The Past, the Present and the Future
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
- 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.
- 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.
- 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.
- 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.