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SPECIALTIES & SERVICES

Urology


The KTPH Department of Urology has a long and memorable history. It originated from the old Alexandra Hospital Urology Service, where it had limited manpower and facilities. Yet it played its humble role in serving the communities in Southwestern Singapore.

When Khoo Teck Puat Hospital was officially opened in 2010, it took on the new challenge to provide comprehensive urological services to the much larger population in Northern Singapore.

It expanded in terms of staff number, equipment and facilities, and service provision, and became the KTPH Division of Urology in 2011.

In July 2012, it gained independence and became the KTPH Department of Urology.

MM Lee at the official opening of KTPH

Today, the department is staffed by five consultants, with expertise and experience in the various sub-specialties in Urology, ranging from uro-oncology, endourology, laparoscopic urology, reconstructive urology, andrology and male voiding dysfunction, female urology, continence and urological emergencies. Two of them have 20 to 30 years of experience in urology, while the other two are the only European Board of Urology certified urologists practicing in Singapore. The department is equiped with a fully digitalised endourology operating theatre its wide-spectrum of endoscopic procedures, high-definition laparoscopies for minimally invasive key-hole surgeries, and a dual localisation shockwave lithotripter for outpatient stone treatment. The department offers routine catheter-free ePOD TURP (early post-op discharge prostate surgery) to patients with prostate enlargement. 

Besides its clinical services, the KTPH Department of Urology also plays an active role in the training of young urologists, and research. The department forms part of the core teaching faculty with the Yong Loo Lin School of Medicine (YLLSoM), and it is a Joint Committee of Specialist Training (JCST) accredited training centre. It was the convening centre for the professional exit examinations for local urologists in 2011 and 2012 and hosted the 2012 Urology Residents’ Course in conjunction with Singapore Urological Association (SUA) and Urology Association of Asia (UAA) under the auspices of the Asian School of Urology (ASU). With its research focus, our staff have presented in both local and international conferences.

The Department is also actively involved in public health promotion. It continues to organise multiple public forums, provide radio, television and print media interviews on interesting topics covering stone diseases, prostate health, men’s health, urinary continence, and chronic pelvic pain.

The department also have outreach programmes to community centres in the heartlands.

The department is in active collaboration with many local professional organisations like the Singapore Urological Association, Society for Continence, Society for Men’s Health, and the Singapore Cancer Society.

Newspaper Interview

 

 



 


Clinic diagnostic and treatment procedures

Cancer treatment

Stone procedures

Men's health 

Prostate health

Female Urology, Urinary incontinence and Urinary tract infections

Common urology surgeries

Urological emergencies and trauma

 

Clinic diagnostic and treatment procedures

The Urology clinic at KTPH performs many procedures to aid in the diagnosis and management of a variety of Urological conditions. These procedures are performed by trained Urology specialists or Urology-trained nurses in a comfortable and conducive environment.

  • Digital Flexible cystoscopy
    • – This procedure is performed by the Urologist under local anesthetic, and a flexible narrow lumen scope is used to evaluate the lining of the urethra, prostate and bladder.
  • Urethral dilatation
  • Urethral catheterisation
    • – A rubber tube is passed via the urethra into the bladder to relieve the patient who is unable to pass urine.
  • Uroflow study
    • – This is the electronic recording of urinary flow rate during urination and is used in the assessment of patients with lower urinary tract symptoms.
  • Post void residual urine assessment
    • – A bladder scanner is used to measure the volume of fluid left in the bladder immediately after passing urine.
  • Transrectal ultrasound of prostate and biopsy
    • – This procedure uses the aid of ultrasound probe to aid the diagnosis  and biopsy of prostate cancer.
  • Urodynamic study
    • – This is a pressure flow study that measures the pressures inside the bladder during urinationBack to top.

 

Cancer Treatment

Our Urologists manage tumors and cancers of the entire urinary tract. Our patients can be referred from other departments, the polyclinic, general practitioners or detected on screening investigations. Whenever possible, minimally-invasive curative surgery is performed for the treatment of cancer. The list below are some of the procedures we perform for cancer treatment.

