Uroandrological care organization in the udmurt republic in terms of a private clinic

Korablinov O. V. Deputy Chief Physician for Surgery.  (tel.+7 912 455 31 60 olegvkor@ya.ru)

Korablinov Oleg Valeryevich, Shalagin Nikolay Igorevich
LLC "Medical Center "Doctor Plus Petrovsky", Izhevsk 
Shalagin N. I.  Head of the Department.  (tel.+7 904 833 55 20 dr.nig@mail.ru

Relevance: The State Statistics Service in the Udmurt Republic registered 334 765 children and adolescents aged 0 to 18 years. However, to date, the provision of children's population with the pediatric urologists-andrologists for the primary specialized health care assistance is only 12.5% of the Medical Care Provision standards for pediatric urology-andrology. As a result, the outpatient care for the children with urological and andrological diseases is carried out mainly by pediatricians and pediatric surgeons, which often has a very negative impact on the quality of diagnostic, therapeutic and prophylactic measures.  At the same time, in the State Health Care System of the UR there is no possibility of obtaining specialized uroandrological care for children in the day patient facilities. The specialized medical care, including high-tech, is provided only in the Uroandrological Department of the Children's Republican Clinical Hospital. The Bed Fund deficit is 25%. The situation has led to the decrease of availability and timeliness of specialized uroandrological care for children.

 Objective: Assess the possibility of providing specialized uroandrological care for children in a Non-state Multi-profile Medical Center for increasing the volume and quality of the diagnostic and treatment process at the pre-hospital stage, expanding the types of uroandrological care in a day hospital and reducing the hospital stage duration of providing specialized medical care, including high-tech. 

Materials and methods: Multi-profile Medical Center has established the pediatric urologist-andrologist doctor's office specialized in consultative, diagnostic and treatment services to the children with genitourinary tract diseases. The equipment of the office fully satisfies the Appendix No.2 of the Order of the Ministry of Health of the Russian Federation No.561н of October 31, 2012. To ensure the activities of the Pediatric Urologist-andrologist Office, the capabilities of the clinical laboratory, urodynamic diagnostics office, the cystoscopic office, the procedure office, the Department of Ultrasound Diagnostics, the Department of Radiology, including an x-ray and magnetic resonance tomography offices are used. All these departments are the structural units of the Medical Center. In order to provide specialized care, including hi-tech care in a hospital and day-hospital conditions, the Children's Uroandrological Department has been established in the Multi-profile Hospital of the Medical Center.

Results: From 2016 to 2018, the Medical Center has registrated 3022 appointments with a pediatric urologist-andrologist. Including 1718 (56.8%) cases of the patients with reproductive system diseases and 1304 (43.2%) patients with the diseases and abnormalities of the urinary system. In the group of patients with reproductive system diseases the most frequent reasons for referring to the pediatric urologist were the following: cryptorchidism – 247 (14.3%); hypospadia – 196 (11.5%); hydrocele – 138 (8.3%). In the group of patients with urinary system diseases the highest number of complaints was registrated for: pyeloectasia – 189 (14.4%); enuresis – 152 (11.6%); overactive bladder - 157(12.0%); PMR – 141(10.8%); hydronephrosis – 124(9.5%); cystitis – 64(3.1%).  The Medical Center provides the ultrasound investigations in outpatient conditions; it also has the capabilities to investigate the local hemodynamics of the urinary and reproductive systems. Antenatal screening and consulting of pregnant women in identifying abnormalities of the urinary system of the fetus are also carried out. The Medical Center Polyclinic is capable of providing clinical, biochemical and bacteriological tests. There were provided 121 diagnostic cystoscopies and 363 urodynamic investigations.

More than 234 Х-ray investigations were provided in a day hospital. Detection of the urinary system malformations, requiring surgical or endoscopic correction – 68.4%.  In the day hospital 43 endoscopic reflux correction and more than 90 operations in the pathology of the vaginal process of the peritoneum by laparoscopic access were performed.

The Uroandrological Department has provided 195 surgeries, of which 74.2% of operations on the reproductive system organs. At the expense of the TFOMS UR the Department has provided high-tech medical care for 39 patients with the following types of surgery: laparoscopic pyeloplasty, endoscopic probing and stenting of ureters, laparoscopic nephrectomy, laparoscopic excision of renal cyst, ureterocystoanastomosis, urethroplasty with a skin graft. The average bed-day time in the Department was 3.6. There is no waiting list for the planned hospitalization.

Conclusions: the organization of outpatient and inpatient specialized care for children with diseases of the genitourinary system in a multidisciplinary medical center allows to achieve an increase in the volume and quality of treatment and diagnostic process at the pre-hospital stage, the expansion of surgical care in a day hospital and reduce the duration of the hospital stage of specialized, including high-tech medical care.