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Prostate Cancer

What is Prostate Cancer?

Prostate cancer is the cancer of the prostate gland. The prostate is a walnut-sized gland in between the bladder and the urethra that nourishes and transports sperm. Prostate cancer is the third most common cancer among men in Singapore.

Symptoms of Prostate Cancer

Early stage of prostate cancer has few or no symptoms as the cancer develops slowly. If symptoms appear, they may include difficulty in passing urine, burning sensation while urinating, blood in urine, loss of appetite and/or weight, and lower back pain.

Diagnosing Prostate Cancer

Prostate cancer is diagnosed through a biopsy. At Urohealth Medical Clinic, we offer MRI Targeted Biopsy of the prostate. Dr Tan Yung Khan, Medical Director and Senior Consultant Urologist of Urohealth Medical Clinic, was the first in Asia to perform the MRI Targeted Fusion Biopsies of the prostate using the UroNav Platform. Using MRI and fusion with ultrasound, targeted biopsies of the prostate are performed. This improves the accuracy of the biopsies and reduces the need for repeat biopsies. However, biopsies are not performed on all men. A biopsy is suggested following some indications such as an elevated PSA (Prostate Specific Antigen), a significant change between consecutive PSA tests and an abnormal rectal examination.

Magnetic Resonance Imaging (MRI) Targeted Biopsy of the Prostate (UroNav Biopsy)

Elevated levels of PSA can be associated with a number of reasons. These include infection, prostatic enlargement but most concerning of them all, prostate cancer.

In the past, to exclude prostate cancer in patients with raised PSA, the patient would be subjected to a systematic or random biopsy of the prostate. This involves 12 biopsies taken from the prostate in a random manner. As such, it is likely possible to miss a cancer and in the event that the biopsy was negative for cancer, the patient would have to undergo another random biopsy if the PSA was still elevated.

In the recent few years, we have discovered that MRI of the prostate can offer valuable insights as to whether an elevated PSA is due to cancer. As such, using MRI and fusion with ultrasound, we can now do targeted biopsies of the prostate. This allows for a quantum leap in accuracy of the biopsies and reduces the need to repeat them. This lowers the risk of infection with repeated biopsies. Targeted biopsy of the prostate can be carried out under sedation or local anaesthesia and patients usually can be discharged on the same day.

Why do it with us?

Dr Tan Yung Khan was the first in Asia to perform MRI targeted fusion biopsies of the prostate using the UroNav platform. In his published series, he has shown that in his hands, there has been a significant improvement in the detection of clinically significant prostate cancer. Dr Tan Yung Khan has also gone on to set up the Asia Pacific Centre of Excellence for UroNav guided targeted biopsies and has given talks and run masterclasses for urologists in the region on the use of this system.

Treatments for Prostate Cancer

Treatment will depend on the type of cancer. Treatments include Radiation (using high-dose x-rays or other particles to kill cancer cells), Hormonal therapy (using hormones to slow or stop cancer growth), Chemotherapy (using drugs to destroy cancer cells) and Surgery to remove the cancer. (Robotic Radical Prostatectomy/Laparoscopic Radical Prostatectomy.
Surgery involves removing the prostate completely.

  • ROBOTIC RADICAL PROSTATECTOMY
    World reknowned Da Vinci Surgical System is the robotic system that surgeons use to robotically remove the prostate. It is less traumatic and minimally invasive. The Da Vinci Robotic Prostatectomy improves the surgeon’s visualisation, dexterity and precision compared with open or laparoscopic surgery while enabling operation through 1-2cm incisions.
  • LAPAROSCOPIC PROSTATECTOMY
    This is a minimally invasive surgery procedure to remove cancerous prostate. The surgeon makes a few small incisions compared to one large incision in open surgery leading to less abdominal trauma and a faster recovery process.
Da Vinci Surgical System

Prostatitis

What is Prostatitis?

Prostatitis is the swelling and inflammation of the prostate gland. The prostate is a walnut-sized gland in between the bladder and the urethra that nourishes and transports sperm.

Symptoms of Prostatitis

Symptoms of prostatitis include painful, difficult and/or frequent urination, pain the groin or pelvic area, blood in urine, body aches, pains and fever.

Diagnosing Prostatitis

Prostatitis is diagnosed by an examination of the prostate gland and a urine test.

