President's Message
Asian Society for Female Urology Report
The development of female urology, previously called the subspecialty of urogynecology has changed dramatically. Since the work cuts across the boundaries between Urologists and Gynecologists, the latter are now at a critical crossroad both in the West and in Asia. There is a call for a new discipline, namely that of “Female Urology” as a field of interest for urologists and gynecologists who can embrace the new generation of Pelvic Floor Specialists practicing a holistic approach to pelvic floor disorders.
Emergence of the Asian Society for Female Urology (ASFU)
Recognising the need for cooperation amongst urologists, gynecologists and colo-rectal surgeons for the betterment of female patients & developing this field in Asia, Assoc Prof Hong Jae Yup from Seoul, Korea, at the Asian Congress of Urology Meeting in Korea in 1996 proposed this Society & Dr Peter Lim to take the leadership.
ASFU was thus officially founded with worthy impetus from key opinion asian leaders and the proponents of this subspecialty in Asia. Member countries included Singapore, Malaysia, Hong Kong, Thailand, Indonesia, Philippines, Korea, China, India, Pakistan & associate member countries from Japan, Australia & New Zealand.
Objectives
The prime objectives of this society are:
  • To facilitate the training of surgeons (urological, urogynecological and colo-rectal) by arranging attachments for young trainees at reputable surgical centres worldwide
  • To provide research and scholarship grants
  • To organize International Congresses of Female Urology, which will serve as forum for scientific meetings worldwide and relatd courses and workshops to upgrade the standards of this sub-specialty
  • To provide an International fellowship of this sub-specialty in order to promote international understanding, mutual cooperation and trust amongst urological fraternities in all parts of the world irrespective of race, nationality, culture or creed.
APCAB
A sister body ie, the Asia-pacific Continence Advisory Board (APCAB) was established to carry out research in the field of female urology and draw up guidelines so as to develop Continence Promotion Programs in the Asia Pacific rim. As there is a belief that incontinence is uncommon in Asians, there was a need for a study on the prevalence of urinary incontinence in Asia.
Asian Study
The first major task the Society did with APCAB was to run an ASIAN EPIDEMIOLOGIC SURVEY ON INCONTIENCE. It was a questionnairebased epidemiological survey conducted in eleven countries in Asia to establish the prevalence overactive bladder assessed by symptoms in the region. A total of 24222 females were included in the study. The overall prevalence of UI was 14.8%. Nearly half (47.8) of the incontinent population had the mixed type. Majority (77.4%) were not significantly bothered by the condition although a significant proportion (43.7%) sought help for their condition. Using the chi-square test for independence, older age, multiparity, manual labor, a positive family history, and a lower income were found to be associated with a greater occurrence of UI. The study also sought to identify the factors related to the occurrence of overactive bladder (OAB). A total of 7871 individuals (5502) females and 2369 males) were included in the study. The overall prevalence of OAB was 50.1%. The most common presenting symptom of OAB was urgency (63.0%). Nineteen percent of the OAB population presented with incontinence, giving an overall prevalence of 9.7% for urge incontinence among Asians. Majority (77.1%) were not bothered by the condition. Only 20.3% sought help for their condition. Using the chisquare test for independence. Older age, multiparity (for the females), manual labor, a positive family history, residence in the rural area and the use of a sitting-type of toilet were found to be associated with a greater occurrence of OAB. The study has shown that the problem of overactive bladder among Asians is a significant one that warrants closer attention. It has also highlighted the low treatment-seeking rate among those suffering from the condition. This is the first report on the epidemiology of overactive bladder among Asians in the medical literature.
