SGH 160th Anniversary | Xinmin Weekly features a report in Shanghai General Hospital: Urology Center: "Forging the Battleship of Urology"

‍https://mp.weixin.qq.com/s/ISQgnOsDYG1BDtXKrTnsPw

Entering the 13th floor of Building 7 at Shanghai General Hospital, one immediately experiences the convenience of the Urology Clinical Medical Center’s (referred to as the Urology Center) "one-stop" services. This floor houses general outpatient services, expert consultations, VIP clinics, and multidisciplinary team (MDT) consultations. Additionally, tasks such as registration, payment, medication collection, laboratory tests, treatment, and medical record printing can all be completed on the same floor. From the patient rooms on this floor, the stunning skyline of Lujiazui, including its iconic "three-piece suit" landmarks, can be admired through large windows, earning the rooms the nickname "river-view suites."

The predecessor of Shanghai General Hospital treated urethral stricture patients as early as 1865. In 1946, the Urology Department was formally established, becoming one of the earliest independent urology specialties in China. In 2024, the Shanghai Shenkang Hospital Development Center released the "2023 Clinical Specialty Capacity Evaluation of Urology Departments in Shanghai Municipal General Hospitals." In this evaluation, the Urology Center of Shanghai General Hospital ranked first in "medical quality" and "development capacity" and second in overall performance among Shanghai’s municipal general hospitals. The center has also maintained its position as the chair unit of the Shanghai Municipal Hospital Urology Specialty Alliance.

Moreover, the Urology Center is recognized as a national clinical key specialty, an endoscopy training base under the Ministry of Health, a leading discipline in Shanghai medicine, and a municipal key medical specialty. At its inception, the department was divided into four subspecialties: prostate diseases, urological oncology, urolithiasis, and kidney transplantation. Each subspecialty was led by a nationally renowned team. Through the collective efforts of generations of academic leaders and healthcare professionals, the Urology Center of Shanghai General Hospital has evolved into a distinguished and pioneering institution in the field of urology—a revered academic haven for urologists across the country.

Three Generations of Pioneers: Forging the “Comprehensive Urology” Legacy

The phrase "renowned for decades" aptly describes the influence of the Urology Department at Shanghai General Hospital. In 1946, Professor Huang Zheng, who had studied in Germany, established the Urology Department and served as its first director. At a time when urology was still underdeveloped in China, Professor Huang introduced advanced small-incision prostate surgeries. He not only brought cutting-edge techniques to China but also conducted numerous training programs to disseminate these innovations nationwide. His efforts significantly improved prostate surgery techniques in the country and established the Urology Department’s initial reputation.

In the 1970s, Professors Xie Tong and Tang Xiaoda, the second and third department heads respectively, ushered in the department’s second phase of development. Both were esteemed experts in kidney transplantation, with Professor Xie excelling in surgical techniques and Professor Tang specializing in tissue matching. They earned national-level scientific awards for their contributions.

Professor Xie initiated kidney transplantation in 1976 and pioneered dialysis treatment and experimental kidney transplantation research in China. In 1987, he introduced cyclosporine A for clinical use and established a monitoring system for its blood concentration, greatly advancing kidney transplantation and aligning China with international standards. Under his leadership, the department participated in the International Congress of Transplantation for the first time in 1990, promoting global academic exchange. The following year, he founded the Chinese Dialysis and Transplantation Association (CDTA), serving as its chairman for seven consecutive terms. The association has trained numerous professionals across China, significantly accelerating the development of dialysis and kidney transplantation nationwide.

The department’s third development phase was spearheaded by Professor Xia Shujie, who, in the early 2000s, championed minimally invasive surgeries over traditional open surgeries. He divided the department into teams specializing in laparoscopic, ureteroscopic, and percutaneous nephrolithotomy procedures, pioneering the transition to minimally invasive techniques. Shanghai General Hospital was the first hospital in the city to perform percutaneous nephrolithotomy (PCNL) and laparoscopic radical prostatectomy in Eastern China. In 2004, Professor Xia developed the transurethral thulium laser enucleation of the prostate (ThuLEP), which has since been incorporated into international guidelines as a standard technique. For his contributions, he was awarded the National Science and Technology Progress Award (Second Prize). Professor Xia’s leadership also saw the establishment of the Shanghai Jiao Tong University Urology Research Institute in 2005 and the Urology Clinical Medical Center at Shanghai General Hospital in 2012. Over two decades, his team addressed numerous challenges in prostate surgery, cementing the department’s leadership in the field.

Today, the Urology Center comprises seven subspecialties: prostate and urinary control surgery, two divisions of urological oncology, urolithiasis surgery, kidney transplantation, andrology, and pelvic floor and incontinence surgery. It is recognized as a “flagship” in the field of urology.

Helping Patients Live Longer and Better

The history of Shanghai General Hospital’s Urology Department highlights how technological innovation has driven its growth. Professor Han Bangmin, the hospital’s Vice President and current Director of the Urology Center, has performed the highest number of transurethral thulium laser enucleation of the prostate (ThuLEP) procedures globally. In 2014, Professor Han introduced anatomical enucleation techniques using thulium lasers. By 2018, his team further refined these techniques, making transurethral prostate surgeries simpler and safer. In 2019, he led the team that completed Shanghai’s first fourth-generation Da Vinci Xi robotic-assisted radical prostatectomy.

