The Department of Urology at Changi General Hospital, Singapore has a comprehensive range of services for the evaluation, diagnosis and treatment of acute and chronic adult and adolescence urological conditions. We have the expertise and surgical skills in general urology and all the subspecialties of urology. All our specialist staff have undergone training and accreditation from well-known overseas medical institutions.
Continence problems like difficulty in controlling urination, weak urinary stream, or incomplete bladder emptying often have physical, treatable causes. Sometimes, these symptoms coupled with others like presence of blood in urine, pain in the lower back or tummy area, or pain when urinating, may be warning signs of other more serious problems like stones or even cancer. CGH Urology not only specialises in treatment of the kidneys, ureters, bladder, prostate and the genitals but also has expertise in handling male infertility and impotence.
The Department plays an important part in the training of medical undergraduates, postgraduates and nurses. Foreign doctors from countries such as India, Myanmar and Indonesia have been attached with us for training in urological surgery. We contribute frequently to the continuing medical education of family physicians / general practitioners (GPs) by organising regular teaching programmes and lectures. Within the Department, there is a wide range of academic activities, such as grand ward rounds, surgery reviews, tumour boards and radiological meetings. We are also active in clinical research, numerous publications and international multi-centre clinical trials.
Our inpatient wards provide standard and Intensive Care Unit urology care. A specialised urology high dependency ward caters to our patients undergoing major surgery. The outpatient clinic operates daily (Monday to Saturday) from its strategic location at levels 2 and 3 of the Outpatient Block. Clinics sessions are readily available the entire day for the convenience of referrals. We also run the following sub-specialty clinics: Andropause & Men’s Health Clinic, Continence Clinic and Urology Nursing Clinic.
UROLOGY SERVICES IN CGH
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Minimally invasive surgery, such as laparoscopic surgery, is gradually replacing conventional open urological operations. The benefits of laparoscopic surgery include reduced blood loss, decreased post-operative pain and faster convalescence. Patients enjoy a shorter and less painful recovery period.
The Department of Urology in CGH spearheaded the development of laparoscopic urology surgery in Singapore for benign and malignant renal tumours, offering state-of-the-art laparoscopic operations, ranging from laparoscopic varicocelectomy, laparoscopic ureterolithotomy, laparoscopic nephrectomy, laparoscopic adrenalectomy to reconstructive surgeries such as laparoscopic pyeloplasty and laparoscopic hernia repair and complex ablative surgery, such as laparoscopic radical prostatectomy. Our Urology Department is also one of the most experienced in pure (non-robotic) laparoscopic radical prostatectomy in Singapore. Progress is being made in frontiers like laparoscopic stone surgery, laparoscopic reconstruction and laparoscopic surgery for prostate cancer.
Patient safety remains our prime concern. Novice doctors must practice at length on a specially made pelvic trainer before performing the actual surgery. A recent review of our series of laparoscopic surgeries showed that our results are comparable to that of other established international centres.
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Urinary stone disease is one of the most common urological problems treated at Changi General Hospital. Though anyone at any age may have stones, these rock-like pieces (about the size of a grain of sand) occur most often in 20 to 30-year-olds. They are mostly formed in the kidneys and may get stuck in the ureter, blocking the flow of urine and causing pain. We offer a range of endourological techniques, minimally invasive procedures, ultrasound and laser non-surgical treatment and the latest technological innovations to treat this common problem.
We offer treatments for kidney stones using non-invasive Extracorporeal Shock Wave Lithotripsy (ESWL), Percutaneous Nephrolithotomy (PCNL) or Holmium Laser Lithotripsy (endoscopic laser surgery) performed through a miniature ureteroscope. Virtually all stones in the urinary tract can be accessed and treated through the endoscopes, without any incision or with only a small incision. For example, patients with large staghorn kidney stones can be treated with PCNL instead of a conventional surgery, which requires a long, painful incision.
