Hernia surgery with 3 key holes

Inguinal hernia is a weakness in the abdominal wall muscle through which some of the abdominal contents can protrude, causing a lump or pain in the groin region. It can occur in young boys or men in the middle age or elderly.

The only method of correcting this problem is by a surgical procedure to close the hole and strengthen the defect. Traditionally, this has been done by an open surgery, involving a cut measuring 5cm over the groin and repairing the defect with surgical sutures.

The latest technique of inguinal repair is by the laparoscopy total extra peritoneal mesh method. It involves making only 3 small holes, measuring between 0.5 to 1.0 cm on the abdomen and repairing the hernia defect with a thin but yet strong synthetic material. This will encourage the growth of natural tissue and muscle over the defect, resulting in a strong repair and lower risk of hernia recurrence in future.

The laparoscopy technique is less painful, results in a smaller scar and quicker recovery from surgery.

No more surgery for Kidney Stones

Kidney stones is a very common urology condition that can occur at all ages. It is four times more common in men than women. Kidney stones can produce a variety of symptoms. A very small stone measuring only a few millimeters can cause such severe pain that warrants a patient to call for an ambulance. On the other hand, a very large kidney stone can be silent and continue to cause damage to the  kidney, leading to infection and eventually destruction of the kidney.

Kidney stone treatment has changed dramatically over the last 20 years. Almost all stones can be treated by a non surgical method called Extra corporal shock wave lithotripsy or ESWL in short. A patient lies on a special bed with a hole to allow shock wave to be passed from the ESWL machine in to the body. These shock waves are focused and directed to the kidney stone, avoiding any damage to the kidney and other vital organs of the body. The shock wave direction is continuously monitored by x-ray or ultrasound to ensure accuracy of treatment. The entire treatment takes between 1- 1.5 hours and the patient can return home on the same day.

Reversal of Vasectomy - 2nd chance after vasectomy

Vasectomy is meant to be a highly effective and permanent method of family planning for men. However, few men may require a reversal of this procedure due to developments in later part of their life. The old relationship may have broken down and they have moved on to a new relationship. They may desire children from the new relationship.

Vasectomy reversal surgery offers a second chance for men who had vasectomy. This procedure is usually performed by an urologist who is trained in micro-surgical surgery technique.

Under general anesthesia, the ends of the previously divided vas deferens are located and brought together. The ends are trimmed to ensure that they are patent and sperm is seen in the fluid draining from the ends of the vas deferens. The ends of the vas deferens is then stitched together with 8-10 very fine stitches in a process called vaso-vasostomy This is done with the assistance of a surgical microscope for magnification and precision. The entire procedure may take between 3-4 hours. This can be done as a day surgery or a single night's stay in hospital.

The colour of the ejaculation fluid should change within 1-2 months after surgery, indicating the return of sperm. Return of sperm is seen in up to 90% of patients undergoing reversal of vasectomy surgery. However, pregnancy rate is much lower, dependant on the age of the patient and his partner.

What are the common urology conditions?

Urology is a surgical sub specialty that deals with problems related to the following organs:

1. kidney

2. adrenal gland

3. ureter (urine tube connecting kidney to bladder)

4. bladder

5. urethra (urine tube connecting bladder to the external)

6. penis and testes in males

Common urology conditions are stones in the kidney or ureter, infections of the bladder or kidney, prostate enlargement and cancer growing in the prostate, bladder or kidney.

These conditions may present with symptoms of pain over the back or lower part of the abdomen, blood in urine, pain during passage of urine, frequent urination and general symptoms such as lack of energy and loss of weight. In some conditions, they remain silent till the disease has progressed to an advanced state.

Evaluation of urology problems involve a physical examination, blood and urine tests and scans of the abdomen (ultrasound, CT scan or MRI). Sometimes, a cystoscope or a fine tube with a camera attached to its end in inserted in to the urine tube to inspect the health of urethra, prostate and bladder.

Male Menopause or Andropause - Does it exist?

Menopause is the time in a women's life when her period stop. This usually occurs between the ages of 45-55. Andropause on the other hand is a gradual and highly variable decline in male hormones, especially testosterone. This may lead to symptoms and may start as early as middle age. It is a highly variable physiological decline and not every man will develop a low hormone state called hypogonadism.

Testosterone level in men will decline with age. A relatively low testosterone level associated with symptoms leads to a state of andropause or late onset hypogonadism.

There are many causes of low male hormones or low testosterone. They range from chronic illness such as diabetes; psychological problems such as depression or testes problems such as testicular atrophy.

Symptoms of male menopause include decline in general energy level, libido (interest in sex), erectile dysfunction, poor short term memory, unrestful sleep and build up of abdominal fat.

Treatment is available in the form of testosterone replacement therapy. This must be coupled with life style changes such as weight reduction, smoking cessation, increase in exercise and healthy diet.

Commonest cancer in young males - Testes cancer

Testes cancer or cancer occurring in the testicles of men is the commonest malignant cancer in men between the ages of 15 to 34.

It is usually diagnosed when a small and painless lump is felt in either of the testes. Sometimes, an unrelated incident such as trauma or infection of the testes would bring the patient's attention to this area, leading to the discovery of the lump. If left alone, the lump may grow very rapidly to the size of an orange in a few weeks. It may also spread to other regions of the body.

Men who are born with undescended testes have a higher chance of developing testes cancer.

Any discovery of a lump in the testes must be verified by a family doctor or urologist. An ultrasound scan of the testes will be performed to confirm the lump. This is a painless examination which takes only about 15 mins.

Blood tests for cancer markers will also be done.

Upon confirmation of a solid lump, the patient will have to undergo surgery to remove the affected testis. This is a simple day surgery with a small incision made over the groin.

Further treatment would depend on the type and stage of the cancer.

New - Green light laser surgery for prostate

Green light laser or Photoselective vaporization of prostate (PVP) is a relatively new treatment for prostate enlargement or BPH. BPH treatment is usually by prostate medications to either relax the urine tube or decrease the size of the prostate gland. However, surgery may be required in patients with more significant obstruction that is not responding to medical treatment or who have developed complications.

It is a form of minimally invasive surgery that evaporates prostate tissue which is blocking the flow of urine from the bladder. Green light laser uses a unique high power energy which is selectively absorbed by blood within the prostate tissue which leads to vaporization and removal of the tissue, leading to an open channel for passage of urine. As it is selectively absorbed by blood, green light laser seals blood vessels beneath the area of vaporization which results in substantially less bleeding, compared to traditional traditional transurethral resection of prostate (TURP). There are much fewer side effects and recovery is much quicker.