Treatments for Prostatitis

Treatment will depend on the underlying cause of prostatitis. Treatments include Medication which is usually antibiotics and/or anti-inflammatory medications.

 


Benign Prostate Hyperplasia (BPH)/Prostate Enlargement

What is Benign Prostate Hyperplasia (BPH)/Prostate Enlargement?

Benign prostate hyperplasia is the benign enlargement of the prostate gland. This is a common condition among older men. As many as 50% of men at 50 years of age will have it and up to 80% at 80 years of age. The main function of the prostate is related to the production of fluids that accompany semen during ejaculation. The prostate lies between the bladder and the penis. As such, when it grows bigger it can lead to obstruction of the flow of urine during urination. Long term obstruction can lead to urinary tract infection.

Symptoms of Benign Prostate Hyperplasia (BPH)/Prostate Enlargement

Symptoms of prostate enlargement include slow urination, starting and stopping of urine flow and frequency of urination.

Diagnosing Benign Prostate Hyperplasia (BPH)/Prostate Enlargement

Prostate enlargement is diagnosed by a rectal examination, a urine test, uroflow test, and PSA (Prostate Specific Antigen) test.

Treatments for Benign Prostate Hyperplasia (BPH)/Prostate Enlargement

Treatments for prostate enlargement include Medication and Surgery. Some drugs known as alpha blockers can help relax the prostate to improve flow. Drugs like 5 Alpha reductase inhibitors can go some way in shrinking the prostate. Both kinds of drugs can reduce symptoms by about 30% but have some side effects and need to be taken in the long term otherwise symptoms may return.

Surgical methods can also be employed to manage an enlarged prostate.

    • TRANSURETHRAL RESECTION OF THE PROSTATE
      This procedure involves scraping the prostate to create a channel for the flow of urine. It is the mainstay of treatment for BPH and is effective in relieving prostatic obstruction. However, this procedure may be associated with urinary incontinence, bleeding and retrograde ejaculation.
    • GREENLIGHT LASER VAPORISATION OF THE PROSTATE
      This laser reduces complication rates and shortens hospital stays. Surgical methods have shown to have long lasting improvement to urinary symptoms and flow. Furthermore, the improvements offered by these surgeries are in the range of 80% compared to the 30% of drugs.

Green Light Procedure

  • UROLIFT SYSTEM TREATMENT
    Not all patients are comfortable with long-term medications or surgery. Fortunately today, we have the UROLIFT SYSTEM TREATMENT. This treatment for enlarged prostates is FDA approved, minimally invasive and bridges the space between medications and more invasive surgeries. This procedure lifts the enlarged prostate and holds the tissues in place using small Urolift implants thereby unblocking the urethra. It does not require cutting, heating or any removal of the prostate. It is usually done under local anaesthesia in a clinic setting or day surgery centre. A catheter will not be required after the procedure and patients can typically return home the same day.

REZUM WATER VAPOR THERAPY

Rezum Water Vapor Therapy is a minimally invasive procedure which involves injecting sterile water vapor (steam) into the prostate gland. It is a targeted therapy as the vapor is confined to a defined area. The result is a reduction of excess prostate tissue which helps to resolve symptoms caused by enlarged prostate. The procedure is done under minimal sedation. Patients can expect gradual improvement of symptoms in two weeks. This varies among patients. Patients no longer need to take any BPH medications. Clinical studies show that Rezum Therapy is safe and effective. It is a day procedure which does not require general anesthesia. Patients are able to preserve sexual function. Lastly, patients are able to return to regular activites within a few days. Patients will have to consult with our urologist in order to determine the best BPH treatment option for you. It will be determined by a couple of factors such as your age, symptoms, expectations, current and past medical conditions, and prostate size.

 

Raised PSA

What is Raised PSA?

The PSA blood test is regularly offered as part of health screenings. PSA stands for Prostate Specific Antigen and as its name suggests, it comes from the prostate. PSA is protein made by both normal prostate cells and also cancer cells of the prostate. It is not made by other body tissues which is why it is “prostate specific”. The function of the prostate is to help make semen more liquid so that the sperm can swim freely. Usually, the PSA is secreted together with semen but abit of PSA can leak back into the blood stream and this is then deteced on the PSA blood test.