Fellowships
Training Fellowships were arranged for several doctors over the last 7 years and they were:
-    Hector Jacinta (Philippines)
-    Anand Kumar (India)
-    Mela Lapitan (Philippines)
-    Kim Sang Jin (Korea)
Finally, to increase greater awareness in the public about incontinence and its other associated disorders, continence societies with the help of urologists, gynecologists and colo-rectal surgeons were developed in most of the Asian countries in the last decade. The Society for Continence was established in Singapore for the first time in Asia. Later ASFU & APCAB assisted other countries such as Hong Kong, India, Korea, Malaysia, Taiwan, Indonesia, The Philippines, Pakistan and Thailand to form their own societies to create awareness among the public and healthcare professionals about Incontinence in general, Female urologic disorders, Faecal Incontinence and its Prevention & Treatment. Recently, there has also been a greater surge of input form the new specialty of Pelvic Surgery after Professor Stuart Stanton from St. George s Hospital in the UK was given the first chair in this specialty.
New Challenges
We will help develop knowledge in Pelvic Floor Dysfunction and face new Challenges in the following areas:
Our ASFU TEXTBOOK (in press) on ASIAN INCONTINENCE will be released in 2005.
Conclusions
I foresee a greater scope for this subspecialty in Asia so that we can effectively manage female urologic patients. However, healthcare providers belonging to the following specialties viz., urology, gynecology, colo-proctology, and reconstructive surgery should provide leadership to reach the relevant basic science of pelvic floor dysfunction and the scientific realms of anatomy, embryology, physiology, epidemiology, pathophysiology, electrophysiology, neurophysiology, pharmacology, drug therapy, wound management, psychology and behavioral therapy so that we can ensure the very best and optimal delivery of healthcare to the incontinent female patient in this new millenium. This will best be realized if special PELVIC FLOOR CENTRES of excellence are developed for conjoint management of patients with pelvic floor disorders that can impact so greatly on our Quality of life.
  • Bladder Disorders
    Bladder failure, Bladder Overactivity, Urinary
    Incontinence.
  • Painful Disorders
    e.g. The Painful Bladder & Interstitial Cystitis
  • Sexual Disorders
    e.g. Female Sexual Dysfunction
  • Neuropathic Disorders
    e.g. Bladder co-ordination and other neuromuscular disorders, spinal cord injury, prolapsed intervetebral disc, Diabetic autonomic neuropathy
  • Latogenic Disorders
    e.g. Gynecological injuries & their prevention
  • Understanding of Urodynamics
There is no doubt that incontinence is associated with stigma and, for many, it is a still a taboo. Diverting the subject from the medical arena to the work environment may be uncomfortable but it is essential if people are to achieve a healthy work/life balance with the ultimate goal of an improved quality of life. The respondents identified a number of environmental and workpractice issues that can easily be addressed without significant cost to employers. Attitudes of colleagues, which some may consider to be outside the remit of an employer ’s jurisdiction, may take a little longer.
There is evidence to suggest that a general awareness-raising initiative among employers, human resource professionals and occupational health staff would be beneficial. This would give individuals who are responsible for employee well-being the opportunity to acquire the knowledge, skills and understanding required to offer practical support and a sensitive approach.
Generally, healthcare professionals should collaborate with occupational health specialists to discuss the development of integrated services. Likewise, occupational health professionals need to raise their profile among the general public and inform them of their role in the employment structure, as well as making sure that employees know they can be assured of confidentiality.
A further recommendation is directed at disability employment advisers and their need for training to identify incapacity claimants who may have continence problems that they are masking with other health-related problems.

Inaugural Scientific Meeting , Korea 1996 (Proposer: Hong Jae Yup)
1st Scientific Meeting Singapore 1998 (Chair: Peter Lim)
2nd Scientific Meeting HK 1999 (Chair: Kwok Tin Fook)
3rd Scientific Meeting KL 2000 (Chair: Shahabudin bin Raja Mohd)
4th Scientific Meeting Bali 2001 (Chair: Rudi Yuwana)
5th Scientific Meeting KL 2002 (Sahabudin bin Raja Mohd)
6th Scientific Meeting 2003 Bangalore INDIA (Chair: SS Vasan)
7th Scientific Meeting, Hong Kong (Chair: Bill Wong)