Can Tech Bridge Urologist Care Gap in Southeast Asia?

Across Southeast Asia, a critical yet under-recognised gap in specialist care is steadily widening—one that technology may be able to help to bridge.

Once viewed as a niche specialty, urology is increasingly positioned at the centre of some of the region’s most pressing public health challenges, including an ageing population, chronic disease management and cancer care.

The mismatch between demand and specialist supply is especially visible in Singapore and Malaysia, where demographic transitions are occurring at pace. Urological diseases disproportionately affect older adults, a growing demographic in Singapore and Malaysia.

In Singapore, widely recognised as one of the fastest-ageing societies in Asia, about 20% of residents are aged 65 or older, a figure expected to rise to one in four by 2030 and potentially one in three by 2050. 

Malaysia is following a parallel demographic transformation. According to the Department of Statistics Malaysia (DOSM), the proportion of Malaysians aged 65 and above is projected to increase from 8.1% in 2024 to 14.5% by 2040.

As populations age, urological conditions such as prostate disease, kidney stones, urinary incontinence, and urological cancers become more prevalent. These conditions require specialised care and long-term follow-up, increasing pressure on clinics and surgical services. Consequently, the cumulative demand for urological services extends beyond episodic surgical intervention and places sustained pressure on outpatient clinics, diagnostic infrastructure, and multidisciplinary care pathways.

Prevalence of Urology

Urology is a multidisciplinary medical and surgical specialty focused on the diagnosis, management, and treatment of diseases affecting the urinary tract in men and women, as well as disorders of the male reproductive system. It covers key organs including the kidneys, ureters, bladder, and urethra, which are essential for waste elimination, fluid and electrolyte balance, and systemic homeostasis.

Modern urological practice integrates pharmacological care, advanced imaging, minimally invasive endoscopic procedures, and complex surgery. This range reflects the diversity of conditions across the lifespan, including urinary incontinence, overactive bladder, kidney stones, urinary tract infections, congenital abnormalities, and functional lower urinary tract disorders.

Epidemiological studies indicate that between 9% and 39% of women over 60 experience daily urinary incontinence, often linked to declining pelvic floor strength and changes in lower urinary tract function. This condition is often associated with significant psychosocial impact, reduced mobility, and increased risk of institutionalisation. Older adults are also more susceptible to kidney stones and infections due to metabolic shifts, comorbidities common in later life, and polypharmacy or use of multiple medications by a patient, often increasing risk of adverse effects.

In men, urology additionally encompasses conditions of the prostate and other reproductive organs. Benign prostatic hyperplasia or BPH an age-related condition that can cause lower urinary tract symptoms due to bladder outlet obstruction, becomes progressively more common in older men. Epidemiological data shows that prevalence rises sharply after middle age and continues to increase in those over 65, contributing substantially to the global urological disease burden.

Ageing also drives higher rates of prostate and bladder cancers, with cancer incidence and mortality for these tumours disproportionately concentrated in older age groups. As life expectancy rises across Southeast Asia, the growing oncological workload within urology further amplifies demand for specialised diagnostic, surgical, and survivorship care pathways.

Small Numbers, Outsized Impact

The demand for specialist urology care is rising faster than the workforce built to deliver it. Long-term workforce projections suggest that declining numbers of urologists relative to population needs could produce shortages of up to 46% by 2035. 

In Singapore, the available data shows a limited pool of urology specialists relative to population needs. As of 2023, there were only 129 registered urologists, with roughly 60% practising in the public sector and the rest in private practice. While Singapore’s advanced healthcare infrastructure supports sophisticated care, this figure underscores how few specialists are responsible for a broad and growing caseload.

The situation in Malaysia is even more concerning. Only 33 urologists are presently serving in Ministry of Health (MOH) hospitals, while another 18 are in teaching hospitals nationwide, but this number is not adequate. Despite advanced medical infrastructure, specialist capacity is becoming increasingly strained. A conservative ratio for Malaysia would be one urologist to 200,000 people or 165 for a population of 33 million. At present, Malaysian public hospitals have only about a quarter of the urologists required to meet projected demand.

Patients Affected by Specialist Shortage

A shortage of urologists is not an abstract workforce issue. It has direct consequences for patient care. Conditions such as BPH, urinary incontinence, and kidney stones that go untreated for extended periods can increase the risk of complications and result in poorer outcomes for the patient.

In Malaysia and Singapore, limited specialist availability contributes to longer waiting times for consultations, diagnostic procedures, and elective surgeries. Several structural factors contribute to Malaysia’s shortage of urologists within the public healthcare system.

Training pathways for urological specialists are lengthy and limited by available training posts, constraining workforce expansion. At the same time, Malaysia’s Ministry of Health (MOH) has acknowledged broader specialist retention challenges, including migration to private practice, workload pressures, and uneven distribution of specialists between urban tertiary centres and underserved regions. Together, these factors create persistent gaps in public sector capacity despite ongoing efforts to strengthen specialist training and service provision. The shortage is so severe that new services cannot be opened anywhere in the country, and it would be difficult to sustain existing urology centres without future urologists.