  • Kidney tumors / Ureteric tumors
    • – Conventional or laparoscopic radical nephrectomy.
    •    - This is the removal of kidney for kidney cancers and can be performed using laparoscopic (key-hole) or open technique. A laparoscopic technique can decrease size of wound, length of stay, and level of pain post-op.
    • – Partial nephrectomy can be performed for small renal tumors. Selected patients with small renal tumors may also be referred to our expert interventional radiologist for minimally-invasive percutaneous radiofrequency ablation.
    • – Conventional or laparoscopic nephro-ureterectomy for transitional cell carcinomas of the ureters.
    • – Segmental resection of distal ureteric tumors.
  • Bladder tumors
    • – Transurethral resection of bladder tumor.
    •    - Using telescopic equipment and heated loop, the bladder tumor is resected and removed via the urethra and sent for microscopic evaluation. Our hospital utilises the latest plasmakinetic technology of bipolar TURBT to decrease the amount of blood loss, duration of catheterisation, and duration of hospitalstay.
    • – Radical cystectomy.
    • – Ileal conduit diversion.
    • – Bladder reconstruction with orthotopic bladder.
  • Prostate cancer
    • – Laparoscopic radical prostatectomy.
    • – Open retropubic radical prostatectomy.
    • – Simple or subcapsular orchidectomy for advanced prostate cancer.
  • Testicular cancer
    • – Radical orchidectomy.
    • – Testicular prosthesis implant.
  • Penile cancer
    • – Partial or total penectomy.
    • – Glansectomy.

 

Stone Procedures

                  Ureterscopy

     Percutaneous nephrolithotripsy

           Laparoscopic surgery 

Kidney stones are common and can happen up to 5% of the population. A variety of options are available for kidney or ureteric stones at different locations along the urinary tract. The selection of treatment depends on the size of the stone, the location of stone, the presence or absence of pain or infection, and the surgeon / patient preference.  The following are stone procedures available in our institution.

  • Extracorporeal shockwave lithotripsy (ESWL)
    • – ESWL is a procedure that uses shockwaves to break a stone into smaller pieces that can more easily pass through the urinary tract and out from the body in the urine.  It is an outpatient procedure that lasts about an hour, and pain can be managed using simple painkillers. You can expect to return to work in 24 to 48 hours. You can expect blood in your urine for 2 days but serious complications are uncommon.
  • Uretero-renoscopic (URS) laser lithotripsy  / Retrograde intrarenal surgery (RIRS)
    • – This is the minimally invasive, endoscopic treatment of stones in the ureter and kidney by passing equipment via the urethra natural orifice procedure, thereby resulting in a scarless surgery. The procedure takes place under general anesthesia in the operating theatre; it takes about an hour to complete and is performed as day surgery. You can return to work in a few days.
  • Percutaneous nephrolithotripsy
    • – Large stones in the kidney and upper ureter can also be treated endoscopically with a minimally invasive 1cm incision on the back skin overlying the kidney. Under general anesthesia, a nephroscope is passed via this puncture into the kidney, and specialised instruments are used to fragment the stone into pieces to be extracted through this opening. You will required to stay in hospital for about 2-3 days for this procedure, and you can resume normal activities after about 2 weeks.
  • Laparoscopic ureterolithotomy
    • – Large stones along the ureter may also be treated by key-hole laparoscopic surgery . Under general anesthesia, key-hole punctures are made in the abdomen to allow laparoscopic instruments and camera system into the abdominal cavity. An incision into the ureter then allows the stone to be extracted. You will have a plastic internal ureteric stent placed at the end of the operation for 1-2 weeks, which can be removed in the clinic by the Urologist under local anesthesia. The hospital stay is 2-3 days, and you can resume normal activities after 2 weeks.

 

Men's Health

The Urology clinic at KTPH manages Men’s health issues, including male sexual dysfunction, fertility related problems, foreskin problems and penile curvature.