PSA was first used in 1986 to monitor patients who already had prostate cancer. A rising level usally indicated that there was progression of the disease whereas a dropping level indicated effectiveness of treatment. In 1994, PSA was approved as a screening test for prostate cancer. Unforuntately, because PSA is also produced by non-cancer cells, it is not very specific for cancer. Nowadays in Singapore, we often use a level of 4.0ng/mL as a cut off for suspicion of cancer where PSA levels of more than 4.0ng/mL are more likely to harbor cancer. This is a rather artificial level as large population studies have found that up to 15% of men with PSA of 4.0ng/mL or less may have cancer of which 15% of those cancers required treatment. As such, patients with a PSA of 4-10ng/mL probably have a 15-25% chance of harboring cancer and a 75% chance that the raised PSA is related to a non-cancerous cause.

Raised PSA levels in the blood can occur in a few situations. This can include situations of enlarged prostate, infections of the prostate or prostate cancer.

Symptoms of Raised PSA

Symptoms of raised PSA include urination issues such as poor urine flow or dribbling of urine, straining while urinating, blood in urine or recurrent urinary tract infections with painful urination.

Management of Raised PSA

In the setting of a likely infection, antibiotics can be taken to reduce raised PSA.

With suspicion of cancer, further evaluation with multiparametric MRI of the prostate and a more sensitive blood test known as the PHI (Prostate Health Index) test can help determine the likelihood of clinically significant prostate cancer.

The PHI test known as the Prostate Health Index is a formula that combines all 3 PSA forms (total PSA, free PSA, and p2PSA) into a single score. Low PHI scores are associated with a lower probability of prostate cancer and higher PHI scores are associated with an increased probability of prostate cancer.


Kidney Cancer

What is Kidney Cancer?

Kidney cancer, also known as renal cancer is a disease in which kidney cells turn malignant (cancerous) and form a tumour. Renal cell carcinoma is a type of kidney cancer where the cancer of the kidney appears in the tubules (tiny tubes) in the kidney. Kidney cancers can be diagnosed and treated early, preventing it from spreading.

Symptoms of Kidney Cancer

Symptoms of kidney cancer include blood in urine, a lump in your abdomen or side, side pain that would not go away, fever and extreme lethargy.

Diagnosing Kidney Cancer

Imaging tests such as computerised tomography (CT) scan or magnetic resonance imagine (MRI) are used to diagnose kidney cancer.

Treatments for Kidney Cancer

Treatment will depend on the stage of cancer, the type of cancer, the side effects, patient’s preferences and overall health. Treatments include: Active surveillance, Immunotherapy (also called biologic therapy, it is suppose to boost the patient’s immune system using the body’s natural materials) , Targeted therapy (treatment that targets the cancer’s specific genes, proteins or tissue environment that contributes to cancer growth while limiting damage to healthy cells), Chemotherapy (the use of drugs to destroy cancer cells), Radiation therapy (use of high-energy x-rays or other particles to destroy cancer cells) and Surgery.

Surgery involves the removal of the tumour and some surrounding healthy tissue during the oepration. This option is mainly for patients whose cancer has not spread beyond the kidneys. Surgery used for kidney cancer includes:

  • RADICAL NEPHRECTOMY
    Surgery to remove the tumour, the entire kidney and surrounding tissues. If nearby tissue and surrounding lymph nodes are also affected by the cancer, a radical nephrectomy and lymph node dissection is performed.

  • PARTIAL NEPHRECTONY
    Surgery to remove kidney tumour. A partial nephrectomy preserves the kidney function. This surgery is effective for some tumours. It is associated with fewer side effects and a faster recovery.

  • LAPAROSCOPIC AND ROBOTIC SURGERY
    During a laparoscopic surgery, a surgeon makes a few small incisions rather than the traditional 1 large incision in the abdomen. The surgeon then inserts a telescopic equipment into the small keyhole incisions to completely or partially remove the kidney. Sometimes, the surgeon uses robotic instruments during the surgery.

Renal Cysts

What are Renal Cysts?

Renal cysts are sacs of fluid that form in the kidneys. They are also known as “simple” cysts chracterised by a thin wall and contain water-like fluid. They are fairly common and usaully do not cause any harm or symptoms.

Symptoms of Renal Cysts

They rarely do cause any symptoms but if they do, they can cause backaches, fever or abdominal pain.

Diagnosing Renal Cysts

Renal cysts are discovered mostly during imaging tests such as an abdominal ultrasound or pelvic ultrasound.

