Annals of African Medicine

: 2012  |  Volume : 11  |  Issue : 3  |  Page : 151--152

Editorial comment on skills acquisition for trainee urologists: Are the federal medical centers in Nigeria suitable?

Kasonde Bowa 
 Department of Surgery, School of Medicine, University of Zambia, Zambia

Correspondence Address:
Kasonde Bowa
Department of Urology, School of Medicine, University of Zambia

How to cite this article:
Bowa K. Editorial comment on skills acquisition for trainee urologists: Are the federal medical centers in Nigeria suitable?.Ann Afr Med 2012;11:151-152

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Bowa K. Editorial comment on skills acquisition for trainee urologists: Are the federal medical centers in Nigeria suitable?. Ann Afr Med [serial online] 2012 [cited 2020 Nov 28 ];11:151-152
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The number of urologists in Africa, outside of Egypt, and South Africa are well below 1 to 50,000 recommended by the World Health Organization (WHO). On the other hand, there is a high burden of disease due to surgical and urological disease. It is, for example, being increasingly agreed that trauma is one of the leading public health concerns in Africa. In addition, the high burden of prostate cancer in Africa, though poorly documented, is close to that in African Americans of 300 per 100,000. This situation has been compounded by the high prevalence of human immunodeficiency virus (HIV) disease, in particular, in Sub-Saharan Africa. It is known that the prevalence in this region ranges between 15 to 35%. When the Lymphocytes cell count falls below 200/mm 3 , there is an increased risk of opportunistic infection and urological disease. This dual problem of low human resource and increasing burden of disease is a key challenge to Africa which can be partly addressed by the expeditious training of specialist in general and urology specialists, in particular. The current article is relevant in this context. [1]

 Urology Training in Africa


The two key elements of health worker outputs are supply and demand driven; the supply which relates to the availability of quality training and the demand which has to do with the burden of urological disease. There are few centers for urology training in Africa, outside of Egypt, and South Africa. Currently, both the West African College and the East and Central African College of surgeons offer specialist examinations in urology. However, training centers in Africa are few. The mechanisms of improving the supply of urologists have been widely debated. Key among these is increasing training sites and training scope. The current article addresses some of these. The concept in medical education of improving training by training close to the community is very well articulated. The specialist training program in the United Kingdom has had to face similar challenges, and through the Calman report has had to revise the specialist surgical training to meet the quality issue challenges. Further issues relate to what is core urology training and what should be left as specialist training. It is clear that currently in Africa core urology training is most desirable. This also is identified by the article. Though a more detailed understanding of the epidemiology of urological disease is required to fully itemize what comprises core urology training. An additional issue is who should train urologists in Africa. Should the training be done by urologists, who are too few? Or by general surgeons who practice urology, at least in part as suggested by the article, quite pragmatically. The current model has been used in most of Africa to provide training by teams of surgeons or more precisely through apprenticeships organized by Colleges of Surgeons (usually general surgeon led). A further supplementary question remains; this is the training of academic urologist and service urologists. The African situation dictates a focus on urologist whose primary focus is service. Notwithstanding, this a case most be made for the training of academic urologists; those urologists who provide some service, but focus largely on training, research, and teaching. This model of training combines the core training with an additional 1-2 years of research training in urology. In many places in Africa, this leads to the award of a research based degree such as the MSc (urology), MD (urology), or M.Med (urology). This type of urologist will drive the expansion of the urology profession as a science. [2, 3]


The burden of urological disease in Africa cannot be disputed. The spectrum is one that ranges from urological trauma, tropical urology, and pediatric urology to uro-oncology. The characterization of this disease burden may not have been fully documented. This documentation will help to direct the training of future urologists in Africa. None the less, some key urological problems have been identified. Some of these constitute what can be broadly called tropical urology. Among these are the major problems of vesico-vaginal fistula work. This area straddles uneasily between the urologists and the gynecologists, depending on the extent and site of bladder damage. The issue of declining male fertility will continue to pose a big challenge to the urologists/andrologists of future years. The dual problem of increasing HIV prevalence and sexually transmitted infection (STI) prevalence is increasingly creating an infertility belt in Africa. This issue will need to be addressed in coming years. Smoldering STIs have created further problem of intractable urethral strictures disease; whereas, many strictures in developed countries are the result of congenital disease such as Balanitis Xerotica Obliterans BXO or failed hypospadias repair. In Africa, in contrast, long multiple stricture disease due to poorly treated STIs is the norm. Many European urologists visiting Africa have been amazed at the severity of urethral stricture disease in many parts of Africa. Several urology clinics are littered with "urethral stricture cripples." Large fresh water bodies have resulted in endemic schistosomiasis with resultant severe morbidity on the urogenital system. The possible connection with high levels of chronic renal disease and renal failure with the consequences and costs on chronic dialysis with the non availability of renal replacement therapies (RRT) present additional challenges on the continent. The current understanding on the high prevalence of cancer of the prostate is its late presentation and its very aggressive course. These represent just a few of the challenges that make the training of urologist both vital and urgent. [4]


The demand for urological services in Africa is high. On the other hand, the supply of urologists is low. In this context, innovative ways of training urologists are a welcome drive to expedite the supply of quality trainees. The training should be as close to the community as possible using the available training sites. The skills should at least encompass the core urology skills important in an African context. More work requires to be done to show the types of urological diseases that are prevalent in Africa and how they can be managed innovatively.


1Bowa K, Labib M. Lower tract urinary calculi as an index of urological services in a developing country. Urology 2006;68 suppl 1:283.
2Bowa K, Goma F, Yikona JI, Mulla YF, Banda SS. A review of outcome of postgraduate medical training in Zambia. Med J Zambia 2008;35:81-93.
3Mulla SM. Correspondences. Surgical Activities in Malawian Hospitals. Trop Doct 2007;37:272.
4Evan C. Rahima Dawood lecture 2002: Surgical Training in Africa: East and Central Africa. J Surg 2005;10:5-9.