  • Erectile dysfunction 
    • – Erectile dysfunction is the persistent inability to attain and maintain a penile erection satisfactory for sexual performance, and is estimated to affect more than 50% of men 40-70 years of age. Your Urologist will take a thorough history taking and perform a full physical assessment. The range of treatment  includes lifestyle changes, hormonal therapy, oral medications, or injection medications. Daily dose medication and penile implant surgery are also available in our hospital. You may find out if one has erectile dysfunction by using the International Index of Erectile Function Questionnaire (IIEF) or the Sexual Health Inventory for Men (SHIM).
  • Testosterone deficiency syndrome
    • – Also known as andropause or late onset hypogonadism (LOH). This syndrome refers to a clinical picture of symptoms of hypogonadism such as erectile dysfunction, loss of libido, tiredness, lack of energy, associated with a low level of blood testosterone.  This condition can be treated with testosterone replacement via intramuscular injections, oral tablets and transdermal patches. Close monitoring with the Urologist is necessary for follow up of testosterone level and side effects.
  • Premature ejaculation (PE)
    • – Premature ejaculation refers to ejaculation that occurs sooner than desired either before or shortly after penetration, causing distress to one or both partners. The condition is said to be present in 20-30% of all men. Treatment of this condition can include behavioral techniques, topical anesthetic gel and oral medications known as SSRIs. The Premature Ejaculation Diagnostic Tool (PEDT) is a good tool to evaluate if one has got PE.
  • Subfertility
    • – About 15 to 20% of couples will have difficulty achieving pregnancy despite trying for at least one year. During the evaluation of the couple, a male factor along may be found in about 40% of couples. Urologists at KTPH can evaluate with a thorough fertility history, physical examination, hormonal assessment, interpretation of semen analysis and ultrasound of the testes. Varicoceles are dilated veins in the scrotum present in 15% of all males, and in 35% to 40% of men with infertility problems. Varicocele ligation can result in improved sperm count in up to 60% of patients.
  • Male sterilisation
    • – Vasectomy is a safe and effective method of permanent contraception. This procedure is performed under local or general anesthesia as a day surgery in less than 40 minutes. A 1cm incision is made on each side of the scrotum to expose the vas (the tube for delivery of sperms), and a 1cm segment of the vas is removed and the ends are tied off.
  • Adult circumcision
    • – Phimosis refers to the partial or complete inability to retract the prepuce (or foreskin) over the glans penis (the tip of the penis). The foreskin of young boys becomes retractable by 3 years old in more than 90% of the time. This occurs naturally without intervention and without intentional retraction of the foreskin. Phimosis can persist in 1% of uncircumcised teenagers. There are other causes of phimosis in adulthood, which include scarring from inflammatory or infectious conditions involving the foreskin, or prior forceful retraction of the foreskin during childhood. Circumcision is the removal of the foreskin that exposes the tip of the penis. Circumcision has several potential benefits, including the prevention of penile cancer, urinary tract infection, sexually transmitted disease including HIV infection, infection of the tip of the penis, and phimosis. The risk of complications after circumcision is very low, around 0.2% to 5%, and the most common complications are bleeding, infection, and the removal of either too much or too little foreskin. The wound heals in about 2 weeks and you can resume sexual activities from 3 weeks to one month onwards.
  • Treatment for penile curvature (peyronies / congenital chordee)
    • – Penile curvature can be congenital or acquired, and can be present in 1%-6% of males. Surgical Correction of the curvature is necessary if the curvature is significant to affect sexual function. The Nesbit Procedure is one of these procedures performed by KTPH Urology. The skin incision is similar to the incision in circumcision, and the wound heals in about 2 weeks.

 

Prostate Health

              Bedside Ultrasound

                  Uroflowmetry

 Cystoscopic view of an obstructing                         prostate


  • Benign Prostate Hyperplasia (BPH) is a very common condition affecting men above the age of 50 years old. If you have this condition, you may present with lower urinary tract symptoms (LUTS) (see urology symptoms): frequency, urgency, nocturia, poor flow, straining, intermittency, and sensation of incomplete emptying
  • There are other causes of LUTS including: overactive bladder, neuromuscular voiding dysfunction, urinary tract infections, bladder stones, bladder / prostate malignancies.
  • The Urology clinic at KTPH performs the following services for the evaluation of LUTS to aid in the diagnosis and management
    • – Ultrasound of the kidneys, bladder and prostate.
    •   - We can measure the prostate volume, and bladder capacity with the aid of an ultrasound. This examination can also diagnose presence of urinary bladder stones and obstruction of the kidneys due to bladder outlet obstruction.
    • – Uroflowmetry.
    •   -This is the electronic recording of urinary flow rate during urination and is used in the assessment of patients with lower urinary tract symptoms.
    • – Post void residual urine assessment.
    •   - A bladder scanner is used to measure the volume of fluid left in the bladder immediately after passing urine.
    • – Urine analysis
    •   - Your urine will be tested for to look for presence of white blood cells (suggest infection/inflammation), red blood cells (suggest blood in urine), and sugars (suggest previous undiagnosed diabetes mellitus).
    • – Prostate Specific Antigen (PSA).
    •   - PSA is an enzyme produced specifically by the prostate glands. Blood levels of PSA can be raised due to BPH, prostate inflammation and prostate cancer.
    •   - Your Urologist may request for this test to assess your risk of prostate cancer.
    • International Prostate Symptom Score (IPSS).
  • Your urologist may stage and grade your condition according to severity
  • The following examinations may be performed in specific situations, especially when diagnosis is in doubt:
    • – Flexible cystoscopy.
    •   - This procedure is performed by the Urologist under local anesthetic, and a flexible narrow lumen scope is used to evaluate the lining of the urethra, prostate and bladder.
    • – Transrectal ultrasound of prostate and biopsy.
    •   - This procedure uses the aid of ultrasound probe to aid the diagnosis and biopsy of prostate cancer.
    • – Urodynamic study.
    •   - This is a pressure flow study that measures the pressures inside the bladder during urination.
  • Transurethral resection of the prostate (TURP)
    • – Surgery for prostate enlargement is required if you do not respond to medications, or if you develop complications of prostate enlargement such as bladder stones, recurrent retention of urine, recurrent urinary tract infections, or kidney failure.
    • – This operation is performed under regional (spinal) or general anesthesia. The urinary tract is first inspected with the cystoscope, subsequently, the enlarged prostate gland is resected piece by piece with a resectoscope until a clear channel is established for urine passage at the end of surgery.
    • – Plasmakinetic technology is available in KTPH. This new technology reduces the risks of electrolyte (salt) abnormality at the end of procedure, and offer better bleeding control.
    • – Complications of this surgery including infection, bleeding requiring blood transfusions, electrolyte abnormality, excessive scar formation are rare.