Treatments for Renal Cysts

Renal cysts generally do not require any treatment unless they are causing symptoms or impeding the kidney function. In such cases, doctors will either perform Sclerotherapy (Also known as Percutaneous Alcohol Ablation where the doctor inserts a long needle through the skin and into the cyst under ultrasound guidance and drain the cyst. The doctor will then fill it with an alcohol-based solution that causes the tissue to harden and shrink thereby reducing the chance of recurrence.) or Surgery. Surgery involves the surgeon making a small incision and accessing the cyst with a laparoscope. The surgeon will drain the cyst and burn or cut away the outer layer of the cyst.


Urinary Stones

What are Urinary Stones?

Urinary stones are hard masses that form inside your kidneys. They are actually mineral deposits. They occur due to many reasons and can occur in any part of the urinary tract- from kidneys to bladder. There are kidney and ureteric stones and bladder stones. Treatment will depend on the type of stone and their location.

Symptoms of Urinary Stones

Stones especially smaller stones can cause excruciating pain. This is known as renal colic where an intense pain can be felt in the area between the ribs and hips, it spreads across the abdomen and extends to the genital area. The pain is usally intermittent. Other symptoms include nausea, vomitting, blood in urine, fever and painful urination.

Diagnosing Urinary Stones

A computed tomography (CT) scan is often used to diagnose urinary stones. It can locate a stone and the degree to which the stone is blocking the urinary tract.

Treatments for Urinary Stones

Treatment will depend on the type, the size, the location of the stone and the symptoms that patient has. Most kidney stones will not recover invasive treatment. They may be able to passed out by drinking water alone and using pain medications and medication to help pass the stones. For large stones causing symptoms, more invasive procedures may have to be performed.

  • URETEROSCOPY AND LASER LITHOTRIPSY (URS & LL)
    A thin lighted scope known as the ureteroscope is inserted through your urethra and bladder to your ureter. Once the stone is located, a laser beam will break it into pieces that will then be passed in your urine. A stent is inserted in the ureter to relieve swelling and help healing. This is the most common endoscopic procedure performed for the treatment of kidney stones which provide patients with a quick relief of symptoms.

  • EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL)
    ESWL uses sound waves to create strong vibrations (shock waves) that break the stones to smaller fragments that can be passed in your urine. However, depending on the type and size of stone, this treatment may not be suitable. Doctor will access patient before recommending the best treatment to ensure a better stone clearance rate.

  • PERCUTANEOUS NEPHROLITHOTOMY (PCNL)
    PCNL involves surgically removing a kidney stone using small instruments inserted through a small cut in your back. This procedure is used for larger kidney stones.

Testicular Cancer

What is Testicular Cancer?

Testicular cancer is cancer of the testicle. It is often detected by patient noticing a lump or some swelling in the testicle.

Symptoms of Testicular Cancer

Symptoms of testicular cancer include a lump or swelling in the testicle, pain and discomfort in the testicle, swollen testicle, backaches or aches in groin area and fluid collection in the scrotum.

Diagnosing Testicular Cancer

Testicular cancer is diagnosed with an ultrasound of the testicles.

Treatments for Testicular Cancer

Treatment will depend on the stage of cancer, the type of cancer, the side effects, patient’s preferences and overall health. Treatments include: Active surveillance (after removing the testicle with cancer), Chemotherapy (the use of drugs to destroy cancer cells), Radiation therapy (use of high-energy x-rays or other particles to destroy cancer cells) and Surgery.

  • RADICAL INGUINAL ORCHIECTOMY
    Surgery involves the removal of the testicle with cancer. This surgery is called radical inguinal orchiectomy. An incision is made just above the pubic area and the testicle is then gently removed from the scrotum through the opening. The tumour is removed entirely along with the testicle and spermatic cord.

  • RETROPERITONEAL LYMPH NODE DISSECTION (RPLND)
    Depending on the stage and type of cancer, lymph nodes around the large blood vessels (the aorta and inferior vena cava) at the back of the abdomen may be removed during the orchiectomy. Not all people with testicular cancer will need to have lymph nodes removed. A large incision is made in middle of the abdomen to remove the lymph nodes.

Varicocele

What is Varicocele?

Varicocele is the abnormal enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). This is a condition that commonly causes low sperm production and decreased sperm quality resulting in infertility. Varicoceles can cause testicles to develop abnormally or shrink in size.

Symptoms of Varicocele

Symptoms of varicocele include a dull ache or sharp pain and imparied fertility.

