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Exciting Trends in Urology

Dr Michael Wong, a usa fellowship-trained urologist and currently associate editor at the british journal of urology international, reveals the new and exciting trends in urology.

The past few years have seen unprecedented changes in the way we manage and approach both male and female patients with urological problems. Some trends are surprises, others expected – but all the advancements that have come about are definitely heartening.

Kidney Stones

Studies have shown that the incidence of kidney stones has increased over the past 10 years. This is likely due to the way we consume our food nowadays, which increases the incidence of medical conditions such as gout, diabetes and obesity. Having personally experienced the painful colic of stones, I am glad to see the technological advances that have been made in this field. Improvements include:

  • Better understanding of the causes of kidney stone formation, which are both hereditary and diet-related. No patient should be without proper counselling about lifestyle changes that will minimise stone recurrences. Thanks to extensive research, mainly from Duke University in the US, we are now able to deliver better stone fragmentation and less kidney injuries with shockwaves (ESWL) with changes to the protocol of its administration in the last two years.
  • Gone are the days where large, semi-rigid instruments were used to enter the human body. Urologists today use instruments as small as 3mm in diameter to remove the offending stones from the kidney.
  • As co-chairman of the World Health Organization international consultation on stone disease, i am committed to being involved academically in this important area. We have already drawn up guidelines on how best to manage stone disease worldwide.

    Male Fertility

    There are more couples realising the need for the male partner to be assessed when the emotional issue of infertility occurs. From an academic standpoint, the male infertility factor is present in more than half of all infertile couples, so it makes sense to have the man assessed in-depth before embarking on the long and difficult journey of assisted reproduction.

    Among the trends I’ve witnessed in the past couple of years are:

    • More males are now turning up in my clinic for a full comprehensive assessment for their male fertility factors.
    • Detailed quality counselling is required to better manage the male partner.
    • Published scientific data is now showing that in a carefully selected group of patients, sperm quality may benefit from microsurgery, resulting in better natural and assisted reproduction pregnancy rates.
    • In 2016, newer and more selective fertility drugs for the male will be launched to improve sperm production.

    Female Bladder Issues

    In the pursuit of managing male bladder issues, newer drugs have been formulated over the past eight years, while the female bladder has been left behind in more ways than one. Today, the understanding and management of the female bladder – with better-funded research – has resulted in the most obvious observation: that the female bladder is not the same as the male bladder! Urologist need to be updated to better deliver care to the female bladder; and some of the interesting trends are as follows:

    • Newer drugs are being launched in 2015 to better tackle Overactive Bladder Syndrome (OAB).
    • Certain drug therapies work better in women than in men.
    • Newer surgical techniques for the treatment of stress urinary incontinence must be appropriately matched to the patient for superior outcomes.
    • Post-menopausal bladder issues are much more common than we believe and need more specialised care and attention to prevent chronic infection and kidney damage.

    Prostate and Male Ageing

    The management of prostate and male ageing has been turned on its head over the past eight years with several important trends:

    • Newer oral therapy for large non-cancerous prostate has resulted in less than 25 per cent of cases requiring surgery today, with the focus on careful patient selection with close monitoring to establish who are likely to fail oral therapy and progress to bladder failure.
    • Use of newer energy sources to treat obstructing noncancerous large prostate with minimal downtime and bleeding.
    • Robotic prostatectomy for early prostate cancer has been redefined with new data in the last five years.
    • The search for a better quality of life past 50 is getting more attention and we are seeing better research data on the hot issue of male ageing.

    The need to be at the forefront of cutting-edge research in urology is paramount as we aim to deliver better and better urology outcomes.

    Dr Michael Wong

    Medical Director & Senior Consultant Urologist
    FAMS (Urology), FICS (USA), FRCS (Edinburgh),
    M Med (Surgery), MBBS (S’pore)

    Dr Michael Wong is a Senior Consultant Urologist who is internationally recognized for his surgical expertise and academic contribution to the field of Urology, in particular the subspecialized field of minimally invasive Endourology.

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