Renowned urologist Guo Yinglu (right) and urologist Tian Long are among six patent-holders for the procedure known as Transurethral Columnar Balloon Dilation of the Prostate. Provided to China Daily

Lack of acceptance

Although the procedure sounds quick and easy to perform, gaining wider acceptance among the medical community has not been easy for Jiang, or those who believe his method has a future.

"The idea of prostate dilation was not my invention," he said. "It was first introduced to China from the West, in the 1980s. Back then, the balloon was shaped like a ball, not a column. Many urologists in China, including myself, performed the procedure. But the results were far from satisfactory, and the procedure was completely abandoned after just one or two years."

It was forgotten by everyone except Jiang, who trusted his medical instincts and began a decade of experimentation with the procedure. In the 1990s, Jing Xuejun, who worked with a medical equipment manufacturer that was owned by the government at the time, not only witnessed but also joined Jiang's endeavor.

"Jiang came to us and asked whether we could make the balloons he needed," Jing recalled. "Over the next few years, we created a bewildering array, of all sizes and shapes, for him to try."

The balloons produced mixed results, but Jiang was unable to pinpoint the exact reasons behind success and failure. His inability to provide plausible explanations meant he and his method were rejected, and sometimes ridiculed.

While some traces of the ridicule still lingers, at least there is an explanation now, according to Guo Yinglu, honorary chair of Peking University's Institute of Urology and China's leading urologist.

"Long-term results depend on whether dilation of the urethra has causes the capsule of the prostate to break or not. If yes, then in most cases, success is guaranteed; if no, then it's inevitably a failure," the 86-year-old said. "Why? Because if the capsule is not ruptured, even if the urethra is dilated by the entry of the balloon, it will be squeezed back to its original state by the surrounding prostate tissue once the balloon is removed."

A decade of research

For the past decade, Guo has headed a research team, including Tian, which has focused on TUDP. After patenting the procedure nationally in 2012, the team is now gathering more clinical evidence and promoting the procedure among doctors across China, from national to county level.

"At a time when creativity is celebrated worldwide, it's still hard for Chinese doctors to break new ground," Tian, 45, said. "Any creative idea in medicine requires the input of capital and technology to become clinically applicable. The congregation of people in various related industries provides fertile ground for the growth of such ideas, as is often the case in the United States. In China, we still very much lack that environment."

But all Jiang, the county doctor, required were just a few tailor-made balloons and a sympathetic ear in higher authority with the resources to offer theoretical support to his clinical experiments and a platform to tell others about the findings. He knocked on many doors before he met Guo about 12 years ago.

"The biggest obstacle for any innovative Chinese doctor, low-level doctors especially, lies in conventional thinking," Guo said. "We are so used to retracing the footsteps of our Western counterparts that any digression from their trodden path risks being dismissed as unworthy of serious investigation."

According to Tian, electrotomy and laser surgery have long been championed as the global "gold standard" for BPH treatment. "Traditionally, the capsule of the prostate is a no-go zone. People worry that insertion of the balloon will exert pressure on the sphincter, the ring of muscles that sits right below the prostatic apex (the base of the prostate) whose proper function is essential to the control of urination. Any potential damage of the muscle may lead to urinary incontinence, or involuntary urination," he said. "But in practice, this (damage) has very rarely happened, and that may be because the balloon is quickly moved further into the urethra to relieve the pressure on the sphincter. It's a matter of just a minute."

Guo said the procedure is significant not only because it offers an entirely new concept of the enlarged prostate treatment, but also because the treatment is tailor-made for people who live far from big cities and are not financially well-off.

That's old news to Jiang, who said that back in the 1990s and early 2000s, many rural patients opted for his method simply because they didn't have any other choice. "Electrotomy and laser surgery didn't appear in China's county-level hospitals until the early 2000s," he said, adding that he performed the procedure on about 1,000 patients between 1990 and 2004, with a success rate of about 75 percent. Later, Guo's team stepped in, making constant modifications to the balloon and establishing the overall protocol for the procedure.

According to Tian, another factor that makes the procedure ideal for use in rural hospitals is that it's very easy to learn. "A doctor needs to deal with at least 100 cases to master electrotomy or laser surgery, but with balloon dilation all that's required is a tube of silica gel and an urologist who has performed the procedure more than 10 times," he said.