The Department has presented the results of our stone treatment outcomes at various overseas conferences and published papers in renowned, peer-reviewed international medical journals. We are at the cutting edge of research for advances in stone treatment, having served as a centre for the evaluation of prototypes of the Extracorporeal Shockwave Lithotripters (ESWL) machine.
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PROSTATE DISEASE
With an aging population, we see a rise in the number of patients with benign prostatic hyperplasia (BPH) or enlarged prostate. These are middle-aged to elderly men who present with lower urinary tract symptoms, such as hesitancy, poor stream, terminal dribbling, sensation of incomplete voiding, frequency, urgency of micturition and nocturia (frequent night time urination). If left undiagnosed and untreated, BPH may lead to bladder stone, recurrent urinary tract infection, acute urinary retention, bladder damage and impairment of kidney function. Occasionally, BPH may be associated with problems like incontinence and impotence.
Besides medications and the transurethral resection of prostate (TURP) surgery, the Department also offers minimally invasive therapy using transurethral needle ablation (TUNA), also called radiofrequency therapy, and laser prostatectomy (diode laser). The goal is to provide a comfortable and effective treatment with minimal adverse experience. Thus, patients can look forward to shorter hospital stays and quicker recovery.
We also treat chronic prostatitis at CGH Urology. Prostatitis is inflammation of the prostate that may be caused by infection and accompanied by chills and fever. Though usually cured with antibiotics the condition can become chronic. Our diagnostic and treatment facilities include:
- Transrectal and transabdominal ultrasound
- Urodynamic measurement of urine flow, bladder pressures & bladder disease
- Laser and hyperthermia treatments
- Transurethral electrovaporization of prostate, a relatively new minimally invasive procedure
- TUNA (Transurethral Needle Ablation)
- Holmium Laser-TURP (Transurethral Resection of the Prostate)
The Department focuses close attention on the ability of novel technologies, like laser, radio frequency and vaporization techniques to reduce prostate gland size. This results in a shorter hospital stay and a quicker recovery. We are actively conducting research into prostate disease and have been involved in Asian BPH registry and international multi-centre clinical drug trials.
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We offer surgical treatment for all forms of urological cancers, ranging from kidney, ureter, bladder, prostate and testes. We run an aggressive program to diagnose cancer of the prostate in the early stage so that intervention can be offered early. We also perform intravesical immunotherapy and chemotherapy for superficial bladder cancers. For cases requiring complex interventions like radiotherapy or chemotherapy, these are referred to the National Cancer Centre for further management. The department also participates in a national clinical trial for the treatment of superficial bladder cancer.
Our forte is in individual assessment of patients and tailoring of therapy. As a unique service to our patients, we have a one-stop Haematuria Clinic for patients with blood in their urine to come for diagnostic tests and treatment planning. All investigations, like Intravenous Urogram (IVU), are performed during one weekend visit, thus saving time and maximising convenience for patients.
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Prostate Cancer
Prostate cancer is now the fifth most common type of cancer affecting Singapore males. The incidence has been increasing steadily over the past 3 decades. The advent of prostate specific antigen (PSA) revolutionized the management of prostate cancer, in terms of early prostate cancer detection, prognostication and follow-up. Most importantly, PSA resulted in the diagnosis of more cases of early prostate cancer, which are potentially curable.
Each patient with prostate cancer is carefully evaluated and the appropriate treatment is individually tailored to the patient. The Department performs radical prostatectomy, which is the gold standard treatment for prostate cancer confined to the organ. The outcome of surgical treatment is good, with more than 80% survival in a 15-years series. Radical prostatectomy can be performed by open or laparoscopic surgery.
The development of laparoscopic radical prostatectomy service is an important milestone. The Department has the largest series of pure (i.e. non-robotic) laparoscopic radical prostatectomies in Singapore. The preliminary results showed comparable postoperative results and significantly lower blood loss, as compared to the conventional open surgery. In addition, the surgical techniques are constantly refined to optimize the surgical eradication of cancer, preservation of post-operative urinary continence and erectile function.
