Urology in Asia – Sri Lanka

Abstract

Neville D Perera M.S. (Col.), F.R.C.S., F.R.C.S.Ed., Dip. Urol. (Lond.), F.C.S. (S.L.). Editor Urology was established as a specialty in Sri Lanka in 1955 when Dr George Nelson Perera, a general surgeon, returned to the country after overseas training and was appointed as the genitourinary surgeon of the General Hospital of Colombo (now the National Teaching Hospital of Sri Lanka). His ward strength was a meager 10 beds, and had shared operating time with the general surgeons and obstetricians. His practice was confined mainly to open urological procedures, and endoscopy was reserved for diagnostic purposes. Similar to his contemporary western counterparts, he faced a fair degree of resistance from the general surgeons who competed for the practice and did not want to part with it. It is legendary that they even went to the extent of seeking legal assistance against Dr Perera for including hydrocelectomy in his list of procedures. They were bitterly defeated at a court of law by Dr Perera, who mentioned to the judge that “anything hanging between the thighs in a male falls within the scope of a genitourinary surgeon” and was unfortunately charged with contempt of court. Despite this resistance, three of his followers, who were also general surgeons who has converted into urologists, carried the baton forward and introduced transurethral resectional surgery (in 1968). This helped tremendously to get the specialty a better recognition which was further enhanced by introduction of extracorporeal shock wave lithotripsy in 1992. In 1980, the Postgraduate Institute of Medicine (PGIM) of the University of Colombo introduced a more formal and structured supervised training program comprising of 2.5 years of general surgery and 4 years of speciality training (2 years at a recognised center in the UK or Australia) with an exit examination – MS/MD (Surgery). This has produced over 25 fully fledged urologists which is still inadequate for a population of 20 million leading to a severe shortage of urological surgeons. This situation leads to the practice and maintenance of the skills of traditional open access surgery by the urologists, especially outside the main teaching centers, with the claim that open surgery is still the most cost-effective and speedy method (except in the case of transurethral resections and ureteroscopic surgery) for an unbelievably large catering population per urologist. Minimally invasive urology has been introduced, established and dispersed in Sri Lanka during the past two decades, predominantly by the National Teaching Hospital of Sri Lanka in Colombo (3547 bed strength), which is the center of excellence for advanced video endourological surgery, including percutaneous renal surgery, retrograde intrarenal surgery, laser therapy and advanced laparoscopy, and caters to the public sector where health is totally free and acts as a referral center to the rapidly developing private sector with health tourism. The Sri Lanka Association of Urological Surgeons (SLAUS), which was formed in 1999, obtained the membership of the Urological Association of Asia (UAA) in 2003 and ever since has been actively participating in UAA activities. SLAUS organizes several regular academic events, which include live demonstration workshops in collaboration with eminent international faculties. During the past two decades, a substantial amount of scientific research and publications have been presented by SLAUS members, and as a result the historical first ever super specialty professorial title awarded to a non-university clinician was offered to a urologist. The Sri Lanka Journal of Urology (SLJU), a peer reviewed journal, has been the official publication of the Association since 2000 and is available at the official website http://www.slaus.com. Annual scientific sessions inaugurated in 2005 by SLAUS have been graciously supported by the Asian School of Urology and took place at the November/December joint meeting with the Urology Section of the Royal Society of Medicine (UK) to celebrate its 10th Anniversary in 2009. The forthcoming joint meeting with the UAA, “Asian Urology Symposium – 2011” (17–19 November 2011) is also expected to meet with similar success and high standards. In keeping with the cessation of 30 years of civil unrest, the ever growing socioeconomic development of Sri Lanka, and the firm government policy and commitment to improve the numbers and quality of specialists supported by technological advances and regional collaboration, SLAUS plans to reach out to the population in all parts of the island (both in the public and private sector), and the future of Sri Lankan urology appears to be bright and promising.