Paediatric Urology in Sarawak
Professor Dr Clarence Lei, FRCS Urol,
Paediatric Urology is Teamwork: The practice of urology is such that it covers a health disease spectrum and not just surgical procedures. It is often multi-disciplinary involving not only urologists but other surgeons especially paediatric surgeons, orthopaedic & neurosurgeons for the spine, pelvis and club feet of spina bifida patients. The growth of paediatric urology in Malaysia is dependent on a strong team of a dozen of dedicated paediatric nephrologists, headed by Dr Lim Yam Ngo. The teams of dedicated paediatric nurses, physiotherapists and other therapists are needed to paediatric urology to standard.
Paediatric Urologyincludes: UDT, undescended testes, inguinal hernia, hydrocele, hypospadias, antenatal hydronephrosis and associated pyeloplasty, ureteric re-implantation, PUV, posterior urethral valve, neuropathic bladder often in association with rampant spina bifida, non-neuropathic voiding dysfunction & BBD, bladder bowel dysfunction. Urinary stones are still endemic in Sarawak.
The State of Sarawak was carved out from Brunei by the White Rajahs, beginning in 1841, became a British Colony in 1946 and finally joining Sabah/ Singapore to form Malaysia in 1963. Western medical practices were introduced to Sarawak by the missionaries in the beginning, e.g. the establishment of the Christ Hospital in Kapit from 1957 – 1974. Paediatric urology would have been part of the general surgical practice. We have many dedicated giants in general surgery, e.g. PR Sengupta, Sarawak State Surgeon from 1970 – 1987, Ranjit Oommen (I was their houseman in 1981), CJ Cumming Smith from Edinburgh, the late Wong Soon Kai, FRCS Ed. The late Sir James Fraser FRCSEd worked in Sibu from 1958 – 1963. Some general surgeons who qualified as surgeons in 1980s also took an interest in Urology and provided the primary care for paediatric urology patients before sending them to Kuala Lumpur GH. Since 1990s, the urologists and paediatric surgeons from Kuala Lumpur made visits every few months to the major towns in Sarawak, namely, Kuching, Sibu and Miri to provide a basic service and hoping to entice young surgeons into their discipline! Sarawak also relied on contract surgeons from India, e.g. Dr AMVC Raju and Ganesh Gopalakrishnan who worked in Sarawak in the 1990s.
The first kidney transplantation of Malaysia was on a young boy from Sarawak who received a kidney from his brother, on 15.12.1975. Since 2000, I have been involved with the paediatric renal transplantation programme in GHKL, with a median of about x paediatric kidney transplants done per year.
The general hospital of Sarawak,. SGH in Kuching, is the referral hospital of Sarawak. Surgical data are often found in the operation theatre records. The entire paediatric urology surgical workload of SGH in 2013 were reviewed. The following are the main cases: ……The da Vinci robot was introduced to the SGH in 2008, mainly for robotic radical prostatectomy, cystectomy and partial nephrectomy. Nevertheless, the technology is also used for robot assisted laparoscopic pyeloplasty(….).
With better communication and air travel, there are good collaboration efforts with Kuala Lumpur, Sabah and Indonesia. Dr S Rajah established a strong paediatric surgical service in Sabah, cumulating in the establishment of the Likas Women & Children Hospital in Kota Kinabalu. I had the opportunity of taking part in his paediatric surgical campaigns to correct undescended testes and hypospadias, which seems plenty in Sabah. Indonesian patients often cross over from nearby Pontianak to Kuching: I also had opportunity to participate in Indonesian workshops, including on hypospadias with my counterpart Arry Rodjani on 18.10.2013.
CONCLUSION: Sarawak has still has a long way to go in terms of training (a dozen urologists have been trained in Sarawak by the Malaysian Board of Urology, conjoint with FRCSG Urol) and keeping paediatric urologists and the multi-disciplinary team. There will also be a need for registries and audit. Needless to say, the team has to work with the necessary hardware in the public hospitals.
Professor Dr Clarence Lei, FRCS Urol, FEBU,
BORNEO SURGICAL DELIGHT @ UMS, Sabah, Malaysia, edited
9thSeptember 2018
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