External beam radiotherapy (also called beam therapy) is an alternative option for patients with organ-confined prostate cancer, who are unsuitable for surgery or who are not keen for surgical treatment. In addition, patients with locally advanced, non-metastatic prostate cancer are candidates for combined radiotherapy and hormonal treatment. These patients are referred to the radiation oncologist at the National Cancer Centre.
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Bladder Cancer
In Singapore, bladder cancer ranks ninth among males and is less common in females. The most common symptom of bladder cancer is haematuria or blood in the urine. In view of this, the Department has set up a special Haematuria Clinic (on Saturdays), which provides a one-stop service for evaluation, diagnosis and treatment for patients with blood in the urine. Standard investigations, such as urine tests, intravenous urography and flexible cystoscopy are performed during this visit. This service allows for rapid detection of cancers and early treatment. Superficial bladder cancers are easily managed and recurrence is significantly reduced by intravesical instillation of BCG or mitomycin (an anti-cancer chemotherapy drug) in selected patients.
Muscle-invasive bladder cancers are not as common as superficial bladder cancers. These patients require urinary diversion (e.g. ileal conduit, Mitrofanoff procedure) after major ablative surgery. The Department has the capability to carry out bladder reconstruction surgery tailored to meet the individual patient’s needs, so as to enhance quality of life. The Department has conducted research through clinical trials involving the detection of bladder cancer markers in the urine.
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Kidney Cancer
Patients with kidney cancers may present with haematuria or an abdominal mass. Diagnosis is usually confirmed using CT scans. If the cancer has not spread, then the option of radical nephrectomy is offered. In recent years, laparoscopic radical nephrectomy has emerged as the new standard of treatment in our department.
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Our urology specialists treat patients with problems of male sexual dysfunction, andropause or male infertility at our outpatient clinics.
The hospital also offers an Andropause And Male Health Screening Package.
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Erectile Dysfunction
We offer the state-of-the-art diagnosis and treatment of erectile dysfunction . We use a colour doppler scan of the penis for easy differentiation between physical and psychological causes. A multidisciplinary approach is often adopted, as many of the patients with erectile dysfunction, have co-existing medical conditions. Treatment options include the use of medications (e.g. Viagra, Levitra or Cialis), penile self-injection therapy (prostaglandin E1) and vacuum device therapy. In severe cases of erectile dysfunction, surgical implantation of a penile prosthesis is a viable option. For patients with psychological erectile dysfunction, sex therapy and psychosexual counselling are available by psychiatrists and psychologists, who work closely with us.
We have participated in numerous multi-centre international clinical trials involving various new forms of treatment for erectile dysfunction. We have the largest local experience in surgical treatment of erectile dysfunction with modalities like venous ligation and penile prosthesis. We also have significant experience in the management of other sexual dysfunctions, such as premature ejaculation and male libido disorders.
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Andropause
Andropause or male menopause is the symptom resulting from age-related decline of male hormone or testosterone. We have a protocol for evaluation, diagnosis and treatment of andropause, which is similar to established international guidelines. Symptoms of male menopause include sexual dysfunction, behavioural, mental and physical symptoms. The documentation of low serum testosterone level confirms the diagnosis. Male hormone replacement therapy is instituted in symptomatic men with low testosterone levels (who have no contraindications to such therapy). The therapeutic options are oral formulation, topical gel or patch, intra-muscular injection or subcutaneous (under the skin) pellet implantation. Close monitoring with blood tests and symptom reviews are performed at regular intervals in the clinics.
Find out more about:
- CGH’s Andropause and Male Health Screening package
- The book ‘Managing Male Ageing: More Health, More Life’ written by CGH Consultant in General Urology, Dr Ng Kok Kit
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Male Infertility
CGH Department of Urology provides services for the evaluation and treatment of male infertility. Diagnostic tools include the blood tests, seminal analyses and ultrasound examination of the testes. Special procedures such as electroejaculation and electrovibration techniques are used in selected patients, to enhance the collection of seminal specimens. Where it is indicated, surgery such as microsurgical vaso-epididymostomy, vasovasostomy, testicular or epididymal sperm extraction and varicocelectomy (open, laparoscopic, microsurgical or percutaneous), will be offered to appropriate patients.
