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GLOBAL STATE OF UROLOGY Progression of Minimally Invasive Urology in Bangladesh: A 15-Year Experience and Future Direction

By: Max Drescher, MD, Hackensack University Medical Center, New Jersey, Summit Health/New Jersey Urology, Maywood; Fahad Sheckley, MD, Hackensack University Medical Center, New Jersey; Mubashir Billah, MD, Hackensack University Medical Center, New Jersey, Summit Health/New Jersey Urology, Maywood; Mutahar Ahmed, MD, Hackensack University Medical Center, New Jersey, Summit Health/New Jersey Urology, Maywood | Posted on: 20 May 2024

With a population of just under 180 million individuals, Bangladesh ranks as the world’s eighth most populous country. Most advanced medical care is centralized in its capital, Dhaka, which boasts a population exceeding 22 million. Dr Mutahar Ahmed has dedicated the past 15 years to advancing urological care in Bangladesh. Born in Sylhet Province northeast of Dhaka, Dr Ahmed moved to the US as a child. Dr Ahmed has emerged as a leading figure in minimally invasive urology and robotics, notably in urologic oncology, pioneering the use of the single-port robotics platform. The enduring impact of his endeavors is palpable within the landscape of contemporary urological practice in the country.


Figure 1. F. Sheckley, M. Drescher, M. Ahmed, T. M. S. Hossain, M. Billah, and C. Mallikarjurna, Bangaabandu Sheikh Mujib Medical University, Dhaka.

In 2013, the Bangladesh Association of Urologic Surgeons (BAUS) reached out to Dr Muhammad Choudhury, current chairman of urology at New York Medical College, to find someone who could provide live laparoscopic cases to demonstrate the capabilities of the technology to urologists in Bangladesh. Having known Dr Ahmed as a personal friend and colleague, Dr Choudhury felt he would be the right ambassador for these demonstrations. After a meeting at the AUA in May between Dr Choudhury, Dr Ahmed, and then BAUS president Professor M. A. Salam, a relationship was formed. The first live demonstrations took place in August 2013 and it has become an annual tradition ever since.

This February we had the opportunity to join Dr Ahmed, Dr Max Drescher (Dr Ahmed’s robotic oncology fellow), Dr Fahad Sheckley (chief urology resident at Hackensack University Medical Center), and Dr Mubashir Billah (urologist at Summit Health/New Jersey Urology and Hackensack University Medical Center). We had the privilege of attending the BAUS annual conference in Dhaka along with Dr Choudhury, who attended as a representative from the AUA. Upon our arrival at the airport, we were warmly welcomed by faculty members who graciously escorted us through the bustling rush-hour traffic to our hotel in downtown Dhaka. The conference’s inaugural day featured live laparoscopic surgery demonstrations led by Dr Ahmed and Dr Mallikarjuna from India. The surgeries were live-streamed to a conference hall of attendees with live interactions from the audience. The cases performed included laparoscopic radical nephrectomy, complex partial nephrectomy, radical prostatectomy, and adrenalectomy. Notably, Dr Ahmed underscored the importance of resident involvement during these demonstrations, which is a challenge to the traditional dogma of resident education in Bangladesh. When Dr Ahmed first commenced his regular missions, the prevailing method for urologic surgery in Bangladesh primarily involved open incisions, with laparoscopic procedures nearly nonexistent prior to 2013. Through his early visits, Dr Ahmed advocated for the adoption of minimally invasive approaches, a stance that has been embraced by the local urology community. We encountered several urologists who had previously assisted Dr Ahmed as residents and had since evolved into proficient laparoscopic surgeons, thereby broadening the scope of minimally invasive urological care.


Figure 2. M. Billah, M. Drescher, F. Sheckley, and M. Ahmed, Bangaabandu Sheikh Mujib Medical University, Dhaka.

Following the operative day, were 2 days of scientific conference and presentations. Some highlights were demonstrations of advanced laparoscopic techniques for reconstructive and oncologic surgery by several up-and-coming Bangladeshi surgeons and initial results from a new burgeoning renal transplantation program. Outside of this was ample time to experience Bangladeshi culture and food; the people were extraordinarily friendly and excited to share their country with us. At the completion of our conference was an overnight train from Dhaka to Cox’s Bazar, a popular vacation beach town to the country’s east on the Bay of Bengal. There we met in a casual setting with the urology residents to share their experiences as trainees. Residency in Bangladesh is a very different experience than in the US. With no guarantee of passage from one year of training to the next, there is much anxiety regarding annual service exams, which determine the progression of each resident. Failure to pass these exams may mean a continuation of training or even termination in certain circumstances. As frontline providers for the government hospitals, residents face the challenges of the health care system head on, with often overwhelming patient volumes and lack of infrastructure. Despite these challenges, they are proud and hungry to progress their skills and knowledge to provide optimal care for their patients.


Figure 3. M. Drescher, M. Ahmed, and F. Sheckley performing laparoscopic radical prostatectomy with urology residents at Bangaabandu Sheikh Mujib Medical University, Dhaka.

Despite significant strides, the future of urological care in Bangladesh confronts numerous challenges, chief among them being financial constraints. Despite being a rapidly burgeoning economy, a substantial portion of the population remains impoverished. Medical tourism exacerbates this issue, with affluent Bangladeshis often seeking advanced care in neighboring India or other nations. Consequently, middle- and lower-income individuals constitute the primary patient demographic seeking surgical interventions within the country. This reality necessitates strategies to minimize costs and mandates exceptionally high patient volumes. The logical progression for surgical urological care in Bangladesh lies in the adoption of robotics. Astonishingly, the entire country lacks a surgical robot, despite serving a population of 180 million—a stark contrast to the US, where even small community hospitals often possess such technology. While the timeline and means for funding such a purchase remain uncertain, there is optimism that robotics will soon be integrated into Bangladesh’s health care landscape. With a palpable need and a pool of skilled professionals, the implementation of this platform holds immense promise for revolutionizing urological care in the country.

Acknowledgments: We thank BAUS, especially President K. Alam and Secretary A. Rana, for their hospitality during our stay. We also thank Summit Health/New Jersey Urology and Hackensack University Medical Center for sponsoring our trip and travel expenses.