Diagnosis of Varicocele

A physical examination with an ultrasound of the testicle is often used to diagnose varicocele.

Treatments for Varicocele

Most of the time, varicocele does not need treatment. Fertility is often not affected. However, if pain and discomfort is affecting the patient, a surgery can be done to repair the varicocele. Surgery will seal off the affected vein to redirect the blood flow into normal veins. This can be done laparoscopically where a small incision is made in the abdomen and the surgeon passes a tiny instrument through the incision to see and repair the varicocele.


Epididymitis/Orchitis

What is Epididymitis/Orchitis?

Epididymitis is the inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm. Inflammation can cause swelling and pain in the testicles. It can affect men of all ages but common among men between 14 to 35. Orchitis is the inflammation of the testicles caused by bacteria or virus. Both testicles may be affected by orchitis at the same time but symptoms usually appear in one of the testicles. This type of testicular inflammation is often caused by the mumps virus.

Symptoms of Epididymitis/Orchitis

Symptoms of epididymitis and orchitis include a red and swollen scrotum, testicle pain and tenderness, painful urination, frequency in urination, penile discharge, blood in semen and pain or discomfort in the pelvic area. For orchitis, fever, nausea and vomiting may develop as well.

Diagnosing Epididymitis/Orchitis

A physical examination with an ultrasound of the testicle is often used to diagnose epididymitis and orchitis.

Treatments for Epididymitis/Orchitis

Treatments for epididymitis and orchitis include Medications which is usually antibiotics and pain medication.


Erectile Dysfunction (ED)

What is Erectile Dysfunction?

Erectile Dysfunction is the inability to get or maintain an erection to have sexual intercourse. It is also referred to as impotence.

Symptoms of Erectile Dysfunction

Symptoms of erectile dysfunction include not being able to get an erection, struggling to maintain an erection for sexual intercourse and an inability to ejaculate.

Diagnosis of Erectile Dysfunction

The doctor will perform a physical examination of the penis and a psychological examination. Blood tests and urine tests may be ordered to exclude other conditions. An ultrasound may be performed to check the blood vessels that supply the penis.

Treatments for Erectile Dysfunction

Treatments for erectile dysfunction include Medications such as Viagra, Cialis, Levitra and Stendra, Testosterone replacement via injection, Shockwave therapy and Surgery.

  • SHOCKWAVE THERAPY
    Shockwave therapy, also called low-intensity extracorporeal shockwave therapy (Li-ESWT) is a treatment which consists of noninvasive low-intensity sound waves that pass through erectile tissue thereby restoring erectile function by clearing plaque out of blood vessels and stimulating the growth of new blood vessels.
  • PENIS PUMPS
    Surgery is considered if other treatments have failed. A penis pump is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over the penis and the pump is used to suck out the air inside the tube. This creates a vacuum pulling blood into the penis. Once there is an erection, a tension ring should slip around the base of the penis to hold in the blood keeping the penis firm. The vacuum device is then removed. The erection usually lasts long enough for sexual intercourse.
  • PENILE IMPLANTS
    This procedure involves surgically placing devices on both sides of the penis. The implants consist of either inflatable or malleable rods. Penile implants are not normally recommended unless other methods have failed.

Male Infertility

What is Male Infertility?

Male infertility is a condition in a man that lowers the chances of his female partner getting pregnant. It can be due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Health issues, injuries, illnesses, lifestyle and other factors can affect male fertility.

Symptoms of Male Infertility

The main sign of male infertility is the inability to conceive. Symptoms associated with male infertility include problems with sexual function, pain or swelling in the testicle area and having a lower than normal sperm count.

Diagnosing Male Infertility

The doctor may order a couple of tests including a semen analysis, hormone testing and post-ejaculation urinalysis. A scrotal ultrasound may also be required to see if there are other medical conditions such as varicocele or other problems in the testicles and supporting structures.

Treatments for Male Infertility

Treatment will depend on the cause of infertility. It includes Surgery (if varicocele is identified and causing the condition), Medications such as antibiotics for infections, other types of oral medications depending on cause and Hormone treatments.


Premature Ejaculation

What is Premature Ejaculation?

Premature ejaculation happens when a man experiences orgasm and expels semen shortly after sexual activity and with minimal stimulation of the penis.

