We are able to treat kidney stones using non-invasive Extracorporeal Shock Wave Lithotripsy (ESWL), Percutanous Nephrolithotomy (PCNL) or Holmium Laser Lithotripsy 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 evaluation of ESWL machine prototypes.

Besides medications and the transurethral resection of prostate (TURP) surgery, the Department also offers minimally invasive therapy using transurethral needle ablation (TUNA) and laser prostatectomy (Diode laser). The goal is to provide a comfortable and effective treatment with minimal adverse experience. These patients may look forward to shorter hospital stays and quicker recovery.

The Department is actively conducting research into prostate disease. It has been involved in an Asian BPH registry and international multi-centre clinical drug trials.

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 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 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 oncolgist at the National Cancer Center.

Bladder Cancer
In Singapore, cancer of the bladder 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 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.

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.

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 the Department. The Department has participated in numerous multi-centre international clinical trials involving various new forms of treatment for erectile dysfunction. The Department has significant experience in the management of other sexual dysfunctions such as premature ejaculation and male libido disorders.

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 documented 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 pellet implantation. Close monitoring with blood tests and symptom reviews are performed at regular intervals in the clinics.

Male Infertility
The Department 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, vaso-vasostomy, testicular or epididymal sperm extraction and varicocelectomy (open, laparoscopic, microsurgical or percutaneous), will be offered to appropriate patients.

We have a modern and comprehensive facility for the diagnosis and treatment of urinary incontinence and voiding disorders. 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 tape (TVT), 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 clam cystoplasty or entered into a clinical trial for intravesical botox injection.

Since 2003, there is a one-stop Continence Clinic which 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.

Our Urology Division provides expert diagnosis, testing, medical consultation, and surgical resolution for paediatric urological conditions like enuresis.