25th World Congress Of The Societe Internationale d'Urologie

29 Oct 2000

By Mr Lim Hng Kiang

Theme : The Challenge of Urology in the New Millennium

Dr Yoshio Aso, President, Societe International d'Urologie

Dr Michael Rochford, Chairman, Congress Organising Committee

Dr Li Man Kay, Chairman, Local Organising Committee

Distinguished guests

Ladies and gentlemen

Introduction

Let me first extend a very warm welcome to all our distinguished overseas delegates. It gives me great pleasure to be here with you at the 25^th World Congress of the Societe International d'Urologie, the first meeting of the Society in the new millennium. Singapore is indeed privileged to host this Congress in Asia after 30 years, the last meeting being held in Tokyo in 1970.

This Congress is a significant event as it brings together a distinguished faculty of experts to share their experiences and discuss the challenges that face the practice of urology at the dawn of the new millennium. I am pleased to note the wide spectrum of topics that will be discussed, ranging from the management of stones and cancers of the urinary tract to minimally invasive and reconstructive surgery.

The Practice of Urology

It is well known that urology has been practised since time immemorial. Chinese physicians were known to use the leaves of spring onions to treat patients with retention of urine. In the early middle ages, barber surgeons moved from town to town performing surgery for the removal of bladder stones. They were reputed to do so without anaesthesia and they were quick and fast. But, they had to leave town as soon as possible, before their patients die of complications!

Over the decades, however, tremendous revolutionary progress has been made towards the safe and effective management of urological diseases, harnessing the technological advances along the way.

An ageing population

The 20^th century has seen a global transformation in human health. An important global health trend is increasingly longer life expectancy. The World Health Organisation estimates that life expectancy in the world, currently 65 years, will reach 73 years in the next quarter of a century. By 2025, the global population of persons aged 65 years and above will be more than 800 million.

In Singapore, our population is ageing too. Our life expectancy was 63 years in 1957. It has increased to almost 78 years in 1999. Today, we have about 220,000 people aged 65 years and above, making up about 7% of our population. By 2010, we will have about 300,000 elderly persons. By 2030, we will have 800,000 elderly, comprising 18% of the population.

An ageing population will present formidable challenges to our health care professionals, urologists included. This is because many urological problems commonly affect older people, especially among men. With ageing, enlargement of the prostate gland, urinary incontinence and prostate cancer, as well as other cancers of the urinary tract, will arise. Prostate gland enlargement and prostate cancer are two common urological conditions seen in the developed world today.

Urological diseases and the ageing population in Singapore

In Singapore, the number of persons treated for prostate gland enlargement has increased almost two-fold in the last 15 years to about 1,500 in 1999. The majority were men more than 60 years of age. Studies have also shown that about 1 in 7 persons more than 60 years old in our population have urinary incontinence, especially among women.

Prostate cancer is most common among elderly men. Since 1983, it is among the top ten cancers in Singaporean men. The incidence of prostate cancer has increased three-fold, from 4 per 100,000 population to 13 per 100,000 over the last 3 decades. Today, it has emerged as the sixth most common cancer among men.

Another common condition is bladder cancer, which occurs mainly among older men. The incidence among men has increased 25% over the same period to 7 per 100,000, but is relatively less frequent among females. It is the tenth commonest cause of cancer among men.

A major challenge is how we can improve survival and outcomes through early diagnosis and treatment of these cancers. Our strategy is to keep abreast with the latest developments in diagnosis and treatment. More importantly, we try to encourage Singaporeans to modify their lifestyles so that they are less susceptible to these problems.

Development of Urology in Singapore

In the early 1980s, the practice of urology in Singapore had been subsumed under the broad category of General Surgery. However, my Ministry recognised the importance of urology as a specialty and that urological diseases will take on increasing importance as our population ages. This led to the establishment of the first full-fledged Department of Urology at the Singapore General Hospital in 1988.

Later, Divisions of Urology were established at each hospital. In 1997, a Urology Centre was established at the Singapore General Hospital. It is a one-stop centre with state-of-the-art systems for patients with urological problems and a focal point for the training of our urologists.

Since 1988, urology in Singapore has developed at an accelerated pace. Today, urology services are available at all major acute hospitals in Singapore. Urology has become recognised as a specialty in its own right, with its own Specialty Board to oversee the training of specialists. There are 27 urologists in Singapore today. Local programmes have been further developed in sub-specialty areas, such as uro-oncology, andrology and transplant urology.

Advances in urology

Over the last 20 years, significant progress has been made in the medical management of numerous urological disorders, which previously could only be treated by surgery. Drug therapy has now become an important option for the treatment of prostate gland enlargement. For conditions that require surgery, the trend today is towards the use of minimally invasive or non-invasive procedures employing lasers or microwaves.

Shockwave therapy has been proven to be a great success for the treatment of kidney and urinary tract stones. Newer diagnostic and therapeutic technologies are still evolving, such as the use of ultrasound, lasers, robotics and image-guided surgery. These new technologies will continue to bring new innovative treatments, which will ultimately benefit our patients with urological problems.

Singapore has kept pace with these developments. Holding the World Congress here is a significant event in this effort.

Conclusion

There will be emerging issues, new challenges and developments that lie ahead in the management of urological diseases in an ageing population. Our local urologists have done well over the last two decades to treat our patients with urological problems in Singapore. I hope that they will continue to contribute in the global effort to search for improved diagnostic methods and more effective therapies.

In conclusion, let me congratulate the Societe International d'Urologie for organising this prestigious World Congress. I wish all participants a fruitful and successful Congress and an enjoyable stay in Singapore.

Thank you.