The matter of urologic diseases

Dr Henry Ho. Photo: Courtesy

Dr Henry Ho is an adjunct Associate Professor at both Duke-NUS Medical School and NUS Yong Loo Lin School of Medicine. He is the Head & Senior Consultant with the Department of Urology.

Dr Ho received his MBBS and Master of Medicine (Surgery) from the National University of Singapore.

He is trained as a robotic and minimally invasive cancer urologist. His fellowship in Europe was in the University of Innsbruck, Austria, under the tutelage of the late Professor Georg Bartsch. He was trained in robotic partial nephrectomy and robotic prostatectomy.

Additionally, he also did an endourology fellowship in Hamburg, Germany, with Professor Andreas Gross. He is trained in endoscopic management of stones disease and laser prostatectomy.

Recently, he was in Dhaka, and was able to share some of his thoughts on the current scenario of urological disorders.

What are the main types of illnesses and disorders associated with urology?

There are various types of kidney related problems — cancers, enlargement of the prostate, and clinical matters of the urinary bladder. There are the three major cancers that usually affect the uterine system, which comprises the kidney, the prostrate, and the bladder.

There is also Benign Prostate Enlargement (BPH), which increases in males in every 10 years, starting from the age of 50. With each passage of 10 years, there is a 10 percent higher chance of being diagnosed with it.

When enough water is not consumed, stones form in the kidneys. This is another major concern for urologists.

What are the symptoms of these disorders and cancers?

A common symptom in all the urological cancers is the presence of blood in urine. There is flank pain, causing intrusive bank pain. Tumours spread and stretches on the kidney, making urination a painful experience.

Prostate cancer is common in men above 50, and symptoms include passing off urine. In cases of cancer in the urinary bladder, symptoms include a burning sensation while passing urine.

In benign prostatic hyperplasia (BPH), there is dribbling at the end of urination, and inability to completely empty the bladder, causing pain. 

With kidney stones, there is an irritation every now and then when wanting to urinate as the pathway has been thickened making it difficult to respond to the calls of nature.



What is the most common type of urologic cancer in Bangladesh?

Bladder cancer is the most common, due to excessive smoking. In other countries, it is prostate cancer.

What are the lifestyle and health choices that should be followed/avoided to tackle these problems?

Smoking should completely be stopped. It is a major cause of cancer, especially in the urinary bladder. One should visit a physician once any of the symptoms are detected. Men above 50 should go for PSA (Prostate Specific Antigen) screening to detect any trace of tumour caused by prostate cancer. Exercise in the streams of yoga and jogging should be a regular practice. One should also drink plenty of water.

What treatments are available for the urologic illnesses?

For kidney cancer, there is nephrectomy to remove the entire kidney, or the infected parts. Cystectomy is carried out to remove the bladder when it comes to bladder cancer.

For prostate cancer, prostatectomy is carried out where a surgical removal of the whole prostate, or the infected part is removed. Radiotherapy is used in both bladder and prostate cancers.

For BPH, there is transurethral resection of the prostate (TURP), which widens the passage for the urine to flow smoothly. For kidney stones, extracorporeal shock wave lithotripsy (ESWL) is carried out using shockwaves to blast stones into pieces. Lasers are also available to break the stones in smaller pieces making them easy to get rid of.

A major improvement in treatments is the key hole operation using small robotic arms with a camera that makes quick and accurate cuts to detect and remove the tumours in sensitive areas such as kidneys, prostate, and bladder.

What are the current ongoing developments in urology?

The robotic arm surgery is a major stride in this field. Focal therapy, a non-invasive therapy to destroy tumours is being developed for prostate cancer, as radiotherapy is harmful.