PREMATURE EJACULATION早洩的問題

李長茂沙巴談少人啟齒的早洩問題 

PREMATURE EJACULATION

Dr Clarence Lei Chang  Moh

MMA Sabah
3rd SABAH GP CONFERENCE
Kota Kinabalu 15 May 2011

 

Premature ejaculation

Premature ejaculation

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古晉泌尿專科Kuching Urology

Kuching Urology.com

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About contributors:

Dr Clarence Lei Chang Moh, born in Sarikei, Sarawak, Malaysia in 1956.

Qualified as a medical doctor from University of Malaya 1981.

Obtained specialist surgical fellowship with Royal College of Physicians & Surgeons in Glasgow in 1986.

Obtained through post graduate studies and examination: FRCS Urology, from Intercollegiate Board of Urology of United Kingdom; Diploma of Urology (with distinction) at University College London and FEBU, Fellow of European Board of Urology.

A past president of Malaysian Urological Association.

Chairman of Malaysian National Specialist Register (Urology).

email: clarencelei@gmail.com

Postal address:

G.P.O. 2194, 93756 Kuching, Malaysia.

I acknowledge the contribution and excellent teamwork from my professional partners in urology (Dr Teh Guan Chou, Miss Anne John, Dr LimMeng Shi etc and in nephrology viz Dr WILLIAM CHAU, Dr SIMON WONG, Dr CLARE TAN towards the development of urology in Kuching.

Forward on UROLOGY IN KUCHING by Dr Ganesh Gopalakrishnan

The Malaysian airlines flight from Kuala Lumpur to Kuching made a perfect touchdown at the airport on a bright midafternoon in September 1999.

This was my first visit to East Malaysia and the scenic beauty of the countryside made the western side of the country pale away. Kuching was like ‘Gods own country’ and I was there to join my wife on a sabbatical as a urologist in UNIMAS.

There was so much of urological disease in Kuching and the number of urologists were few. The city was lucky in having Dr. Clarence Lei a senior urologist to shoulder responsibility but that could never fill the void between supply and demand.

Kuching General Hospital was the place where I was posted to work and teach the medical students. Dr. Clarence had worked there before he moved into the private hospital Normah Medical Centre. This was the only urological setup in the public sector for the whole of the state of Sarawak and we had to cater to a lot of patients from different corners of the region. Apart from general urological problems we had to treat many with chronic renal failure. With his help, we were able to provide access to hemodialyis for them . This saved them going all the way to Kuala Lumpur for this procedure. In fact we were also able to do a cadaver kidney harvest and send the organs to KL for transplantation.

We had facilities for both endourology and shockwave lithotripsy. There was a state of the art ultrasound machine in the outpatient department of Kuching General Hospital with which we were able to provide an efficient and quick service to the patients. A quick scan of their kidneys, residual urine in patients with bladder outflow obstruction and transrectal guided prostatic biopsies in those with raised PSA to look for prostate cancer.

Urological services were also available at the Timberland Medical Centre where I was doing some private work once I was free from the work in Unimas . here again urological services in the form of transurethral prostatectomy, percutaneous nephrolithotripsy, ureteroscopy and other open procedures for both local Kuching residents and those from across the border in neighbouring Pontianak .

Professor Ganesh Gopalakrishnan,

Professor of Urology, Christian Medical Centre Vellore,

(Visiting Professor, Universiti Malaysia Sarawak 1999 - 2000)

President, Urological Association of India.

December 2008

Dr Tang Sie Hing’s introduction in Mandarin:

李長茂醫生是砂勞越第一位泌尿及腎臟外科醫師，他不但醫術高明并且很熱心于醫學教育。雖在私人界服務，他也不停地在馬來西亞砂勞越大學教導醫學生。他也不間斷地在砂勞越中央醫院參與訓練及培訓泌尿及腎臟外科醫生。李醫師是一個難得的人才，我們每一位砂勞越人都為他感到自豪。