Symptoms of Premature Ejaculation

The main symptom of premature ejaculation is the inability to hold back ejaculation for more than one minute after penetration.

Diagnosis of Premature Ejaculation

The doctor will ask you about your sex life and medical history. A physical examination may be done by the doctor as well in order to diagnose premature ejaculation.

Treatments for Premature Ejaculation

Treatments for premature ejaculation include Behavioural techniques such as masturbating an hour or 2 before intercourse to delay ejaculation during sex and Medications to delay orgasm.


Vasectomy

What is Vasectomy?

Vasectomy is a procedure which involves the cutting off of small tubes in the scrotum that carry sperm. It is also known as male sterilisation. A vasectomy blocks or cuts each vas deferens (two tubes through which the sperm leaves the testicles) keeping sperm out of the semen. Sperm cells remain in the testicles and are absorbed by the body. About 3 months after a vasectomy, the semen will not contain any sperm. However, patient will still have the same amount of semen as previously. There just will not be sperm in it.

Things To Note About A Vasectomy

Vasectomies are permanent and there are risks involved such an infection, pain and swelling. A reversal surgery is complicated and expensive, also they do not always work. Please discuss with the doctor your concerns before the procedure.


Bladder Cancer

What is Bladder Cancer?

Bladder cancer happens when cells in the urinary bladder start growing uncontrollably. As more cancerous cells develop, they will form a tumour and could spread to other areas of the body.

Symptoms of Bladder Cancer

Symptoms of bladder cancer include haematuria (blood in the urine), painful urination, burning sensation while passing urine and frequency in urination.

Diagnosing Bladder Cancer

A cystoscopy is often done to diagnose bladder cancer. It involves inserting a small and narrow tube (cystoscope) through the urethra. The doctor will send tissue sample for biopsy and urine for cytology.

Treatments for Bladder Cancer

Treatment will depend on the stage of cancer, the type of cancer, the side effects, patient’s preferences and overall health. Treatments include Chemotherapy (the use of drugs to destroy cancer cells), Radiation therapy (use of high-energy x-rays or other particles to destroy cancer cells), Immunotherapy (known as Biologic therapy, it is suppose to boost the patient’s immune system using the body’s natural materials), Intravesical therapy (doctor puts a liquid drug directly into the bladder using a catheter to prevent cancer from coming back after surgery) and/or Surgery.

  • TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT)
    Transurethral resection of bladder tumour is also known as transurethral resection (TURBT). This is recommended for early-stage or superficial (non-muscle invasive) bladder cancers. An instrument is inserted into the urethra (no cutting into the abdomen). A rigid cystoscope called a resectoscope is placed into the bladder through the urethra. The wire loop at the end of the scope removes any abnormal tissues or tumours. The removed tissue is sent for biopsy.

  • PARTIAL CYSTECTOMY
    This option is for the kind of bladder cancer that has invaded the muscle layer but the affected area is not very large and only in one place. This surgery will remove the cancer along with part of the bladder wall without taking out the whole bladder. The hole in the bladder wall is then closed. Nearby lymph nodes are also removed and examined for spread of cancer.

  • RADICAL CYSTECTOMY
    If the cancer is more aggressive and is larger or in more than one part of the bladder, a radical cystectomy is required. This surgery will remove the entire bladder and nearby lymph nodes. In women, the ovaries, fallopian tubes, uterus, cervix and a samll portion of the vagina are often removed along with the bladder. In men, the prostate and seminal vesicles are also removed. In radical cystectomy, reconstructive surgery is needed as you will need another way to store urine and remove it. There are several types of reconstructive surgery such as incontinent diversion, continent diversion and neobladder. The type of reconstructive surgery done will depend on the medical situation and personal preferences of patient.

Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is the loss of bladder control. It occurs more often in women than in men especially after childbirth and menopause. It is also common among elderly. This condition can also be caused by urinary tract infection or an overactive bladder. If urinary incontinence affects your lifestyle and daily activities, get it treated. The situation can improve!

Symptoms/Types of Urinary Incontinence

Symptoms and types of urinary incontinence include stress incontinence (urine leaks when exerting pressure on your bladder by a certain activity like coughing or sneezing), urge incontinence (sudden urge to urinate followed by uncontrollable urine leak), overflow incontinence (frequent and constant dribbling of urine), functional incontinence (a physical or mental impairment that prevents you from making it to the toilet in time) and mixed incontinence (experiencing more than one type of urinary incontinence).

