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By: Juan G. Corrales Riveros, MD, Clinica Ricardo Palma, Quiron Salud, Lima, Peru | Posted on: 15 Mar 2024

The practice of urology in Peru has changed a lot in the last 35 years. At the end of the 1980s, Peru was going through a serious economic crisis and the danger of the development of terrorist activities by radical left groups. For this reason, state health institutions did not have technologies that could be frequently used in other countries, such as electrohydraulic lithotripsy, the semirigid ureteroscope, and an ultrasound machine for the exclusive use of ultrasound, among others. Very few urology services nationwide had resectoscopes, which is why most operations for prostate adenoma were performed with the conventional open technique. Despite these limitations, much progress was made with conventional surgery; by the end of 1990, continent neobladders were already being performed for bladder cancer, as well as the radical prostatectomy technique described by Patrick Walsh.

At the beginning of the 2000s, the direction of Peruvian urology was changing; young urologists who had had the opportunity to complete their training abroad had a more economically stable country. The Peruvian Society of Urology at that time was established by 215 members. The treatment of lithiasis was improved with the acquisition of lithotripters, and laparoscopic surgeries began to be performed. Access to information on advances in urology worldwide was available to everyone, which also allowed an improvement in the academic level in general.

On the other hand, the incursion of women into urology increased, this being a great achievement to diversify gender in the specialty. The first Peruvian urologist finished the specialty in 1984. According to a review, in 2021, there were 51 women of the 718 members of the Peruvian Society of Urology, of whom 3 had the title of general and oncological urology and 1 was completing the second and last year of the pediatric urology subspecialty.

Currently, there are only 2 urology subspecialty programs with university accreditation: oncological urology and pediatric urology. The training of other subspecialties is carried out with rotations abroad and attendance at courses and conferences, such as urogynecology, endourology, andrology, and minimally invasive urology.

In private practice, as well as in public practice, it has been understood that the urologist must subspecialize, especially in services that have a high volume of patients. We have professionals dedicated to lithiasis, oncology, urogynecology, pediatrics, and prostate hyperplasia.

One of the emerging technologies has been the arrival of the laser, for the treatment of both lithiasis and prostate hyperplasia. The use of minimally invasive surgery produces undeniable benefits for the patient. Although it involves a high-cost investment, it has benefits such as a shorter duration of surgery and quick recovery.

The biggest challenge we face is uniform specialty training. Until 1999, only 2 state universities in Lima, the capital city, offered the specialty of urology. Currently there are 3 more universities in Lima and 4 in the provinces that train urologists. The Peruvian Society of Urology is concerned about this and is developing virtual and in-person courses and workshops, and even creating an area for training with simulators.

An important aspect in the development of Peruvian urology has been the contact established with urologists from Europe and the United States, and likewise that obtained with foreign urological institutions. We have also had the selfless help of urologists from Latin America who have allowed our young urologists to visit for training. In this regard, the Peruvian Society of Urology has played an important role by inviting foreign urologists to the congresses. This has allowed us to get to know prominent professors up close, learn about their work, see our weaknesses, and try to overcome them. This friendly relationship has initially been formalized in agreements with important institutions such as the AUA, Confederación Americana de Urología, and the European Association of Urology, which have allowed us to improve academically.

The recommendation I would give to young urologists in training in Peru is to have a solid theoretical base that allows for the correct diagnosis and treatment of urological pathologies. This knowledge enables and facilitates the acquisition of practical skills. Carry out basic research or clinical studies that show what you are doing. Finally, travel, complementing what you have learned by attending courses or internships outside the country. This enriching experience also allows us to develop bonds of friendship with our colleagues from other parts of the world.