 

Female Urology, Urinary incontinence and Urinary tract infections and Urinary tract infections

  • Urinary incontinence is the involuntary loss of urine. The problems can be mild (few drops of urine) or severe (large amount of urine loss). This problem can lead to social distress, and impact the patient’s quality of life.
  • Your Urologist will assess your symptoms and determine the type of incontinence that you have: stress, urge, mixed or complete incontinence.
  • Some examinations that the Urologist may consider include:
    • – Focused pelvic examination
    • – Voiding diaries
    • – Pad tests
    • – Urinalysis
    • – Postvoid Residual Measurement
    • – Flexible cystoscopy
    • – Urodynamic study
  • Urinary tract infections (UTI) are common with 20 to 50 percent of women developing an UTI during their lifetime
    • – The incidence of UTIs is similar for men and women above the age of 50.
    • – Infections of the bladder and kidney can present in both men and women, but men can present with infections of the urethra (urethritis), prostate (prostatitis), and testis / epididymides (orchitis/epididymitis)
    • – The Urology Clinic at KTPH can perform a rapid urine dipstick test for the rapid detection of urinary tract infection.
    • – Urine samples may also be sent to the lab for complete urine analysis, as well as urine culture
    • – Radiological imaging may be requested for further evaluation of UTIs in male patients, as well as female patients with complicated or recurrent UTI. These investigations may include:
    •   - Intravenous Urography,
    •   - Ultrasound of the kidneys, ureter, bladder
    •   - Computer tomography scan

 

Common urology surgeries

This section shows a list of common Urology surgeries performed at KTPH. Most of these surgeries are described in further detail in other relevant sections of our website.

 

Urological emergencies and trauma

KTPH is an acute hospital and the on-call Urology doctor deals with a variety of emergencies and conditions that include:

Patients who have had injuries to their urinary tract will also be quickly assessed by the Urology specialist on-call. They may include trauma to the kidney, bladder, scrotum or urethra. Urgent investigations are performed 24 hours a day by the Diagnostic Radiology department to assist in the diagnosis:

  • CT scans
  • Ultrasound scans of the testes
  • Contrast scans of the bladder or urethra

 

  • Urology Centre in KTPH Clinic C31
    • –Contact number: 6602 3031

 

Lower urinary tract symptoms (LUTS) – Prostate and bladder symptoms

Pain 

Changes to the appearance of urine

Male sexual dysfunction

Penile symptoms

Scrotal symptoms

 

Lower urinary tract symptoms (LUTS) – Prostate and bladder symptoms

  • Lower urinary tract symptoms (LUTS) refers to a variety of symptoms/terms used describe alterations related to the act of passing urine. The prevalence of LUTS increase with age, and older men have a higher incidence than women. It is said to affect up to 40% of older men. A variety of diseases can result in similar LUTS.
  • LUTS can be caused by obstruction to urinary flow due to prostate enlargement, bladder muscle weakness or over activity, urinary tract infection, urinary stones, or even bladder or prostate cancer.
  • Some LUTS are irritative and include painful urination, frequent urination, night urination, urgency. Other LUTS include poor urinary flow, straining to pass urine, intermittency of flow, dribbling of urine at end of urination, and sensation of incomplete emptying.
  • KTPH urology department evaluates LUTS with urine analysis, uroflowmetry, and bedside ultrasound of the kidneys, bladder and prostate. Some patients will have a Prostate Specific Antigen blood test, flexible cystoscopy evaluation of the lower urinary tract, or biopsy of the prostate gland.
 

