneous nephrolithotomy sets, which comprised puncture needles, both plastic and metallic dilators, and rigid nephroscopes. Imaging support was provided by gray-scale ultrasound. pneumatic lithotripsy connected to oxygen cylinders for compressed air was used for intracorporial lithotripsy. Most procedures utilized normal saline and 5% dextrose in water as irrigation fluids.\u003c/p\u003e \u003cp\u003eThere was a lack of operational equipment essential for performing vital minimally invasive urologic procedures, such as retrograde intrarenal surgery and extracorporeal shock wave lithotripsy. Some equipment was entirely absent, while others were unavailable due to inadequate maintenance.\u003c/p\u003e \u003cp\u003eThe urology unit consists of 9 urologists, 3 urology fellows, and 17 urology residents in training.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn this study, we analyzed data from 2,139 patients who underwent endourologic procedures for urinary tract issues at Tikur Anbessa Specialized Hospital, a tertiary facility in Ethiopia, over a one-year period. The cohort comprised 1,692 males (79.1%) and 447 females (20.9%). The age of the patients ranged from 12 to 88 years, with a mean age of 48.9 years. The median age group was between 50 and 59 years, as displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency distribution of the age range\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge range(years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e80\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNotably, 55.5% of all procedures were performed for diagnostic purposes, with nearly all utilizing rigid cystourethroscopy. The most common indication for these procedures was the evaluation of bladder outlet obstruction due to benign prostatic hyperplasia, which accounted for one-third of the cases. This was followed by procedures for ureteric DJ stent removal and evaluations for bladder tumors, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndications for urinary tract endoscopic procedures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for endourology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenign prostatic enlargement (BPE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreteric DJ stent removal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder tumor with or\u003c/p\u003e \u003cp\u003ewithout hematuria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreteral stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrethral strictures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreteric DJ stents\u003c/p\u003e \u003cp\u003eInsertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder neck stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreteric stricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrethral diverticula with stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior urethral valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstatic abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAlmost two-thirds of the procedures were performed using rigid cystourethroscopy, followed by semirigid ureteroscopy, monopolar transurethral resection and percutaneous endoscopy using Rigid Nephroscope. This distribution is illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency Distribution of types of endoscopic procedures performed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedures performed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCystourethroscopy (rigid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreteroscopy (semirigid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrans-urethral resection of bladder tumor (TURBT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercutaneous Nephrolithotomy (PCNL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonopolar trans-urethral resection of prostate (M-TURP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCystodilation of urethral strictures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransurethral resection of prostate ca (channeling)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransurethral deroofing of prostatic abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder Neck Incision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDVIU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransurethral ablation of PUV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCystolitholapaxy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLocal anesthesia with lidocaine was the most commonly used type of anesthesia, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of procedures (67.8%) were carried out as day cases, while the remainder were performed on admitted patients\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eUrinary tract endoscopy is a vital component of urologic patient management, routinely performed by urologists\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In our study conducted in Ethiopia, the mean age of patients was 48.9 years, which is notably lower than the mean ages reported in earlier studies that typically correspond to the sixth decade of life. Consistent with previous reports, our cohort was predominantly male, reflecting the gender distribution commonly observed in urologic cases\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe most frequent diagnostic indication for lower urinary tract endoscopy in our study was the presence of bladder outlet obstruction, accounting for 33.3% of cases followed by evaluation for bladder tumor consistent with high prevalence of this conditions\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Usman M. Tela reported in Borno State, Nigeria the commonest diagnostic indication for LUT endoscopy as bladder tumor presenting (31.3%)\u003csup\u003e9\u003c/sup\u003e. Other common indication for endoscopic procedure in our study was the insertion and removal of double-J stents via urethrocystoscopy.