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GLOBAL STATE OF UROLOGY Evolution of Urology in Central America

By: Hugo R. Arriaga, MD, President, Urology Association of Central America and the Caribbean, Urologia Integral Clinic, Guatemala City, Guatemala | Posted on: 20 Mar 2024

Central America and the Caribbean is a region with great natural and human wealth and a history of more than 4000 years. Medicine has been developed academically in the region since the first chair of medicine was created in October 1681 at the University of San Carlos in Guatemala. Previously, the Mayans with their 4000 years of history had developed medical arts, fundamentally, in the field of natural medicine.1

In 1785, in colonial times, Dr José Felipe Flores developed an anatomical mannequin where the organs could be removed for anatomical teaching.2 Subsequently, several doctors in the region specialized in the area of urology, which emerged as an independent specialty, contributing to knowledge as well as developing devices and surgical techniques that would be of global benefit. Among these was Dr Joaquín María Albarrán y Domínguez, of Cuban origin, who adapted the deflector for ureteral catheterization to the Nitze cystoscope, which was reported in 1905 (Figure 1).3 Another renowned urologist of that time was Dr Alejandro Palomo from Guatemala, who developed the technique for the cure of varicocele in the 1940s (Figure 2).4 Subsequently, the practice of urology began throughout the region, and teaching hospitals were created in several countries to guarantee the training of new specialists.


Figure 1. Schlifka’s ureterocystoscope with Albarran lever. Reprinted with permission of the European Association of Urology History Office and the European Association of Urology European Museum of Urology.


Figure 2. Palomo varicocelectomy approach. Reprinted with permission from Palomo, J Urol. 1949;61(3):604-607.4

The presence of a tropical climate and the high rate of poverty, which has accompanied a large part of the regional population, have led to the high prevalence of pathologies such as lithiasis and chronic UTIs, including tuberculosis, that urologists in the region still must face, which has allowed them to accumulate experience in the diagnosis and treatment of these pathologies, although with low-budget treatment options.

As recognized from the introduction of minimally invasive procedures for the treatment of urinary lithiasis, an uninterrupted technological revolution is occurring in the world, which is gradually spreading throughout Central America and the Caribbean, although slowly in its beginnings.

Currently we are witnessing the transformation of regional urology, which has evolved from the use of basic and limited technology to having centers specializing in laparoscopic surgery, such as the National Center for Minimum Access Surgery in Havana, or assisted surgery by robot in several hospitals in Panama City, or in the use of laser technology for the treatment of prostatic hyperplasia as occurs in Guatemala, Nicaragua, and Costa Rica. On the other hand, the technology for the diagnosis of prostate carcinoma has also improved with the introduction of MRI and microultrasound, which provides the opportunity to combine better diagnostic and treatment tools for a population that increasingly demands specialized treatments for diseases that the specialty treats.

This development has occurred in a relatively short period, probably due to the better economic situation of countries such as Panama, Costa Rica, and the Dominican Republic. The region has urological surgeons with the potential to quickly acquire training in emerging technologies and with the possibility of leading in the Americas and other regions in the practice of new technologies, such as Dr Rodríguez Lay from Panama City, who performs biopsies using microultrasound in prostate disease.

However, being an expert in new technologies and even being pioneers in their practice must be complemented with the publication of the results, based on an adequate research process supported by a methodological design that guarantees a high level of evidence and reliability, which remains the main challenge for urologists in this region. This process must be accompanied by investments in the centers where the technology is introduced and research is carried out, to cover the costs of secondary researchers, statisticians, designers, illustrators, and librarians, among others, to support the desire to publish.

The region has a journal, Revista Guatemalteca de Urologia, which has become the official organ of the Urology Association of Central America and the Caribbean (AUCA), one of whose projects is to support scholarships for conferences and specialization courses for the editors and reviewers, so that the role of these actors is promoted. The new editor of the journal, Dr Marco Ortiz, intends to fulfill this objective during his administration. It will also be necessary to take advantage of the experience of other urological colleagues around the world to improve these processes, as well as promote the exchange of information by stimulating the publication of his experience in the AUCA journal.

For 6 years, an academic movement has resurfaced in the area with the creation of the AUCA and the journal as an organ for the dissemination of local experience. It has aroused interest throughout the region to improve the practice of the specialty, and the intention is not only to promote academic development in the field of urology, but also to transmit to the world the results of the innovative and decisive treatments that are applied to the population from our perspective.

I have no doubt that the professionalism and talent of many of the region’s urologists provide first-class treatments, as medical and surgical advances do not stop and our region is no exception in seeking to restore the health of each patient

Finally, I thank Drs Tania González León from Cuba, Ramón Rodríguez Lay from Panama, Mario González from Costa Rica, Federico Suero from the Dominican Republic, and Gery Castillo from Guatemala for his contribution in writing this article.

  1. Martínez Duran C. Las Ciencias Médicas en Guatemala, Origen y Evolución. 4th ed. Guatemala Editorial Universitaria, Universidad de San Carlos de Guatemala; 2009:221.
  2. Museo de la Universidad de San Carlos en Línea. Biografía del Dr. Flores. Accessed August 14, 2014.
  3. Pérez-Albacete M. Joaquín María Abarrán y Domínguez (1860-1912): in the centenary of his death. Article in Spanish. Actas Urol Esp. 2012;36(4):246-251.
  4. Palomo A. Radical cure of varicocele by a new technique: preliminary report. J Urol. 1949;61(3):604-607.