Singapore’s relative shortage of urologists reflects a combination of structural workforce and demographic factors. Specialist training pathways in urology are lengthy and capacity-limited, which constrains the pace at which new specialists can enter practice.

According to Dr Gerald Tan Yau Min, Urology Specialist, Mount Elizabeth Novena Hospital, Singapore, while public hospitals in Singapore are highly regarded, wait times for non-urgent urology appointments and elective procedures can take up to 25 days. This can lead to delays in both diagnosis and treatment, particularly for patients who do not require emergency intervention.

The Singapore Ministry of Health workforce planning analyses further indicate that increasing procedural complexity, sustained follow-up requirements for chronic urological conditions, and the distribution of specialists between public and private sectors contribute to capacity pressures, particularly within subsidised hospital settings, causing an increase in patients being pushed toward private care, raising concerns about affordability and health equity.

Can Technology Close the Gap?

While workforce expansion remains a long-term priority, technological innovation is increasingly recognised as a critical complementary strategy for addressing capacity constraints in urological care.

Digital health tools and advanced medical technologies are enabling urologists to manage growing caseloads more efficiently while maintaining clinical quality and patient safety. Rather than replacing specialist expertise, these innovations function as productivity multipliers, enhancing diagnostic precision, streamlining workflows, and supporting more personalised treatment pathways. Advances in imaging, AI-assisted diagnostics, and laser-based therapies are also transforming how urological conditions such as kidney stones are managed.

In digitally mature health systems such as Singapore, the strategic focus is increasingly shifting towards precision and efficiency gains enabled by AI. AI-assisted tools are being explored to support laser lithotripsy procedures, where real-time visualisation and pattern recognition can inform automated adjustments to laser parameters. By analysing stone characteristics such as size, density, and anatomical location, these systems have the potential to guide energy delivery more accurately, reduce procedure duration, and minimise collateral tissue damage.

“In Singapore especially, where healthcare systems are well-developed and digitally integrated, the focus will likely be on enhancing precision and efficiency through artificial intelligence (AI). AI-assisted tools are already being explored to support laser lithotripsy procedures, as laser adjustments can be automated as the system visualises and recognises the stone size, density and location and then designs the most appropriate treatment,” says Mr Wong Yau Chung, Global Chief Executive Officer of Dornier MedTech, a wholly owned subsidiary of Advanced MedTech Holdings (AMTH) Singapore.

For example, AI-assisted laser lithotripsy systems are already being developed to automatically adjust treatment parameters based on stone size, density, and location, ultimately improving procedural accuracy, efficiency, and clinical outcomes. Beyond intraoperative support, digital patient engagement tools are also gaining traction internationally. In the United States and parts of Europe, AI-powered platforms such as UroGPT™ have been introduced to provide kidney stone patients with round-the-clock, guideline-aligned education and decision support.

Dr Gerald Tan concurs. “In the future there is also likely to be more use made of robotic-assisted surgery for urology procedures as robotic devices offer more precision and control. There will still be surgeons operating the robotic arms via a console, but the robotic arms allow ultra-precise movements in tight anatomical spaces,” he adds. “Minimally invasive robotic procedures will mean smaller incisions, faster recovery and less pain. These tools can reduce unnecessary clinic visits and preserve specialist capacity, particularly in public healthcare systems where waiting times for elective procedures may be prolonged,” Dr Tan continues.

AI-powered triage tools and conversational platforms are similarly being explored across Germany and other European healthcare settings, where specialised urology chatbots have demonstrated strong accuracy in answering clinical questions and supporting guideline-based decision-making. These tools extend specialist expertise beyond traditional clinical settings.

At the system level, AI-powered triage tools and symptom checkers can help healthcare providers use resources more efficiently. By identifying patients based on urgency and risk, these tools allow high-priority cases to be seen earlier while lower-risk patients can be managed through conservative or remote care. Tele-urology further supports this approach by enabling specialists to consult across multiple locations, reducing geographical barriers and making better use of limited specialist capacity.

At the same time, advances in minimally invasive and robotic surgery are improving procedural efficiency and patient recovery. Compared with traditional open surgery, these techniques are linked to shorter hospital stays, fewer complications, and faster return to daily activities. This not only benefits patients but also frees up hospital beds and clinical resources, an important advantage in ageing societies where demand for healthcare continues to rise.

“I believe that AI-assisted tools are here to stay in the urology space. In the next decade, I foresee kidney stone management advancing in two main areas, which are laser lithotripsy and AI across Singapore and Southeast Asia,” Mr Wong adds. 

Without coordinated action, healthcare systems risk remaining in a reactive posture, continually responding to rising demand rather than anticipating it. However, with strategic planning and collaboration between policymakers, clinicians, and industry partners, Singapore and Malaysia are well positioned to lead the region in redefining specialist care for ageing populations.