The Past, Present and Future of Urology in Taiwan and the Taiwan Urological Association

As technology has rapidly developed, medicine has also made great progress and advancements. In terms of the history of medicine in Taiwan, it is intertwined with economic and technological developments. At present, the level of medicine in Taiwan is not inferior to advanced countries in the world. Expensive treatment equipment from abroad has been purchased and installed in most of the hospitals and health institutes in Taiwan. Aside from the advancement in equipment for administering treatment, medical administration and organization have also been combined and are more efficiently managed, striving toward the goal of providing economical, efficient and integrated medicine. Focusing on the development of urology in Taiwan, four aspects can be demonstrated as follows:  

  1. Evolution of organization and processes
  2. Changes in types of diseases
  3. Development of medical equipment and techniques
  4. Research and development trends
Evolution of organization and processes

At the early stage of the retrocession of Taiwan, urology was not an independent department. It was instead a part of the dermatology department, a system which was derived from Japan. The Taihoku Imperial University Medical School Affiliated Hospital, known as the Taiwan National University Hospital nowadays, was the representative hospital that adopted this system. As the Nationalist government took over the power in Taiwan, the National Defense Medical Center of the military system moved to the Taiwan Water Park. This center followed the system of the Peking Union Medical College Hospital which formed part of an English and American school, creating a vast gap between the system of the National Taiwan University Hospital, which adopted a pure traditional Japanese system of medical education. As a result, new thinking and behavioral modes have been brought to the world of medicine in Taiwan. At an early stage of the retrocession of Taiwan, academic exchange among the colleges of medicine in Taiwan was rare, which hindered the development of medicine in institutions. At that time, new technology in the field of urology was learned and adopted from the USA. When confronted with difficult cases, the military system and National Taiwan University system would discuss treatment plans without any bias for the good of their patients. Since then, due to a genuine cooperation between the two big systems, urology departments with different systems in Taiwan have worked harmoniously together.

As urologists were scattered at every corner, and worked alone without communication, in 1978, some senior doctors such as Hsieh, You-Fu, Jiang Wan Xuan, Chiang, Ching-Pei, Cheng, Bu-Fei, Ma, Cheng-Ping, Lue, Yeh-Bin, called for the establishment of the Urological Association of the Republic of China in order to facilitate effective communication among urology departments in hospitals. It was then renamed the Taiwan Urological Association in August of 2002. The association established several regular committees (the Magazine Committee, the Educational Research and Medical Ethics Committee, the Specialist Review Committee, the International Affairs and Welfares Committee, the Training Hospital Assessment and Human Resources Planning Committee, the Health Insurance and Public Medical Consulting Committee, and the Academic Information Committee), and functional committees (the Urodynamics and Female Urology Committee, the Urologic Oncology Committee, the Pediatric Urology Committee, the Urological Endoscopy Committee, and the Urinary Tract Stones Committee) to promote the affairs of the association. Since the hard work invested by the senior physicians in creating these organizations, urology in Taiwan has become a well-organized medical network, working closely with the government to offer as many benefits for the public as possible.

Changes in Types of Diseases

At the early stage of the retrocession of Taiwan, patients in urology mostly suffered from urolithiasis, urinary tuberculosis, or urethral stricture caused by gonorrhea. As health and living conditions improved, and anti-tuberculosis drugs were invented and developed, occurrences of tuberculosis have decreased. Furthermore, thanks to the invention of antibiotics, urethral stricture caused by chronical gonorrhea has been kept control in recent years. Instead, because of an increase of national life expectancy, benign prostatic hyperplasia has become a common disease in urology. As for southern Taiwan, in places like Beimen, Xuejia, Budai and Yizhu, blackfoot disease and urothelial cancer are known to have frequently broken out. In addition, the incidence rate of upper urinary tract urothelial carcinomas in Taiwan was even at the top list in the world. Taiwan is still an area where this disease prevails. Further worth mentioning is the incidence rate of prostate cancer which has continually grown over the years, the same as cancer of the bladder.