Pain

  • Kidney pain
    • – Pain over the loin or back, this pain may radiate to the flank, around the abdomen, and the testis or external genitalia in women of the same side.
    • – This pain may be due to kidney tumor, infection, or obstruction causing distension eg. stone.
  • Ureteric pain
    • – Pain along the urine tube (between kidney and bladder). 
    •  - Upper ureter – may be felt similar to kidney pain.
    •  - Lower ureter – felt in the lower abdomen (suprapubic area, bladder, penis or urethra).
    • – This pain is usually caused by sudden obstruction or distension. Eg.stone.
  • Bladder pain
    • – This pain is felt at the suprapubic area (lower abdomen), and may radiate to the tip of penis and entire urethra in females.
    • – This pain may be due to infection, or distension due to inability to pass urine.
  • Prostate / Perineal pain
    • – This pain is felt at the lower back, the rectum, or at the space between the scrotum and the rectum (the perineum.
    • – This pain may be due to prostate inflammation.
  • Penile pain
    • – Penile or urethra pain are generally directly related to a site of inflammation.
  • Scrotal pain
    • – This pain may be caused by trauma, torsion (twisting) of the spermatic cord, or acute infection / inflammation of the epididymis.
    • – Occasional, testicular swelling, such as a tumor, can also cause pain.
 

Changes to the appearance of urine

  • Cloudy urine
    • – May be due to excess precipitation of phosphate after taking large quantities of milk.
    • – Pyuria: Can be due to white blood cells in urine during urine tract infection.
    • – Chyluria: rarely due to lymph fluid in urine.
  • Hematuria (Blood in urine)
    • – Blood in the urine may be gross (visible) or microscopic (invisible to eye, but positive on urine tests).
    • – Blood in the urine warrants a thorough assessment by an Urologist.
    • – This is an important symptom as the causes may include urinary tract infection, urinary stones, or tumors along the urinary tract.
    • – The tests may include some or all of CT scan, Ultrasound the urinary tract, X-ray of the urinary tract, flexible cystoscopy of the urethra and bladder, and further urine tests.
  • Pneumaturia (gas in urine)
    • – This is an uncommon symptom whereby gas is present in the urine due to a connection between the bowel and urine tract, or an infection by bacteria producing gas. 
  • Coloured urine
    • – May result from a variety of foods, medications or medical disorders.
 

Male Sexual dysfunction

  • Erectile dysfunction
    • – Erectile dysfunction (ED) is defined as the consistent or recurrent inability to acquire or sustain an erection of sufficient rigidity and duration for sexual intercourse. The prevalence of ED increase in older age, with up to 35-40% of men older than 40 years old having some degree of ED.
  • Testosterone Deficiency Syndrome / Late-onset hypogonadism (LOH)
    • – LOH is also referred to as testosterone deficiency syndrome or andropause. This problem occurs as the male patient ages. It refers to symptoms of hypogonadism such as erectile dysfunction, loss of libido, loss of muscle mass, loss of body hair, and hot flushes, associated with low levels of blood testosterone level. Other causes of low testosterone has been ruled out. 
  • Premature ejaculation
    • – Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners. Normal intravaginal ejaculatory latency time (IELT) is about 5-7min, premature IELT is less than 3min. This problem happens to 20-30% of men.
 

Penile symptoms

  • Foreskin problems such as phimosis / paraphimosis
    • – Phimosis refers to the partial or complete inability to retract the prepuce (or foreskin) over the glans penis (the tip of the penis).
    • – Balanitis.
    • – Paraphimosis.
  • Penile curvature
    • – This refers to the bending of the penis during erection. There may be difficulty with penetration as a result of the curvature.
  • Urethral discharge
    • – The Urologist will evaluate the nature of the discharge and the relation of the discharge with recent sexual intercourse.
  • Bloody ejaculate
    • – This may be due to congestion or inflammation of the seminal vesicles.
 

Scrotal symptoms

  • Scrotal skin problems
    • – Scrotal skin may be affected by conditions that affect other skin areas. It may also be prone to fungal skin infection and viral warts.
  • Scrotal lumps and masses
    • – Scrotal lumps and masses should be referred to a Urologist. They may be due to testicular tumor, varicocele, hydrocele, testicular torsion or epididymitis.
 
 
 

 

Kidney cancer

  • The majority of kidney cancer are renal cell carcinoma (RCC). This tumor causes blood in the urine, flank pain and sometimes sensation of a mass at the loin / flank. Nowadays, half of the cases of RCC are detected incidentally on ultrasound or CT scans performed for other purposes.
  • The evaluation of RCC include ultrasound or CT scans of the kidney. Following which, a chest X-ray, CT lungs or Bone scan is used for staging.
  • Treatment of RCC includes removal of the primary tumor whenever possible and this includes a nephrectomy. Adjuvant (additional) targeted therapy may be indicated in situations whereby the cancer has spread beyond the kidney itself (metastatic).
 