\u003c/p\u003e \u003cp\u003ePercutaneous nephrolithotomy (PCNL) and semirigid ureteroscopy (URS) are the main endoscopic procedures used for treating upper urinary tract stones\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.In our study they accounted accounting for 6.3% and 14.1% of cases, respectively. However, the unavailability of advanced options like retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESWL) leaves most intrarenal stones to be managed conservatively. This limitation significantly affects urology services, leading to increased patient morbidity and a higher burden on healthcare resources.\u003c/p\u003e \u003cp\u003ewe employed rigid cysto-urethroscopes for all the diagnostic and therapeutic procedures including removal of DJ stent.In contrast, the availability of flexible provides for a more thorough yet less morbid and less expensive examination\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMonopolar transurethral resection of the prostate (TURP) and transurethral resection of bladder tumor (TURBT\u003cb\u003e)\u003c/b\u003e are among the other commonly performed procedures, collectively accounting for 10.7% of cases\u0026mdash;a figure that is relatively low compared to the disease burden\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The lack of advanced equipment such as bipolar TURP or laser technology necessitates that most procedures are still performed via open surgery, contributing to increased surgical morbidity and resource demands.\u003c/p\u003e \u003cp\u003eThe other less common procedures reported are transurethral resection of ureterocele and posterior urethral valve, bladder neck incision, cystolithotripsy, direct vision internal urethrotomy\u003c/p\u003e \u003cp\u003eAlmost all urethrocystoscopies and urethroscopies in this study were conveniently performed under local anesthesia. This approach was effective even for procedures requiring double-J stent insertions and the majority of direct vision internal urethrotomies (DVIU). These findings are consistent with previous studies, which have highlighted the safety, practicality, and cost-effectiveness of local anesthesia in minimally invasive urological procedures\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. For major procedures, such as transurethral resection of the prostate (TURP), transurethral resection of bladder tumors (TURBT), cystolitholapaxy, and semirigid ureteroscopy, spinal anesthesia was predominantly used, reflecting standard practice in similar healthcare settings. In contrast, all reported percutaneous nephrolithotomy (PCNL) procedures were performed under general anesthesia\u003c/p\u003e \u003cp\u003eNormal saline at room temperature, elevated to a height of 60 centimeters, was used as the standard irrigation fluid in the majority of procedures, as normal saline is isotonic and minimizes the risk of complications such as electrolyte imbalance during endoscopic procedures. However, for procedures involving monopolar resection, 5% glucose in water was used as the irrigation fluid due to its non-conductive properties. This approach yielded good procedural outcomes with minimal complications, aligning with evidence from previous studies that highlight it\u0026rsquo;s efficacy and safety\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn conclusion, Urinary tract endoscopy is a critical aspect of standard urological practice. In this study, urethrocystoscopy was the most frequently performed procedure, alongside other common interventions. However, despite the high prevalence of urologic diseases, the limited availability of advanced urological equipment presents significant challenges. These limitations restrict treatment options, delay care, and negatively affect patient outcomes. Bridging these gaps through investment in diverse, modern urologic tools and comprehensive training for healthcare providers is essential to enhancing the quality of care and improving patient outcomes in Ethiopia.\u003c/p\u003e\n\u003ch3\u003eSTRENGTH:\u003c/h3\u003e\n\u003cp\u003e A robust retrospective review of 2,139 cases provides a significant sample size, ensuring that the findings are statistically meaningful and representative of the hospital's patient population.\u003c/p\u003e \u003cp\u003eThe study provides a foundation for future research aimed at improving endourological care in Ethiopia and similar settings.\u003c/p\u003e \u003cp\u003eIt provides valuable information on the prevalence of urological conditions requiring endoscopic interventions, contributing to a better understanding of disease patterns in Ethiopia.\u003c/p\u003e\n\u003ch3\u003eLIMITATION:\u003c/h3\u003e\n\u003cp\u003eData were collected from a single tertiary hospital, which may limit the generalizability of the findings.\u003c/p\u003e \u003cp\u003eThe retrospective nature of the study relies on existing medical records, which may have incomplete or inconsistent documentation, potentially introducing information bias.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDISCLOSURE: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Approval of the research protocol by the Addis Ababa University College of Health Sciences Institutional Review Board, conducted in accordance with Declaration of Helsinki\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding available\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003eRegistry and the Registration No. of the study: N/A\u003c/p\u003e\n\u003cp\u003eAnimal study: N/A\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePatel, Hiten D., Adam L. Kushner, and Mohamad E. Allaf. \u0026quot;Waiting for global access to urologic care.