Laura Bukavina, MD, MPH, is one of the recipients of the 2024 Urology Care Foundation™ Humanitarian Grants. Urology Care Foundation™ humanitarian grants support the efforts of urologists and projects providing patient care and education in underserved areas, either within the United States or worldwide.

“I will remember that I remain a member of society, with special obligations to all my fellow human beings…”¹ These words of the Hippocratic Oath recited by physicians for centuries have remained the cornerstone of our guiding principles. Current geopolitical events have far-reaching consequences beyond just identified conflicts. Since February 2022, the war in Ukraine has inextricably altered the health care domain through scarcity of resources and personnel for general citizens, creating unique challenges with complex injuries sustained on the battlefield. According to the WHO Surveillance System for Attacks on Health Care, there have been 1355 Russian attacks on Ukrainian health care facilities, resulting in damage to 630 facilities since the onset of the war.² The human toll for the Ukrainian population has also been staggering with reports of wartime casualties hovering around 31,000 with up to 120,000 injured.³ Civilians also experience delays in care for routine care, which place further strain on the health care system. Taking this all into account, our group saw vulnerable populations in dire need of assistance.

Genitourinary trauma has been reported in 4.2% of modern-day battlefield injuries.⁴ These include blast injuries and penetrating traumas. These injuries are complicated by extensive tissue loss, dense fibrosis, and fistulas. Following initial stabilization, patients require complex repairs, oftentimes necessitating adjunctive techniques such as autologous grafts, flaps, or creative operative approaches in settings of multiple previous operations.

The field of urological reconstruction in Ukraine is in its infancy. Unfortunately, due to the aforementioned injuries, this field is being forced to expand and evolve to address the needs of its population. Through partnership with both local civilian and military urologists, a reconstructive surgical mission was created to address the disparities in comprehensive urological care. This initiative was launched following in-depth discussions with patients, nongovernmental organizations, and urologists to identify the most pressing needs, allowing for targeted interventions in areas requiring the most attention. Across 2 surgical missions in Kyiv and Lviv, Ukraine, 31 patients were treated in collaboration with local urologists and urology trainees (Figure). A key focus of the mission was the educational component, emphasizing the foundational principles of reconstructive urology. This approach ensures that high-quality care will continue to exist within the community, extending the impact well beyond the initial interventions and fostering long-term benefits.

The cases performed included urethroplasty with buccal mucosal grafts and/or gracilis muscle flaps, excision and primary anastomosis urethroplasty, staged perineal urethrostomy with pendulous urethral reconstruction, Orandi flap pendulous urethral reconstruction, rectourethral fistula repairs, simple cystectomy with urinary diversion, ureteral reconstruction with bowel interposition, ureteral reimplant with Boari flap, simple nephrectomy, corporal reconstruction, and penile prosthetics. The educational components encompassed not only intraoperative techniques but also preoperative decision-making and postoperative management, delivered through a series of in-person sessions and Zoom meetings. This comprehensive care has been longitudinal thanks to close communication with our partnering local urologists long after we returned stateside. We look forward to continuing our partnership, providing healing to those affected by the War in Ukraine, and further developing the field of reconstructive urology in the region.

Funding/Support: The Fox Family funded Dr Bukavina’s grant.