Urology Clinic

The Urology Clinic is designed as a one-stop destination for outpatient management of urological conditions. In addition to outpatient consultations, day-surgical procedures such as ultrasound imaging, flexible cystoscopy, urodynamic study, transrectal ultrasound and biopsy of prostate are routinely performed in the clinic.

Urology Services In CGH

• Urinary stone disease
• Prostate disease
• Uro-oncology
• Andrology
• Incontinence and voiding dysfunction
• Reconstructive urology

Urinary Stone Disease

Urinary stone disease is one of the most common urological problems treated at Changi General Hospital (CGH). They are usually 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 and minimally invasive techniques to treat this common problem.

Treatments for urinary stones include Extracorporeal Shock Wave Lithotripsy (ESWL), Percutaneous Nephrolithotomy (PCNL) or laser lithotripsy (endoscopic laser surgery) performed through an endoscope. Virtually all stones in the urinary tract can be accessed and treated through the endoscopes, without any incision or with a small incision. For example, patients with large staghorn kidney stones can be treated with PCNL, using a small key-hole incision instead of conventional open surgery, which requires a long and painful incision.

Prostate Disease

With an ageing 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 urinary symptoms, such as hesitancy, poor stream, terminal dribbling, sensation of incomplete voiding, frequency, urgency in passing urine and nocturia (frequent night time urination). If left undiagnosed and untreated, BPH may lead to bladder stones, 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.

The first-line treatment of BPH is usually medication. However, in patients where medications are ineffective, we offer endoscopic or minimally invasive options such as Transurethral Resection of Prostate (TURP) surgery or procedures that reduce the size of the prostate gland. The goal is to provide a comfortable and effective treatment with minimal adverse effects.

We also treat prostatitis at CGH Urology. Prostatitis is inflammation of the prostate that may be caused by infection and accompanied by chills and fever. Though it is usually cured with antibiotics, the condition may become chronic in some patients.

Uro-oncology

Uro-oncology refers to the treatment for urological cancers, ranging from kidney, ureter, bladder, prostate and testes cancers. Surgical approaches for treatment of urological cancers include open, laparoscopic or robot-assisted surgery. For selected cases, local ablative therapy may also be an option. We refer patients who require non-surgical interventions like radiotherapy or chemotherapy to the National Cancer Centre in Singapore for further management.

Prostate Cancer

Prostate cancer is now the third most common type of cancer affecting Singapore males, and this incidence has been increasing steadily over the past three decades. The use of prostate specific antigen (PSA) has revolutionised 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. Diagnostic procedures include transrectal ultrasound, biopsy of prostate and MRI-ultrasound fusion biopsy of prostate.

Each patient with prostate cancer is carefully evaluated and the appropriate treatment is individually tailored to the patient. Robot-assisted Radical Prostatectomy is currently our usual surgical approach as studies have shown better oncological and functional outcomes when compared to laparoscopic and open approaches.

External beam radiotherapy ( 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. These patients are referred to the radiation oncologist at the National Cancer Centre Singapore.

Bladder Cancer

The most common symptom of bladder cancer is haematuria, otherwise known as blood in the urine. Standard investigations such as urine tests, CT scans and endoscopy of the bladder are usually done to diagnose this and it allows for early detection and treatment. Superficial bladder cancers are usually managed with endoscopic surgeries. Recurrence is significantly reduced by instillation of medication into the bladder of selected patients.

Muscle-invasive bladder cancers are not as common as superficial bladder cancers. These patients require removal of the bladder with urinary diversion (e.g. ileal conduit, orthotopic bladder neobladder, Mitrofanoff procedure). 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. Some patients, for whom surgery may not be an option, may be referred for radiotherapy.

Kidney Cancer

Patients with kidney cancers may present with haematuria or an abdominal mass. Diagnosis is usually made or confirmed using CT scans. If the cancer has not spread, then the options of partial nephrectomy (removal of the cancerous tumour only in selected patients) or radical nephrectomy (removal of affected kidney) could be offered. In recent years, partial nephrectomy using the minimally invasive surgical approach (i.e. robot-assisted or laparoscopic) has emerged as a preferred approach for early kidney cancers in our department. The main advantage of a partial nephrectomy is the preservation of as much kidney function as possible after surgery.

Andrology

We treat patients with problems of male sexual dysfunction (i.e. impotence, premature ejaculation), andropause or male infertility at our outpatient clinics.

Erectile Dysfunction

We offer diagnosis and treatment of erectile dysfunction. A colour doppler scan of the penis may be used 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 to induce penile erections, 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.

Besides erectile dysfunction, we also manage 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 the male hormone, testosterone. We have a protocol for evaluation, diagnosis and treatment of andropause which is similar to established international guidelines. Male menopause can result in sexual dysfunction, behavioural, mental and physical symptoms. The documentation of low serum testosterone level confirms the diagnosis and male hormone replacement therapy is instituted in symptomatic men with low testosterone levels who are suitable for 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 clinic.

Male Infertility

We provide services for the evaluation and treatment of male infertility. Some diagnostic tools we utilise include the blood tests, seminal analyses and ultrasound examination of the testes. Where it is indicated, surgery such as microsurgical vasovasostomy and varicocelectomy (open, laparoscopic, microsurgical or percutaneous) will be offered to appropriate patients.

We are actively involved in the management of male sexual dysfunction, such as impotence, premature ejaculation and libido disorders. Psychosexual therapy and counselling by affiliated specialists are available for patients with psychologically induced impotence.

Incontinence and Voiding Dysfunction

Incontinence and voiding dysfunction deals with urinary bladder storage and voiding disorders in both men and women. Diagnosis may require the use of bladder function test at our computerised urodynamics laboratory.

Our one-stop continence clinic 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 may consist of bladder training, pelvic floor exercise with biostimulation, counselling on fluid management, and prescription of oral medication or planning for surgical procedures.

For those with urinary stress incontinence, initial treatment consists of pelvic floor muscle training with biofeedback stimulation, fluid management and weight control. Patients with severe urinary incontinence may require surgical interventions such as tapes, slings or artificial urinary sphincters.

Patients with urinary urge incontinence from overactive bladder syndrome are managed with bladder training, fluid control and anti-cholinergic medication. Patients who do not respond to conservative management may be offered intra-vesical botox injection or augmentation cystoplasty.

Reconstructive Urology

This subspecialty involves surgery to restore normal anatomy and function where substitute tissue may be used in these procedures to restore the diseased tissue. This involves the harvest and manipulation of suitable tissues or organs. An example would include the reconstruction of a new bladder using intestine tissue, which may be reconstructed to the native urethra or to a continent diversion (e.g. Mitrofanoff).

The various types of reconstructive surgeries performed include pyeloplasty, cystoplasty, urethroplasty and correction of penile curvatures. Ureteric strictures have been successfully managed by minimally invasive techniques such as endoscopic balloon dilatation. Complex ureteric strictures may need reimplantation or reconstruction.

We have experience in reconstructive surgery for conditions such as complex urethral strictures. Other forms of reconstruction work include bladder reconstruction after radical cystectomy with continent- bladder pouches and orthotopic bladders.

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