\u0026quot; \u003cem\u003eEuropean urology\u003c/em\u003e 64.2 (2013): 344-345.\u003c/li\u003e\n\u003cli\u003eMiller, R. A. \u0026quot;Endoscopic surgery of the upper urinary tract.\u0026quot; \u003cem\u003eBritish medical bulletin\u003c/em\u003e 42.3 (1986): 274-279.\u003c/li\u003e\n\u003cli\u003eNedjim, Saleh Abdelkerim, et al. \u0026quot;Global viewpoints: proposals for the development of endourology in resource‐limited countries in Africa.\u0026quot; BJU international (2024).\u003c/li\u003e\n\u003cli\u003eKifle, A.T., Biyani, C.S., Bogdanowicz, J. et al. Urologist Workforce and Services in Ethiopia. World J Surg 47, 2628\u0026ndash;2634 (2023). https://doi.org/10.1007/s00268-023-07169-0\u003c/li\u003e\n\u003cli\u003eMahadevan, Vishy. \u0026quot;Anatomy of the lower urinary tract.\u0026quot; \u003cem\u003eSurgery (Oxford)\u003c/em\u003e 34.7 (2016): 318-325.\u003c/li\u003e\n\u003cli\u003eShu\u0026apos;aibu, S. I., et al. \u0026quot;Lower Urinary Tract Endoscopic Procedures in Jos.\u0026quot; \u003cem\u003eJournal of Medicine in the Tropics\u003c/em\u003e 14.1 (2012): 74-77.\u003c/li\u003e\n\u003cli\u003eGeremew, Lijalem Mekonnen, Samuel Amare Gelaw, and Andualem Deneke Beyene. \u0026quot;Assessing the complications of monopolar transurethral resection of the prostate (M-TURP) using Clavien-Dindo complications grading system.\u0026quot; \u003cem\u003eEthiopian journal of health sciences\u003c/em\u003e 32.3 (2022).\u003c/li\u003e\n\u003cli\u003eKacker, Ravi, and Stephen B. Williams. \u0026quot;Endourologic procedures for benign prostatic hyperplasia: review of indications and outcomes.\u0026quot; \u003cem\u003eUrology journal\u003c/em\u003e 8.3 (2011): 171-176.\u003c/li\u003e\n\u003cli\u003eTela, Usman M., et al. \u0026quot;Audit of lower urinary tract endoscopic procedures in Borno, North-Eastern Nigeria.\u0026quot; \u003cem\u003eInternational Journal of Research in Medical Sciences\u003c/em\u003e 9.2 (2021): 325.\u003c/li\u003e\n\u003cli\u003e. Payne, S. R., T. F. Ford, and J. E. A. Wickham. \u0026quot;Endoscopic management of upper urinary tract stones.\u0026quot; Journal of British Surgery 72.10 (1985): 822-824.\u003c/li\u003e\n\u003cli\u003eKavoussi, Louis R. \u0026quot;Office flexible cystoscopy.\u0026quot; \u003cem\u003eUrologic Clinics of North America\u003c/em\u003e 15.4 (1988): 601-608.\u003c/li\u003e\n\u003cli\u003eAwedew, Atalel Fentahun, et al. \u0026quot;The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.\u0026quot; \u003cem\u003eThe Lancet Healthy Longevity\u003c/em\u003e 3.11 (2022): e754-e776.\u003c/li\u003e\n\u003cli\u003eAther, M. Hammad, Ammara Mushtaq, and M. Nasir Sulaiman. \u0026quot;Urological surgical procedures under local anesthesia.\u0026quot; \u003cem\u003eClinical Use of Local Anesthetics\u003c/em\u003e (2012): p-39.\u003c/li\u003e\n\u003cli\u003eHahn, R. G. \u0026quot;Fluid absorption in endoscopic surgery.\u0026quot; \u003cem\u003eBritish Journal of Anaesthesia\u003c/em\u003e 96.1 (2006): 8-20.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endourology, Urinary tract, challenges, urethrocystoscopy","lastPublishedDoi":"10.21203/rs.3.rs-6194849/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6194849/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eEndourology has advanced rapidly in developed countries, offering minimally invasive solutions for complex urological conditions. However, in Ethiopia, the practice of endourology faces enormous challenges and remains limited in tertiary hospitals. This study aims to evaluate the current state of endourology in an Ethiopian public tertiary hospital and identify the challenges hindering its growth. It provides insight into endourological practices within a resource-limited healthcare setting\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eConducted in the urology unit of a leading tertiary hospital in Ethiopia. A comprehensive retrospective review of medical records was performed for all patients who underwent diagnostic and therapeutic endourological procedures at the hospital between September 2023 and August 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results reveal that a total of 2,139 endourological procedures were performed, making up 70.4% of all urological interventions by the unit during this period most being done for diagnostic purposes. Bladder outlet obstruction due to benign prostatic hyperplasia (33.2%) was the most common indication, followed by ureteric DJ stent removal (20.1%) and bladder tumor evaluation (17.3%). Limited availability of essential equipment, including for retrograde intrarenal surgery, restricted the scope of interventions\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite the significant advantages of minimally invasive endourological techniques, widespread adoption in Ethiopian public hospitals remains constrained by limited equipment, a shortage of trained personnel, and insufficient funding.\u003c/p\u003e","manuscriptTitle":"Endourology in a Resource-Limited Setting: Current Practices and Key Challenges in an Ethiopian Tertiary Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 17:54:43","doi":"10.21203/rs.3.rs-6194849/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80b9f22d-3e09-49a8-ad12-90a09c93a118","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T22:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-06 17:54:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6194849","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6194849","identity":"rs-6194849","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}