Recommended links:

www.acadmed.org.my

www.national specialist register.org

www.urology-malaysia.org

www.malaysian urology association-CME

www.normah medical specialist centre

www.European Association of Urology

www.American Urological Association.org

www.Urology.Health.org

www.ramuro.com

blogsites:

sarawak cardiology

sarikei time capsule

TOPICS COVERED

ABOUT KUCHING

Forewords

Hypospadias

Hydronephrosis

Testis, undescended

Hydrocele

Posterior urethral valve, PUV

Reflux, vesico-ureteric reflux, VUR

Duplication Urological Anomalies

Cancer, kidney

Cancer, ureter

Cancer, bladder

Cancer, testis

Cancer, prostate

Prostate, benign prostatic hyperplasia, BPH

Prostate, prostate specific antigen, PSA

Prostate, biopsy

Prostate, transurethral resection, TURP

Stones, modern management

Stones, extracorporeal shockwave lithotripsy, ESWL

Stones, kidney, percutaneous nephrolithotomy, PCNL

Stones, ureter, ureteroscopic lithotripsy, URS

Stones, bladder

Stones, urethra

Infection – urinary tract infection, UTI

–Tuberculosis, TB

Kidney Failure, arteriovenous, AVF

Transplantation, kidney

Transplantation, kidney in children

Aging: Testosterone deficiency syndrome (TDS), Andropause, Menopause

Subfertility, male

Sexual Dysfunction, male

Sexual dysfunction, female

Blood in urine

etc

General Interest WRITINGS

Guides

TEXTBOOK references

Application for Medicine

Malaysian Urological Association

Urology Training

EXAMS in Urology

Specialist Register in Urology

HOW TO EXERCISE THE PELVIC FLOOR MUSCLES?

Weakness of these muscles is a common cause of leakage of urine with physical stress,

e.g. laughing, sneezing or jumping.

(1) How to feel the pelvic floor muscles?

We do not usually consciously use the pelvic floor muscles and therefore, they are

not easy to identify in the beginning. These are the muscles that one uses to stop

from passing wind or faeces or stopping the passage of urine in the mid stream.

Therefore, you have to tighten the muscles around the anus. You can feel the anus

contracting. These are not the abdominal and leg muscles.

To confirm that you are contracting the correct pelvic floor muscles, try to stop

urination mid way. If you are not able to slow down the urination, it means that you

are not exercising the pelvic floor muscles.

You may also be able to use a pelvic floor muscle indicator inserted into the vagina

over a condom to see the strength of the contraction.

(2) Pelvic floor exercises

You should try to contract the muscles and hold on for as many seconds as you can.

Try to hold the contraction to a count of 10. Repeat 10x. Allow a 5 seconds rest in

between each squeeze. Do at least 3 sets per day, at your convenience, e.g. every

time you go to toilet, while waiting or watching TV, in the morning and before going

to sleep. The muscles can be contracted while you are lying down, then sitting and

later you can contract them even when you are standing. You should have a routine

for doing this exercise. You should feel an improvement after 3 months. Whenever

you need to sneeze or cough, you can prevent urine leaking by tightening your pelvic

floor muscles. You can also monitor the progress of your pelvic floor muscles by re-

inserting the pelvic floor meter over a condom to see the strength and duration of your

pelvic floor muscles. You can do this as often as you like with the continence nurse.

If you insert your finger into the vagina and try to grip the finger with the pelvic floor

muscles, you may appreciate an increase in strength of the pelvic floor muscles. You

can also test the strength of the pelvic floor muscles by insertion of various weights

of vaginal cones which usually come in sets with increasing weights of 1 to 5. These

cones are inserted like a vaginal tampon, leaving the string outside. You can insert

the vaginal weights and hold it while walking around for 15 minutes twice a day.

The strength of the pelvic floor muscles by itself cannot be improved by surgery nor

medication and therefore, pelvic floor exercise is the mainstay for long term control of

stress urinary incontinence.