Urinary tract stones still account for the most patient cases in urology, but severe complications have gradually been reduced. Staghorn kidney stones currently also represent a proportion of urological diseases; a challenge urologists still face. Furthermore, since the quantity of new urologists has increased, iatrogenic harm to the urinary system can still occur on occasion while physicians are in training. As the changes to society take place and with the technological developments of the times, the incidence rate of some urinary diseases has diminished, but some have increased. Thus, our aim now is to emphasize how these diseases can be prevented, or how they can be discovered and treated sooner rather than later.

Development of medical equipment and techniques

In early times, the urological equipment in Taiwan was mainly remaining American military equipment. Their cystoscope’s heat source was generated by a bulb, so visibility was bad and the bulb was vulnerable to damage. From the 1970s, an optical fiber source was used so the problem was solved. Moreover, ureteroscopy and ureter-renalscopy with multifunctions were developed, and in recent years, screens were added to assist with these techniques, which made it easier for trainees to use. Thanks to this technology, urology has made significant breakthroughs in the treatment of diseases, especially for urinary tract stones. In early times, surgery was the main approach to remove the stones, which was the main treatment used urology. For staghorn stones, anatrophic nephrolithotomy and extended pyelolithotomy were techniques used in operations. In the early 1980s, with the progress of optic devices, ureteral stones could be treated using a ureteroscopy so that an operation could be avoided. Furthermore, percutaneous nephroscopic lithotomy could be used to treat stones or staghorn stones in the kidneys; again, eliminating the need to perform a surgical procedure. With regards to urinary tract stones, a less invasive surgical procedure rather than an invasive one could be adopted with the aim of reducing post-operative complications and post-surgical effects for the patients.

In addition, the extracorporal shock wave lithotiptor (ESWL) was invented, and currently, over 80% of patients with stones can be cured just by using the ESWL. This invention could be regarded as the best technological advancement in the field of urology in the 20th century. ESWL was introduced to Taiwan in 1985 and since then, diseases that had been treated surgically can be managed by adopting a non-surgical approach. Another new treatment which was also invented on account of the advancement of technology was the laparoscopic surgical procedure. This invention can be used to treat cancerous prostate cells. At the end of 20th century, robotic arms started being used to develop remote control surgery. Patients now endure a smaller laparoscopic perforation instead of a big scar caused by an open surgical procedure. This not only solves issues in the technique of laparoscopic surgery, but also thanks to remote control, post-operative complications and the numbers of days of hospitalization following surgery are reduced. To review, urology has developed from nothing to a highly-advance and progressed field. As well as the advancement of technology, this progress can be attributed to the talent cultivation and hard work of senior physicians. They continuously developed new techniques, brought new ideas to urology in Taiwan, and built upon their achievements. The progress made in Taiwan evenly matches advanced countries in the world. For now, the primary goal is to bring this talent to the world stage: presenting our results on a global level, facilitating effective communication, and creating our own chapter in history.

Research and development trends

Early urology placed emphasis on how to enhance surgical techniques, the main focus of which included resection of prostate hypertrophy with an endoscopic approach, renal artery angiography, surgical skills removing stones and stone analysis, etc. Afterwards, some senior urologists started studying the treatment and prevention of carcinoma. Then, as the living standard improved, some scholars moved their focus to the penis erection function, and researched reasons leading to premature ejaculation and male infertility. What is more, since molecular medicine has flourished, the trend of future study will head toward disease prevention and gene therapy. Combining technological developments and people’s efforts, urological techniques in Taiwan are no less sophisticated than those of any other country. Only when speaking of the improvements of professional departments does Taiwan need to more actively develop holistic medicine and enhance medical ethics, which not only would enable doctors to become masters in their fields, but also provides patients with better overall care. This is also the goal that all staff in urology endeavors to achieve.