Flexible Ureteroscopy (F-URS) Course

Flexible Ureteroscopy (F-URS) Course

Hospital St. Francois de Sales,

Port-au-Prince, Haiti

March 24-27, 2019

Project Haiti Report:

Despite the planned GASHU meeting cancellation which was necessary due to sociopolitical unrest in Haiti, close contact with our Haitian colleagues cleared the way for a “mini” F-URS stone workshop at our urology teaching center at Hospital St. Francois de Sales (HSFDS) in the center of Port-au-Prince.

Project Haiti Faculty:

Dr. Henri Lanctin

Primary Haitian Urologist Attendees:

Dr. Bernard Brutus

Dr. Youry Dreux

Dr. Reginald Valme

Dr. Christian Valme

Dr. Mitelot Clervil

A number of other urologists and residents attended the lecture and observed cases.

Conference room at HSFDS

Course Sponsor:

Project Haiti

Special thanks to David Weigel (Prairie Lakes Healthcare System), Phil Ritter (Olympus), Mark Smieja (Boston Scientific), Dr. Bernard Brutus and Food for the Poor, and Mike Stickler (Fortec Medical)

Course Summary:

HSFDS staff anesthesia and nurses provided professional and competent assistance with rapid room turnover. In particular, Global Philanthropic Committee funded urology nurse, Japhare Joseph, was an invaluable leader.

Well stocked urology store room at HSFDS

 

Upon arrival on March 23, we spent the afternoon at HSFDS assembling equipment and organizing supplies. These had been shipped last fall. We then reviewed patients and x-rays and set our OR schedule.

Monday the workshop started with a lecture and discussion of the management of upper tract stones as well as indications for F-URS. We considered how F-URS would fit into the other treatment options offered in the stone center at HSFDS (semi-rigid ureteroscopy, ESWL and open surgery). The procedure was reviewed in detail and the ancillary equipment such as safety and working guide wires, access sheaths, baskets and stents were discussed. Complications and management of them were covered.

F-URS in Haiti has been made possible with the recent development of disposable technology. Reusable scopes are prohibitively expensive and delicate with expensive repair costs. Disposable scopes which are discarded after a single use in the US can be processed and deliver several more cases. With several centers saving the scopes it is felt that we can keep the stone center at HSFDS supplied with adequate numbers.

Drs. Brutus and Dreux performing first flexible ureteroscpic stone removal in Haiti

The remainder of Monday through Wednesday morning was spent doing cases including the first known F-URS case in the country.  Given the instructional nature of the cases and the complexity (big, hard stones!) we managed 6 cases, including a patient with bilateral stones. With their previous experience in semi-rigid ureteroscopy, the Haitian urologists were quick to learn and performed exceptionally well.

Image of kidney stone with Boston Scientific Lithovue monitor

My opinion upon leaving was that Drs. Brutus, Dreux, Valme and Clervil had a solid understanding of the technique, potential pitfalls and better handle on patient selection. They also had a better appreciation of the importance of preoperative imaging, including CT scanning. With current internet connectivity and ability to share radiological images and live surgery, they have ongoing support from members of GASHU. They are a solid core of individuals who work well together, share the vision of improved urological care in Haiti and are committed to teaching residents and the other urologists.

Future Planning:

The trip concluded with discussions and planning for the support of the 2 urologists in Gonaives where a new Canadian-funded hospital has been built. They have no cystoscopic equipment and also need training as they have recently completed the urology residency program in Port-au-Prince.  Dr. Clervil and the other urologists at the Partners in Health hospital in Mirebalais also are in need of cystoscopic instruments. We determined that shipping a set of ACMI instruments that has been donated by Dr. Ed Miedema, Colorado, to Dr. Clervil would be the best course of action and he will start training the young urologists in Gonaives. Once we acquire another set of instruments for Gonaives we can deliver and perform an endoscopic / TURP workshop.

We also initiated plans for the next trip in June 2019 for a workshop at HSFDS on percutaneous nephrolithotomy (PCNL) with Drs. Bob Marcovich, Keegan Maxwell and Henri Lanctin as well as site visits to Gonaives and Mirebalais.

On a personal note, I need to thank my Haitian friends and colleagues for their great concern and care during my 24 hour illness!

Henri P. Lanctin, MD, FACS