With the rapid advancement of
technology in the world, there is also
amazing advancement in the development
of medicine. When we discuss the history
of medicine in Taiwan, it resembles the
history of economic and technologic
development. Currently, the medical
standard in Taiwan is at the same level
as other advanced countries in the
world. High priced diagnostic equipment
owned by medical centers abroad can also
be seen in the medical centers in
Taiwan. Other than the progression of
medical diagnostic instruments, there is
a stronger union and management of
medical administrative and
organizational systems. The goal of
being economic, prompt, and united in
medical treatment can be achieved by
these advancements.
With the focus on the development of
Urology in Taiwan, it can be described
from the following four aspects: 1. The
change in systems, 2. Alteration of the
types of urologic diseases 3. The
expansion of equipment and personnel,
and 4. Research and Development Trends
1.
The Change in Systems
In the beginning stages of the
restoration of Taiwan, Urology itself
was not an independent division, but was
combined with dermatology to be called
the division of dermatology and urology.
This terminology was obtained form the
Japanese system. The representative of
that system at the time was Taipei
Imperial University Hospital, which is
the National Taiwan University Hospital
today. With the government relocating to
Taiwan, the National Defense Medical
Center, which belonged to the military
system, also moved to Taipei. National
Defense Medical Center inherited the
hospital system of Peking Union Medical
College Hospital, which relates closely
to the British and American style. Thus,
it is in direct contrast to National
Taiwan University Hospital, which
inherited its medical educational
standards purely from the Japanese
system. Therefore, a new model of
thought and behavior was added to the
medical world in Taiwan. Few scholarly
communications among the hospitals in
Taiwan existed in the beginning of the
restoration of Taiwan, and had
obstructed the advancement of medicine
in the nation. All new skills and
technologies in Urology were learned
from the United States of America. When
encountering difficult cases in both the
National Defense Medical Center and the
National Taiwan University Hospital, the
two systems frequently discussed such
cases for the benefit of the patients,
without any selfish motives. Due to the
sincere collaboration of the two major
systems, mutual cooperation among
specialists in Urology in Taiwan became
unrestricted, and they worked together
in a united, pleasurable fashion.
Based on the observation that doctors
specializing in urology were often
individualistic and isolating, and
professional communications were scarce,
the Urological Association of the
Republic of Chine was initialized in
1978, organized by predecessors such as
Dr. You-Fu Hsieh, Dr. Wan-Shuen Chiang,
Dr. Chin-Pei Jiang, Dr. Bu-Fei Cheng,
Dr. Chen-Ping Ma, and Dr. Yeh-Bin Leu.
The purpose of the association is to
enhance the exchange of professionals in
urology among hospitals. Until today,
the association has established regular
(journal, educational research and
medical ethics, specialty physician
examinations, international affairs and
benefits, hospital evaluation and
manpower assignment training, national
health insurance and public medical
consultation, academic information
committee) and functional committees (urodynamics
and female urology, urological tumor,
pediatric urology, urological
laparoscopic surgery, urolithiasis
comiittee), in order to promote the
affairs of the association as a whole.
From the combined efforts of the
pioneers in Urology in Taiwan, the
division has since then formed an
organized and systematic medical
network, and aims to pursue optimal
benefits for the people in accordance to
the administrative system of the
country.
2.
Alteration of the types of urologic
diseases
In the beginning of the restoration
period, most patients in the division of
urology in Taiwan were diagnosed with
urolithiasis, urinary tract
tuberculosis, and narrowing of the
urethra caused by gonorrhea. Afterwards,
due to the improvement in sanitation,
and the invention and advancement of
antitubercular medications, the cases of
tuberculosis reduced rapidly. And, due
to the improvement of antibiotics,
narrowing of the urinary tract from
chronic gonorrhea has become rare in
recent years. Benign Prostatic
Hypertrophy, however, has become a more
prevalent urologic disease due to the
increase of the average life span. In
the southern parts of Taiwan (Peimen,
Shuejia, Budai, Yizhu), Blackfoot
disease is very prevalent, and the
regions have a high rate of transitional
cell carcinoma of the urinary tract.
Also, the occurring rate of transitional
cell carcinoma of the upper urinary
tract in Taiwan is on top of other
countries in the world. It is still
highly prevalent today. One other
notable is prostate cancer, which has
increased in rate each year and has
already matched the rate of bladder
cancer.
Urolithiasis has, until now, still
maintained the majority of the cases in
urology, although severe complications
from urolithiasis have reduced.