DR CLARENCE LEI CHANG MOH, 李 长 茂 泌 尿 科 专 科 医 生

MBBS(Mal), Dip.Urology(London), FRCS(G), FRCS Urol(UK),FICS (USA) FEBU, FAMM

Consultant Urologist

Kidney & Urology Centre

Normah Hospital, Petra Jaya, 93050 Kuching

Tel: 082-440055 (Nurse Cannie Bong/Drusila Taylor ext. 264/269) Fax: 082-313494

For best results, please e-mail to: leicm@normah.com and cmlei@tm.net.my

Dr Lei in London

A recent photograph of myself when I was in London at the Holborn Tube Station.

FLYING FROM MALAYSIA TO LONDON, STANSTED AIRPORT
By Dr Clarence Lei, 25.4.2011

With 2 children studying in the U.K., I have now become a frequent flyer using Air Asia
X to London Stansted ! The returning trip is just over RM3,000 and if one can afford
to upgrade to premier class, the trip is more than comfortable. If you take a 1.15 am
flight from Kuala Lumpur, it will arrive London at 8 am., after a good night sleep and 2
Malaysian meals.

IMMIGRATION:

There is usually not much queue compared to other international airports, especially
when I used to fly into Heathrow. The immigration officers are more friendly and hardly
ask any questions. Before Air Asia lets you board, it would have already checked that
you have a return ticket of some sort. The immigration boarding card would require you
to state where you are staying in the U.K.

CUSTOMS:

There is usually no custom officer if you arrive before 9 am. I had been stopped only
once and they asked simple questions.

STANSTED AIRPORT TO CENTRAL LONDON:

It is advertised that the cheapest way to London is to use a bus, for ₤8. However, I
usually prefer the “fastest way, 45 mins.” using a Stansted Express by train. However, it
does cost ₤21. However, there is free internet and power supply on the train and there
is hardly any people using the train. The train goes to Liverpool Street Station and you
can take a tube to any part of London from there. However, if you are travelling with a
few people with many bags, it is cheaper to take the Checker taxi which is a large MPV
and takes you to the destination for about ₤100.

BUDGET ACCOMMODATION IN LONDON:

If you book online earlier (may be 2 weeks), you can find a number of good B&Bs for
about ₤80 per night. Most also comes with a free internet and the facilities for you to
keep your bags and to take a shower, if your flight is in the evening. I had stayed at
reservations@goodenough.ac.uk ( a postgraduate hall, 5 mins from Russell Square
tube station) and info@fitzroy-hotel.net (B&B, 3 mins from Warren Street station).

POWER SUPPLY AND INTERNET AT THE AIRPORT:

KLIA is one of the few airports in the world that has a good free wi-fi for 2 hours. It
would be handy to keep some ₤1 coins when you are at the London airports as you
need the ₤1 coins to get a baggage trolley and also to use about 10 mins of internet.
The internet would be useful for you to retrieve the emails upon arrival and also before
departure. There are very limited power points in the airport and some of them would
require you to put in coins as well. Fortunately, there are a number of ATM machines
throughout the airport and they allow you to have “free cash withdrawals”.

Departure Checks: Air Asia allows you to carry 1 bag of 7 kgs and a small laptop bag.

Nowadays, they threaten to weigh all the hand luggage as well!

You can also do an online check-in and send the boarding pass through the hotel
reception by email for them to print out the boarding pass for you. I find this very useful
because the queue for the baggage drop and document check is very short, compared
to the otherwise very long queues at check-in.

There is not much queue at the security screening but they do still require us to take out
the laptop to be screened separately.

TRAVELLING AROUND LONDON:

I find that the underground (or tube) is the most convenient. It is a little bit cheaper if
you start after the rush hours, i.e. after 9.30 am. If you intend to stay for a few days
and make a number of journeys, the most convenient ways is to buy a travel credit card
called Oyster Card. One usually finds that ₤20 would be sufficient for a few days travel.
The card is quite an intelligent card and therefore, you should remember to touch the
machine in and out at each trip, otherwise, the system will deduct ₤4.1 automatically if
you forget to touch out. There are plenty of cheap food and simple meals sold in the
supermarket, e.g. Sainsbury, Marks &Spencer.

CONCLUSION:

It need not be expensive to be a frequent traveller to London and it is generally safe.