Given the varying conditions of benign prostatic hyperplasia (BPH) patients, including differences in prostate size and shape, the department has prioritized personalized treatment plans. Under Professor Han’s leadership, the department emphasizes comprehensive evaluations before surgery, individualized surgical precision, and targeted postoperative rehabilitation to preserve urinary control. Their efforts have resulted in a 60% early urinary control rate after prostatectomy, far exceeding international averages. In 2020, the department introduced an integrated care model for prostate cancer, establishing a Comprehensive Care Center (CCC) that provides personalized, proactive, and holistic health management for patients.

Innovation is deeply rooted in clinical practice. The department has also made significant strides in treating bladder cancer, one of the most common urological malignancies. Bladder cancer has high recurrence rates, with 5-year recurrence rates ranging from 24% to 84%. The bladder cancer team employs advanced techniques and comprehensive treatments to improve outcomes and control recurrence, adhering to guidelines that recommend immediate and periodic postoperative bladder instillation therapy.

The bladder cancer sub-specialty team within the Urology Department at Shanghai General Hospital leverages innovative technologies to enhance treatment efficacy and control recurrence rates. According to authoritative guidelines, all patients with non-muscle-invasive bladder cancer are advised to undergo immediate post-operative bladder instillation chemotherapy or regular bladder instillation therapy to reduce the risk of recurrence. Immunotherapy via bladder instillation, primarily with Bacillus Calmette-Guérin (BCG), remains a key recommendation; however, its costs can reach nearly 100,000 RMB, and many patients struggle to endure the associated pain.

Under the leadership of Dr. Wang Xiang, Deputy Director of the Urology Center and Director of the Urologic Oncology Department (North Campus), the hospital has pioneered photodynamic therapy (PDT) for bladder cancer, making it the only institution in Shanghai to clinically offer this treatment. Typically, patients require only three post-operative PDT sessions, at just one-third the cost of BCG therapy, with significantly reduced treatment durations.

Dr. Wang’s team is also collaborating with the University of Shanghai for Science and Technology on an interdisciplinary research project. This novel method uses flexible catheters to deliver liquid nitrogen at -196°C directly to the affected bladder tissues, inducing necrosis for therapeutic purposes. Dr. Wang revealed that cryotherapy is primarily suited for early-stage bladder cancer patients with smaller lesions. The research has reached the final stage of preclinical trials.

A Leader in Kidney Transplantation

Kidney transplantation is a traditional strength of the Urology Department at Shanghai General Hospital, forming a core component of the Shanghai Organ Transplantation Clinical Medical Center, housed within the hospital. To date, the team has performed over 2,200 kidney transplants, with an annual volume of approximately 100 cases. The youngest recipient was 11 years old, and the oldest was 72, with the longest-surviving transplanted kidney functioning for over 29 years. The team’s comprehensive technical indicators rank among the best domestically and have reached internationally advanced levels.

The hospital also leads in dialysis treatment for end-stage renal disease in Shanghai, with an average 10-year hemodialysis survival rate of 41%. The longest-surviving hemodialysis patient has lived for approximately 34 years, a record in Shanghai.

Fostering Excellence in Urology

The Urology Clinical Medical Center boasts a rich academic tradition and strong faculty. It was one of the first disciplines approved by the State Council to confer doctoral degrees following China’s reform and opening-up policy. Currently, the department has 14 doctoral supervisors and seven master's supervisors, having cultivated numerous outstanding specialists over the decades.

A rigorous academic atmosphere is evident in daily morning meetings, handovers, and scholarly discussions. Every Monday at 7 p.m., the center hosts regular professional development sessions, inviting leading domestic experts to review the latest techniques, theories, and research findings. On Wednesday afternoons, comprehensive case discussions take place, where senior experts often return to challenge and mentor younger physicians.

These assessments are notably thorough, with senior experts posing challenging questions that require meticulous preparation from younger doctors. According to Dr. Han Bangmin, academic inheritance involves not only learning from predecessors but also encouraging innovation. During surgical training, he often prompts younger doctors to think critically, asking, "What areas of this method could be improved?"

Support for Young Talent

The Urology Center places significant emphasis on fostering young doctors through a comprehensive incentive program. Innovations by doctors are rewarded by the department and hospital, with support provided for conducting research and participating in academic exchanges. This initiative enables young physicians to grow rapidly and continue the legacy of the department, delivering higher-quality medical services and spearheading more innovations.

Public Health Advocacy and Education

Beyond providing diagnosis and treatment, the Urology Department actively engages in public health education and disease prevention. Recognizing the limited efforts in early prostate cancer screening in China, the team has developed a multi-dimensional health education system for urological diseases.

This system employs a horizontal approach to educate the general public through newspapers, magazines, new media, expert lectures, poverty alleviation programs, and comprehensive services throughout the patient journey. Vertically, it targets primary care physicians through rural support initiatives, academic exchanges, and the promotion of innovative techniques, enhancing their understanding of urological diseases.

The flagship program, Urology Lecture Hall, led by the center’s team, combines presentations by young and mid-career physicians with expert commentary and Q&A sessions. Since September 2023, nearly 40 live-streamed sessions have been held, amassing over 500,000 replay views. Additionally, the weekly Voice of Urology educational series has conducted 38 sessions, blending online and offline formats with diverse themes.

A Commitment to Compassionate Care

Medical care is not just about advanced technology—it’s about addressing the health needs of patients and the public. The Urology Department at Shanghai General Hospital serves as a safe harbor for urological health, offering top-tier diagnostic and treatment services while striving to educate and empower individuals to manage and prevent diseases.

Source: Issue 38, Xinmin Weekly, 2024

Reporter: Ying Chen

Editor: Public Relations and Spiritual Civilization Office, Shishi Cai

Translator: International Cooperation and Exchange Department, Yuhan Wang