CGH Urology is actively involved in the management of male sexual dysfunction, such as impotence, premature ejaculation and libido disorders. As one of the best clinical and research centres in the field of erectile dysfunction, we specialise in the comprehensive team approach. Psychosexual therapy and counselling by affiliated specialists are available for patients with psychologically induced impotence. We also collaborate with the Department of Obstetrics and Gynaecology at KK Women’s & Children’s Hospital to provide treatment and advice to couples seeking solutions to infertility. We have successfully helped couples conceive after microscopic vasovasostomy or vaso-epididymostomy surgery.
Summary of Treatments for Impotence & Infertility:
Non-surgical treatments for impotence
- Urethral suppository
- Penile self-injection therapy
- Vacuum device therapy
Surgical treatments for impotence
- Penile prosthetics (implants)
- Venous leak ligation
- Abnormal penile curvature correction
- Penile revascularisation microvascular surgery
Infertility solutions
- Artificial reproductive techniques for the male
- Microsurgical Vasovasostomy
- Vaso-Epididymostomy
- Electroejaculation
- Electrovibration techniques
- Sperm preservation, concentration and separation.
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Female Urology and Voiding Dysfunction deals with the management of incontinence & bladder disorders in women, the study of neurogenic diseases of the bladder (diseases due to or resulting from nerve problems) and urodynamic testing (at our advanced computerised video urodynamics laboratory). We offer many safe, advanced surgical procedures at a modern and comprehensive facility.
For those with urinary stress incontinence, initial treatment consists of pelvic floor muscle training with biofeedback stimulation, fluid management and weight control. Some patients may require surgical intervention and there is a wide range of surgical procedures, such as tension free vaginal or transvaginal (TVT) and periurethral injections of bulking agents.
Patients with urinary urge incontinence from overactive bladder syndrome are managed with bladder training, fluid control and anti-cholinergic medication. For patients who do not respond to conservative management, are offered augmentation cystoplasty / clam cystoplasty or entered into a clinical trial for intravesical botox injection.
Our Treatments include:
- Reconstruction of the upper and lower urinary tract
- Gynetherm (heat therapy for female urethral syndrome)
- Augmentation cystoplasty
- Fistula repairs
- Injectables like Contigen, Macroplastique, and Durasphere (carbon particles)
- Urosurge (self-detachable balloon system)
- Pelvic floor training & physiotherapy
Our one-stop Continence Clinic also provides integrated evaluation and treatment for patients with urinary incontinence or voiding dysfunction. The service includes a clinical assessment by the urologist, pad tests, urodynamics and treatment. Treatment consists of bladder training, pelvic floor exercise with biostimulation, counselling on fluid management, prescription of oral medication or planning for surgical procedures.
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RECONSTRUCTIVE UROLOGY
This subspecialty involves surgery to restore normal anatomy and function. Normal or substitution tissue may be used in these procedures to restore the diseased tissue or organ has been removed. It involves harvest and manipulation of other tissue or organ. (For example, reconstruction of a new bladder using tissue from the small or large intestine.)
Types of surgery performed include pyeloplasty, cystoplasty, urethroplasty and correction of penile curvatures. Other types of reconstructive surgical procedures include ureter reimplantation or replacement and urinary diversion using techniques such as the Mitrofanoff procedure.
We have wide experience in reconstruction surgery for conditions like hypospadias and complex urethral stricture. Other forms of reconstruction work include support to the oncology team in bladder reconstruction after radical cystectomy with continent- bladder pouches and orthotopic bladders.
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ADOLESCENCE UROLOGY
The department sees a high number of patients in the adolescent age group with problems like enuresis (including bed wetting), incidental hematuria or pyuria and requests for surgeries like circumcision and herniorraphy (surgical repair of a hernia).
Appointment
To make an appointment, call our Appointment Centre at 6850 3333 or go to our Online Appointment Booking page.
Staff Members
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