Kidney and ureteric stones

  • Kidney stones are common and can happen up to 5% of the population.
  • Patients with urinary stones can present with loin pain, blood in the urine, nausea and vomiting, and occasionally lower urinary tract symptoms. Patients may also present insidiously with kidney impairment due to stone obstruction of urinary tract.
  • Patients may present acutely via the Emergency department with severe pain or infection requiring admission. They may also present electively to the Urology clinic after an episode of pain that resolved or due to microscopic or frank blood in the urine.
  • Your Urologist may evaluate with a plain XR, a dynamic Intravenous Urogram, an ultrasound scan, or CT scan. A urine analysis can determine is there is associated blood traces in the urine or presence of concomitant infection.
  • KTPH Urology department performs a number of stone procedures for kidney and ureter stones, including ESWL, endoscopic laser lithotripsy, percutaneous nephrolithotripsy, and open stone surgeries.
 

Kidney infections

  • Kidney infections (pyelonephritis) is commonly ascending – due to infection originating from the urine in the bladder. It can also result from obstruction of the urine tract due to stones and rarely from infection from the blood (hematogenous). 
  • Patients with kidney infection can be very ill with high fever, rapid pulse rate and a low blood pressure. The loin of the affected side is tender. There may also be blood in the urine.
  • The patient needs to be treated with aggressive fluid resuscitation and intravenous antibiotics. Radiological imaging may be necessary to rule out stone causing obstructing of the urinary tract. Patients with obstruction or hydronephrosis may require a percutaneous drainage of the kidney for rapid relief of the obstruction. 
 

Kidney cysts

  • Kidney cysts are fluid collections in the kidney. They are very commonly seen on ultrasound or CT scans of the kidney. While the majority of the cysts are non-cancerous (benign) in nature, some of the cysts require further evaluation with a detailed CT kidneys scan with intravenous contrast medium to determine if they are cancerous. 
  • Kidney cysts which are suspicious for cancer on CT scan need to be removed.
 

Bladder cancer

  • Bladder cancer is the second most common urologic malignancy. The patients are often present with frank blood in the urine, or sometimes referred by polyclinic for microscopic blood in the urine on dipstick testing. They may also complain of irritative LUTS. 
  • If the Urologist suspects a risk of bladder malignancy, he may perform a flexible cystoscopy to evaluate and examine the lining of the urethra, prostate, and the bladder. He may also send a urine sample for cytology to detect the presence of sinister high-grade cancer cells. An intravenous urogram or CT urogram can detect tumors that originate from the lining of the upper urinary tract above the bladder.
  • A transurethral resection of the bladder tumor (TURBT) is the common initial treatment of bladder tumor or cancers. This operation uses telescopic equipment and heated loop to resect and remove bladder tumor via the urethra. This procedure:
    • – Obtains bladder specimen for microscopic (histology) checking
    • – Is curative for superficial bladder cancers 
    • – Stops bleeding from bladder tumors 
  • Medications may be administered into the bladder to prevent recurrence of tumor.
  • Patients with muscle-invasive bladder tumor requires surgery to remove the bladder – radical cystectomy, and diversion of urine. 
 

Bladder stones

  • Large stones may form in the bladder due to bladder infection or stagnant urine in the bladder from bladder outlet obstruction eg. Enlarged prostate. Occasionally, stones from the kidney and ureters may be lodged in the bladder and subsequently grow in size.
  • Patients with bladder stone may complain of suprapubic pain, difficult urination, painful urination, urinary tract infection or blood in the urine.
  • The Urologist may diagnose this problem from a simple X-ray, bedside ultrasound, CT scans or flexible cystoscopy.
  • Bladder stones up to 5cm can be treated endoscopically using the rigid cystoscope and stone crushing forceps, while larger stones require open surgery to remove.
 

Bladder infection

  • Bladder infection (or bacterial cystitis) is a common condition presenting with painful urination, urinary frequency, urgency and suprapubic pain or pressure. 
  • The patients are usually treated with oral antibiotics. The majority of patients with uncomplicated infection do not require further investigations. 
  • Your urologist may consider further imaging investigation in:
    • – Females with infection and fever
    • – Male patients
    • – Patients suspected with have urinary stones or other causes of urinary tract obstruction
    • – Patients with recurrent urinary tract infection
 