Diagnosing Urinary Incontinence

A urinalysis to check for signs of infection or blood traces is done together with a bladder diary. A bladder diary will record how much you drink, your output of urine and when you urinate. The doctor will also perform a post-void residual measurement using an ultrasound to check if there is leftover urine in your bladder after you urinate. This will enable the doctor to diagnose you accurately.

Treatments for Urinary Incontinence

Treatments for urinary incontinence will depend on the cause of urinary incontinence and the type of urinary incontinence. There are many ways to treat urinary incontience. They include: Bladder training, Fluid and diet management, Pelvic floor training, Medications such as anticholinergics, mirabegron (myrbetriq) and alpha blockers, Interventional therapies such as Injection of Bladder Relaxing Medication and Surgery.

  • SLING PROCEDURES
    A pelvic sling is created around the urethra and the area of thickened muscle where the bladder connects to the urethra. The sling is made of your body’s tissue, synthetic material or mesh. The sling helps to keep the urethra closed. This procedure is used to treat stress incontinence.
  • BLADDER NECK SUSPENSION
    This procedure where an abdominal incision is made provides support to the urethra and bladder neck.
  • PROLAPSE SURGERY
    Prolapse surgery may be done in combination with a sling procedure if the female patient presents with mixed incontience and pelvic organ prolapse.
  • ARTIFICIAL URINARY SPHINCTER
    In men, a small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter closed until the patient has the urge to urinate. In order to urinate, patient will need to press a valve implanted under the skin that causes the ring to deflate and allowing urine from the bladder to flow.

Urinary Tract Infection (UTI)

What is Urinary Tract Infection?

Urinary tract infection is an infection in any part of the urinary system. When it affects the lower urinary tract, it is known as cystitis, a bladder infection. When it affects the upper urinary tract, it is known as pyelonephritis, a kidney infection.

Symptoms of Urinary Tract Infection

Symptoms of urinary tract infection include painful urination, frequency in urination, feeling the need to urinate even though the bladder is empty, fever and pain in the flank.

Diagnosing Urinary Tract Infection

A urinalysis and urine culture test are done to diagnose urinary tract infection. It will look for white blood cells, red blood cells or bacteria. If you have recurrent urinary tract infections, the doctor may perfrom a cystoscopy using a small and narrow tube (cystoscope) to see inside the urethra and bladder.

Treatments for Urinary Tract Infection

Treatment for urinary tract infection includes Medication which is usually antibiotics. Patients are advised to drink plenty of water.


Overactive Bladder

What is an Overactive Bladder?

An overactive bladder is a condition which causes a sudden urge to urinate and may even lead to involuntary loss of urine.

Symptoms of Overactive Bladder

Symptoms of overactive bladder include a sudden urge to urinate that is hard to control, the involuntary loss of urine (urge incontinence), frequency in urination (more than 8 times in a day) and nocturia (waking up 2 or more times in the night to urinate).

Diagnosing Overactive Bladder

Urine sample may be sent for testing to exclude infection, traces of blood in urine or other abnormalities. The doctor may perform a post-void residual measurement using an ultrasound to check if there is leftover urine in your bladder after you urinate. A uroflow test to measure urine flow rate may also be required.

Treatments for Overactive Bladder

Treatments for overactive bladder include Medications to relax the bladder and Interventional therapies such as Injection of Bladder Relaxing Medication and Surgery.

Surgery can be done to increase the bladder capacity. This involves using pieces of the bowel to replace a portion of your bladder. However, this surgery is only recommended in cases of severe urge incontinence that has failed to respond to other conservative treatments.


Nocturia

What is Nocturia?

Nocturia is the excessive urination at night. Waking up 2 or more times at night to urinate is indicative of nocturia.

Symptoms of Nocturia

People who have nocturia wakes up 2 or more times at night to urinate causing disruptions in a normal sleep cycle.

Diagnosing Nocturia

A bladder diary may be required by the doctor to diagnose nocturia. A bladder diary will record how much you drink, your output of urine and when you urinate.

Treatments for Nocturia

Treatments for nocturia include Medications such as anticholinergics drugs and diuretic drugs and Surgery.

Surgery can be done to treat an overactive bladder by increasing the bladder capacity. This involves using pieces of the bowel to replace a portion of your bladder. However, this surgery is only recommended if patient has failed to respond to other conservative treatments.

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