New prostate procedure could bring relief to rural millions

Lukewarm welcome

Despite its apparent benefits, the procedure has received a lukewarm welcome in Chinese hospitals. "Nationally, about 400 balloon dilations were performed between June and December at about 150 hospitals in China," Tian said, noting that most of the hospitals were located in second- or third-tier cities and counties. The procedure is only performed at three hospitals in Beijing, including Chaoyang Hospital, Tian's employer.

In the past 12 months, Tian has performed about 30 balloon-dilations, although mostly outside Beijing. "The operation is covered by national medical insurance in just six out of 32 provincial-level administrative regions on the Chinese mainland, excluding Beijing," he said.

Even within his own urological department, Tian faces opposition because few of his colleagues are as enthusiastic about the procedure as he is.

That's understandable, according to Zhang Yushi, deputy director of the urological department at Peking Union Medical College Hospital, China's most prestigious hospital, who has listened to Guo's lecture on the procedure, but hasn't yet witnessed it.

"Personally, I have reservations about the method. I don't think any doctor in our department would vote for it. The whole thing sounds implausible to me. And they don't have enough statistics to support what they are doing," he said.

Zhang has a point. Guo estimates that his success rate is now about 85 percent, similar to electrotomy and laser surgery, but as only about 1,000 people have undergone the procedure since 2008, by which time it had matured, it's still difficult to assess its effectiveness compared with other methods, especially the long-term impact on patients.

To improve the flow of data, Guo is planning to oversee research into the procedure in several hospitals that will cooperate in a comparative clinical study that's scheduled to begin sometime before June.

He applauded Jiang for his "stubbornness". "None of this would be possible without his perseverance," he said. Guo has attracted more than 1 million yuan ($150,000) to the project's research fund, mostly as a result of his reputation and status as China's top urologist.

A global problem

Worldwide, 60 percent of all men aged 60 and older suffer from an enlarged prostate gland. For men age 70 and older the figure rises to 70 percent, and for men age 80-plus it is 80 percent.

"For every medical expert in Beijing or Shanghai, there are tens of thousands, and probably hundreds of thousands, of doctors working at the grassroots level. Their first-hand knowledge of the situation on the ground sometimes makes them the best-positioned - despite the belief voiced by many experts - to tackle the issues faced by their patients and hospitals, including a lack of funds and a shortage of well-trained doctors," he said. "Their inventions and innovations are often aimed directly at solving those problems. However, that doesn't mean that what they have come up with are makeshift measures inferior to international practices."

"It's the responsibility of national medical research institutions and hospitals to push forward such ideas and practices, to continue the relay if it's deemed valuable. And the government should establish a channel so voices from down below can be heard and judged fairly," he said.

In around 2004, Guo attended a medical conference in Qingdao, Shandong. "I asked a participating doctor what he thought of Jiang's cause, and the answer was: 'Don't waste time on him. He's a madman.' "

Jiang, who retired in 2011, appreciates the work undertaken by Guo and his team and the support they have shown. "They have made sure my life's work isn't wasted and have proved that, in the end, I'm not completely mad," he said.