Prostate cancer

  • Prostate cancer is the most common cancer in men. The incidence of this cancer increases with age. This disease is now detected at earlier age due to increased awareness and opportunistic screening. 
  • Prostate cancer may not have any symptoms or signs. If symptoms are present, the patient may present with LUTS or hematuria. The Urologist may find a prostate nodule on digital rectal examination of the prostate.
  • Prostate Specific Antigen (PSA)
    • – PSA is an enzyme produced specifically by the prostate glands. Blood levels of PSA can be raised due to BPH, prostate inflammation and prostate cancer. 
    • – Your Urologist may request for this test to assess your risk of prostate cancer. 
  • If you are assessed to be at high risk of having prostate cancer, your urologist may counsel you for a transrectal ultrasound guided biopsy of the prostate gland (TRUS biopsy). Biopsy results are ready after one to two weeks. 
  • Localized early stage prostate cancer may be curable by surgery to remove the prostate gland or radiation therapy. The surgery is radical prostatectomy and this surgery can be performed using robots or using the open surgical technique, both methods are available in our hospital.
  • Late stage prostate cancer can be controlled by hormone therapy.
 

Benign Prostate Hyperplasia (BPH)

  • BPH refers to the nodular growth of the male prostate gland. 
  • This is a common cause of obstruction to urinary flow in men.
  • Symptoms of BPH can occur to up to 30% of men greater than 55 years old.
  • The patient with BPH presents with lower urinary tract symptoms.
  • The Urologist assess your symptoms with the aid of Uroflowmetry, post-void residual volume, bedside ultrasound, and urine analysis.
  • Treatment include medications to relax the smooth muscle lining of the prostate, medications to reduce prostate volume, combination medication therapy, and surgery (TURP).
 

Prostatitis (prostate inflammation)

  • Prostatitis refers to symptoms of pelvic pain, perineal pain, low back discomfort, painful and irritative passing of urine, and urinary tract infection.
  • The symptoms may occur acutely or may be chronic and intermittent.
  • These symptoms may or may not be related to presence of an infection.
  • Treatment of prostatitis requires an adequate course of antibiotics if a bacteria source is identified, exclusion of important diseases such as cancer or stones, and management of the symptoms with specific medications.
 

Phimosis

  • Phimosis refers to the partial or complete inability to retract the prepuce (or foreskin) over the glans penis (the tip of the penis). The foreskin of young boys becomes retractable by 3 years old in more than 90% of the time. This occurs naturally without intervention and without intentional retraction of the foreskin. Phimosis can persist in 1% of uncircumcised teenagers. There are other causes of phimosis in adulthood, which include scarring from inflammatory or infectious conditions involving the foreskin, or prior forceful retraction of the foreskin during childhood.  
  • Phimosis can cause problems in adulthood, such is difficulty retraction of foreskin during erection, urinary tract infection, infection of the glans penis, paraphimosis, retention of urine, and even increase the risk of penile cancer. 
  • Phimosis in teenagers and adults are commonly treated by circumcision. Circumcision is the removal of the foreskin that exposes the tip of the penis.
  • The risk of complications after circumcision is very low, around 0.2% to 5%, and the most common complications are bleeding, infection, and the removal of either too much or too little foreskin.
 

Penile cancer

  • Penile cancer is an uncommon disease affecting only about 1 per 100,000 males a year. The diagnosis is frequently delayed, and the disease and its treatment frequently result in significant morbidity to the patient. 
  • The patient may present with discharge, bleeding, penile lump, swelling or even lower urinary tract symptoms. 
  • Smoking, infection of the foreskin with warts, phimosis, and increasing age are risk factors for this cancer.
  • Early stage of the disease can be treated with penile-preserving techniques, however, many patients are treated with penectomy (partial / total), and some patients would require surgery to remove lymph nodes at the inguinal (groin) region due to the risk of lymph node spread.
 

Testicular cancer

  • Testicular cancers are uncommon cancers involving either of the male’s testis.
  • This cancer is more common in patients with a history of undescended testis, and in patients with a family history of testicular cancer. This disease occurs most frequently in young men between the ages of 20 and 34 years.
  • An assessement of the testis with ultrasound may be necessary, and further staging with blood tests and CT scan may be required.
  • The primary cancer requires treatment  by radical orchidectomy and adjuvant treatment with radiotherapy or chemotherapy may be required. 
 

Varicocele

  • A varicocele refers to large dilated veins in the scrotum producing distension and fullness of the scrotum. It can be found in 15% of males in the general population, but is found in 35-40% of men presenting with infertility.
  • Patients with varicocele may discover it incidentally, or present with pain or swelling of the scrotum, or may find it during assessment for infertility.
  • A varicocele can be treated with surgical ligation of the affected veins (varicocelectomy).
 

