Urology in Asia – Bangladesh

Abstract

AKM Anwarul Islam M.B.B.S., F.C.P.S., F.R.C.S. Editor Bangladesh is the eighth most populous (164 million) and the ninth most densely populated (1099/km2) country in the world, having characteristic features of a developing nation. Urological diseases were managed by general surgeons for a long time. In 1965, Dr Idris Lasker founded the first urology unit at Dhaka Medical College. The next units started in 1973 at the Combined Military Hospital, and in 1982 at the Institute of Post Graduate Medicine and Research (IPGMR). Development of skilled manpower was the initial challenge and was overcome by overseas training of several general surgeons. The MS (Master of Surgery) Urology course started at Dhaka Medical College in 1995, followed by IPGMR in 1996. The course is now being run in three more institutions. The urology courses in Bangladesh are of 3-year duration after obtaining a degree or training in surgery. The urology degree is either a MS from a university or a fellowship (FCPS) from the Bangladesh College of Physicians and Surgeons (BCPS), the later being started in 2001. Starting in the mid 1970s, endourology was confined to the lower tract until 1993, when extracorporeal shock wave lithotripsy (ESWL) was launched at IPGMR. A boost to endourological development occurred after several live operative workshops organized at Dhaka, as well as short overseas training of midlevel and young urologists in regional advanced centers. As a result, ureterorenoscopy, percutaneous nephrolithotripsy and laparoscopy are now carried out regularly and 14 ESWL set-ups are functioning in centers throughout Bangladesh. Beginning in 1982, transplantation gained momentum in 1988 through a WHO-aided program, and more than 800 live related renal transplantations have been carried out in several hospitals so far. Advancement in technology and skill led the super-specialties of urology to grow in Bangladesh. Several such units (Uro-oncology, Pediatric Urology, Female Urology, Transplant) were opened in 2005 at Bangabandhu Sheikh Mujib Medical University (the former IPGMR) in Dhaka. However, the developments are mostly confined to big cities and the vast population has limited access to specialty services. The majority of urological problems are still managed by general surgeons working in 64 district hospitals. Roaming urologists provide some endourological services in these areas. The government has recently started 17 new urology units in medical colleges, mostly in the peripheral part of Bangladesh, boosting up the service and training. The Bangladesh Association of Urological Surgeons was founded in December 1988. Today it has 138 members. The association holds a monthly continuing professional development program. An international scientific conference is held once every 2 years and a national seminar in the year in between. At the conference, the “Idris Memorial Gold Medal” is awarded to a distinguished urologist and the “Siraj Jinnat Memorial Gold Medal” is awarded for the best scientific paper. Reputed faculties, mostly from neighboring countries, are invited for live operative workshops, symposiums and plenary. The Asian School of Urology has been actively and regularly contributing to the conferences. At the seventh International Conference on 4–6 February 2011, the third Asian and European School of Urology Joint Course was carried out successfully. The association has active collaborations with Urological Association of Asia, Société Internationale d'Urologie, European Association of Urology and their member associations. The association discharged several social and ethical responsibilities. It took a strong stance against threatening organ trading in the mid 1990s in Bangladesh and played an active role in formulating the “Organ Transplant Act 1999”, which allows live related (first- and second-degree) and deceased (opting-in system) transplantation, prohibiting organ trading. The association took part in programs for raising awareness of urological diseases and in creating new urology units throughout the country. The Bangladesh Journal of Urology is the official journal of the association, published twice-yearly since 1998. It is recognized by the national medical council, but is yet to be indexed in a host of abstracting indices. In Bangladesh, as in any developing country, public research is limited and priority-based. However, with the aforementioned background, organized research in the urological field is expected to evolve in the near future.