Currently, there is still a significant
rate of kidney staghorn stones, and
present as a challenge to physicians in
urology. Also, with the increase of new
urology doctors, adverse effects of the
urological system from medical sources
are occasionally found. With the change
of the society and the advancement of
technology, certain urologic diseases
have gradually reduced, but the rates of
some diseases have not decreased. In
fact, the rates of these diseases are on
the rise. The direction of focus from
now on should be to develop methods to
prevent these diseases or ways to
discover and treat the diseases quicker.
3.
The expansion of equipment and personnel
In the early period of urology
in Taiwan, the hospitals mostly
inherited and utilized the leftover
instruments and supplies from the
American army. Among those items, the
cytoscope is made with a light bulb as a
light source. The visibility from the
light bulb is less than ideal, and the
light bulb becomes defective easily. In
the seventies, fiber-optic light sources
were developed, and the effectiveness of
the cytoscope was significantly
improved. Other major developments
included the invention of ureteroscope
and renoscope, and thus the apparatus
became multi-functional. In recent
years, the cytoscope can be connected
with a television monitor, and personnel
under training can learn the skills
rapidly and efficiently. In the 60 years
of developing the treatment of urologic
diseases, thanks to technological
advances, several revolutionary changes
have occurred. One change worth
mentioning is the treatment of
urolithiasis. In the earlier years,
surgery is the major method of treating
urolithiasis. And, this surgery is the
major treatment method in the department
of urology. As for the treatment of
staghorn stones, the development of
Anatrophic Nephrolithotomy and extended
pyelolithotomy has become major surgical
options in this case. In the early
eighties, with the improvement of
fiber-optic scopes, stones in the ureter
can be extracted by a ureteroscope, and
eliminated the use of invasive surgery.
Also, using percutaneous nephrolithotomy
(PCNL), larger stones or staghorn stones
can be removed without utilizing the
traditional method of surgery.
Management of urolithiasis has shifted
from invasive operations to the
minimally invasive methods, in order to
reduce the complications and after
effects of the patients. Furthermore,
with the introduction of Extracorporeal
shock wave lithotripsy (ESWL), more than
80% of the current urolithiasis patients
can be treated with ESWL. The invention
of ESWL can be stated as the most
incredible creation in the 20th century,
changing the treatment option form
surgery to non-surgery.
Another treatment option created, due
to advanced technology, is the invention
of Laparoscopy. Right now, it is even
effective in removing prostate cancer.
At the end of the 20th century, the
technology of using a robotic arm to
perform remote-controlled operations was
developed. The patient only needed to
receive a few punctures for the
laparoscope in order to perform the
surgery. It replaces the traditional
surgery, which usually involves a large
incision site. This production not only
minimizes the problem of human errors
during the operation, and can be
operated remotely. This procedure has
decreased the complications and days
spent hospitalized of patients.
After observing the development of
urology from non-existence to the
situation today, other than the
development of technology and economy,
the most important developments are the
training of professional personnel and
the diligent management of the
forerunners, which continually bring in
new skills and concepts. Through the
accumulation of bits and pieces of
improvements, Urology in Taiwan today
can compete with all the other advanced
nations in the world. Currently, what we
need is to internationalize the
developments, so the achievements in
Taiwan can be presented to the
international stage, and international
exchange as well as the creation of our
own international expertise can become
possible.
4.
Research and Development Trends
In the early years in Urology, the
emphasis is on how to improve on
surgical skills. The focuses of early
studies include Endoscopic Benign
Prostatic Hyperplasia Removal surgery,
renal arteriography, skills involved
with urolithiasis operation, and the
analysis of the stones. Afterwards,
forerunners in urology started to
research on the prevention and treatment
of tumors. In the ten recent years, the
standard of lifestyle has increased,
researchers have begun to study erectile
functions of the penis, the causes of
premature ejaculation, and male
infertility. Also, due to the rapid
development of molecular medicine, the
future trends of research will move
towards the prevention of diseases and
gene therapy.
With the combination of advanced
technology and diligence of the
professionals, the medical technology in
Taiwan is not inferior to any other
countries internationally. Apart from
the advancements and the division of
specialization, though, we must
concentrate on the medical treatment of
the whole person and the increase of
medical ethics. Therefore, the
physicians are not only skilled
professionally, but also provide warmth
and care to the patients. This is the
future direction to work hard on for all
the physicians in the division of
Urology.