Hydrocele

  • A hydrocele is an accumulation of clear fluid in the membrane surrounding the testis (tunica vaginalis), causing symptoms of typically painless swelling of the scrotum.
  • It is important to ensure that the swelling is not due to physical trauma, infection or testicular tumor, although the cause in most cases is unknown.
  • Depending on the cause of the hydrocele and the severity of your symptoms, your urologist may recommend to observe, aspirate the fluid, or do an minor operation called Jaboulay procedure to relieve the swelling.
 

Epididymal cysts

  • Epididymal cysts usually develop in adults around 40 years old. Patients usually present with a lump outside of the testis, with the testis palpable separate from the swelling.
  • A testicular ultrasound can be performed if the diagnosis is uncertain. 
  • Patients are reassured that epididymal cysts are benign and generally do not require treatment. They are advised to seek medical attention when the cysts become painful or suddenly increase in size.
  • Epididymal cysts can be surgically excised.

Public Events

Internal Events

Training Events

Public Education

 

Public Events

"Improving Lives, Giving Life" Public Forum

March 2011

 

World Continence Week

June 2011

 

 

Prostate Awareness Month: "How do lifestyle and diet affect prostate health?"

July 2011

 

"Leave No Stones Unturned" Public Forum

November 2011

 

 

Painful Bladder Forum

October 2012

 

 

GP Symposium : What's Exciting About BPH Today?"

November 2012

 

 

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 Internal Events


Nurses Day


Urology Capstone Retreat

September 2012

 


Alexandra Health Dinner and Dance

October 2013

 

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Training Events


 

Urology Residents Course

[(In conjunction with Singapore Urological Association

(SUA) and Urology Association of Asia(UAA) under the auspices

of the Asian School of Urology(ASU)]

September 2012


 

Urology Residents Workshop @ NHG-AHPL: Laparoscopic Animal

Workshop 

November 2012

 


Certificate Course on Practical Andrology 

July 2013

 

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Public Education


 

Interview by "Lianhe Zaobao" on

Prostate Cancer Screening

2012

 

      Click here to read more


 

Interview by Berita Harian on Nocturia

June 2013

 

 

       Click here to read more


Class 95: Men's Health Friday: Interview on Premature Ejaculation

August 2013

 

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Poster Presentations


  • Shum CF, Teo CPC, Mukherjee A, Lim TP. Catheter-Free Early Post-Operative Discharge for TURP Patients, a Pilot Study of 30 Patients. Urofair 2011, Asia Pacific Congress of Urological Diseases, Singapore, Mar 2011
  • Shum CF, Mukherjee A, Ong CH, Lim TP, Teo CP. A Prospective, Randomised Study on Comparing Etoricoxib Plus Diclofenac Versus Pethidine as Analgesia in Extracorporeal Shockwave Lithotripsy. 32nd Congress of the Societe Internationale d’Urologie, Fukuoka, Japan, Sep 2012
  • Lau WD, Ong CH, Mukherjee A, Lim TP, Teo CPC. Penile cancer: A local case series and review of the literature. Urofair 2013, Singapore, Mar 2013
  • Ang JC, Shum CF, Mukherjee A, Teo CPC, Ammar A. Bilateral Scrotal Masses mimicking Testicular Tumor: A Diagnostic Dilemma. Urofair 2013, Singapore, Mar 2013
  • Lau WD, Teo CPC. A Prospective Randomized Control Study of Circumcision Wound Closure with absorbable sutures and Octylcyanoacrylate tissue adhesive. 14th Biennial Meeting of the Asia-Pacific Society for Sexual Medicine, Kanazawa, Japan, Jun 2013

Podium Presentation


  • Shum CF, Teo CPC, Mukherjee A, Lim TP. Predictors for Extracorporeal Shockwave Lithotripsy Outcome. Alexandra Health Research Forum 2011, Singapore, Feb 2011 (The Johnson-Johnson Medical Research Prize, Doctors’ Category, 2nd Runner-Up)
  • Shum CF, Mukherjee A, Teo CPC. Bipolar TURP with Catheter-Free Discharge on First Post-Operative Day: Outcomes of our First 100 Cases. Urofair 2013, Singapore, Mar 2013 

PUBLICATIONS IN SCIENTIFIC JOURNALS


  • Shum CF, Mukherjee A, Teo CPC. Catheter-free discharge on first postoperative day after bipolar transurethral resection of prostate: Clinical outcomes of 100 cases. Int J Urol. 2013 Aug 25. doi: 10.1111/iju.12246. [Epub ahead of print]
  • Teo CPC, Shum CF, Wong YCM, Review of the New Energy Sources for the Surgical Management of BPH . Pending publication in Advances in Endourology
  • Foo KT, Teo CPC. Pathophysiology of Benign Prostatic Hyperplasia (BPH). Pending publication in Int Jurol.