The current territorial organisation of urology in France

For several years now the reorganisation of the French urologicalcommunity has been accelerating.Why this reorganisation ? The surgical know-how needed hasbecome more and more specific for the majority of operations onthe urinary apparatus and this increasing level of technical complexityis confirmed by the fact that urologists today can no longermaster all the techniques linked to their speciality. What is more, tofurther complicate matters, the cost of the medical instrumentsindispensable for modern urology has become exorbitant: few doctorscan afford to buy, maintain, share and renew frequently. Tocomplicate matters even further, the obligation to provide care, 24-hours a day, all year long, by specialist surgeons who have both theknow-how and the instruments required.What needs to be done ? This situation imposes two fundamentalchanges. From now on, urologists should not do non-urologicalsurgery and surgeons from other specialities should not do urologicalsurgery. The second change involves the internal organisation ofurology: as urologists can no longer neither master all the techniquesof their speciality, nor afford all the instruments required,they should work in a urological team, on one or two sites. Eachmember of the team should have a skill level of 50, sufficient fordaily or emergency urology treatment; each member should alsohave a skill level of 100 for one or two hyper specialities allowingthem to accomplish difficult or rare treatments linked to their fieldof hyper specialisation such as: oncology, lithiasis, endo-urology,incontinence, neuro-urology, transplantation, andrology etc. Theidea being, that the team as a whole, has all the specialist knowledgerequired and is fully equipped with up-to-date medical instruments.