Urogenital Emergencies in Post-Disaster Libya: A 12-Month Prospective Study at a Tertiary Referral Centre

Abstract

Background: Al-Wahda Hospital stands as the sole tertiary referral centre for Derna and northeastern Libya's surrounding district—a region battered by a decade of armed conflict and, in September 2023, the catastrophic Cyclone Daniel. Urogenital emergency patterns in this setting have never been systematically documented. We therefore conducted a 12-month prospective study to characterise the epidemiology, management, and clinical outcomes of acute urological conditions at this institution. Methods: We consecutively enrolled all patients presenting with urogenital emergencies to Al-Wahda Hospital between January and December 2024. Urological emergency was defined as any condition requiring investigation or intervention within 24 hours of presentation to prevent mortality or permanent morbidity. Using a standardised proforma, we collected data on demographics, presentation timing, diagnosis, interventions, complications, length of stay, and transfers. The principal investigator verified all entries weekly. Major complications were defined as Clavien-Dindo grade ≥IIIb (return to theatre, organ loss, vasopressor-dependent sepsis, or ICU admission). We computed descriptive statistics with SPSS v22 and compared outcomes between transferred and non-transferred patients using Fisher's exact test. Results: Of 106 patients (mean age 47.2 years; 77.4% male), the commonest emergencies were iatrogenic bladder injury during caesarean section (17.9%, n=19), acute urinary retention (17.0%, n=18), obstructed ureteral stones (16.0%, n=17), and Fournier's gangrene (15.1%, n=16). Ninety-four patients (88.7%) underwent surgical intervention. No in-hospital deaths occurred; however, 24 patients (22.6%) developed major complications (Clavien-Dindo ≥IIIb) and 8 (7.5%) suffered organ loss, six potentially preventable with earlier presentation. Thirty-six patients (34.0%) required inter-hospital transfer due to three distinct system gaps: consumable supply (n=3), absent endourological equipment (n=17), and lack of reconstructive surgical expertise (n=16). Transferred patients had significantly higher complication rates (44.4% vs. 11.4%; p<0.001). Conclusion: Al-Wahda Hospital saves lives reliably but cannot yet deliver definitive or reconstructive urological care. Three distinct system gaps, consumable supply, capital equipment, and surgical expertise—drive a 34.0% transfer rate. Addressing these through targeted investment and community awareness campaigns would tackle the principal drivers of preventable morbidity identified in this cohort.