Down Memory Lane, Asian Congress of Urology in 2002, somebody sent this to me today!

 Report of 6th Asian Congress Of Urology, 14-17.8.2002,

C Moh

Citation

C Moh. Report of 6th Asian Congress Of Urology, 14-17.8.2002,. The Internet Journal of Urology. 2002 Volume 1 Number 2.

Abstract

6 th Asian Congress of Urology 31 December 2002

850 urologists from 45 countries participated in the above Congress which was held for the first time in Malaysia. The Congress was organised by the Malaysian Urological Association in association with the Urological Association of Asia (UAA). It has obviously grown from the smaller gatherings of previous years in Bangkok, Singapore and Beijing. The local organising chairman was Dr Sahabudin Raja Mohamed who was elected as the new President of the UAA. The Secretary of the Malaysian Urological Association, Dr Rohan Malek was elected by the UAA Council to become the new Director of the Asian School of Urology, taking over Prof. Pitchai of Thailand. The highlight of the Congress was a pre-congress event which showed live surgery via video cyber conferencing linking Mainz hospital in Frankfurt, St Mary's Hospital London and Hospital Kuala Lumpur. As the host country, the Institute of Urology & Nephrology in Kuala Lumpur was the main venue for the pre and post congress surgical workshops. The Institute has an audio visual centre which allows it to be linked up with the rest of the world. The Malaysian Urological Association also took the opportunity to launch its landmark publication, viz “The History of Urology In Malaysia”. The Tourism Ministry of Malaysia hosted the Cultural Night in the garden of the famous Twin Tower of Kuala Lumpur. The Gala Dinner was graced by none other than the King of Malaysia.

“Urology in the IT era” is a most fitting theme for the Congress, as Malaysia aims to be the Multimedia Super Corridor of the East. The scientific program was a splendid combination of many lectures by Asian and international speakers. There were symposia of Asian speakers or Asian topics including a symposia under the auspicious of FAUA, Federation of Asian Urological Associations. All the lectures were presented only in a digital format, making it possible to produce CDs for all the events as well as to web cast the

entire proceedings of the Congress ( http://www.meditech.co.uk ). It is anticipated that the Asian School of Urology will take it from here and make available on the internet the Malaysian Board of Urology advanced urology courses which were conducted on an average about 6 times a year in Malaysia. The Ministry of Health in none other than the Minister of Health himself showed a keen interest and support for the activities of the Asian urologists. The Ministry of Health has agreed in principle to sponsor a fellowship program and has allocated a budget for fellows to be accepted from Asian countries to Malaysia.

An Asian School of Urology website based in KL is also being planned so that all the activities of Asian urology can be circulated quickly to all the Asian urologists. The meeting also re-elected Dr K T Foo of the Singapore General Hospital as the Secretary General of the UAA. The UAA council had conveyed through Dr K T Foo that the Asian School of Urology will be located in Malaysia for a period of 4 years initially.

The almost 400 abstracts from the 6 th Congress of Urology were published in the prestigious indexed International Journal of Urology,(2002, Vol 9 suppl.) published by Blackwell Publishing. The scientific sessions were grouped roughly into interest topics for each day, namely, on the 1 st day, ED; Fertility Research BPH on the 2 nd day; Incontinence Infection, Uro-oncology on the 3 rd day; and on the 4 th day, to cover the other topics of Stone Disease, Transplantation, Reconstructive & Paediatric Urology, and Transplantation. In addition to the usual State of Art lectures and various trade sponsored symposia (3 teas and 3 lunches), there was an Asian Forum running concurrently on each day. A master class session was also held on each day to cover Incontinence, Uro-oncology and Endourology respectively. The whole spectrum of free papers on the various topics were presented and the quality of the papers reflected the

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Report of 6th Asian Congress Of Urology, 14-17.8.2002,

tremendous amount of clinical material available in Asia. There was also considerable basic as well as clinical research being undertaken in Asia. An authoritative half- hour session of “Highlights” of the previous day was held on the first session of each day. A wide range of Exhibitors took up 73 booths.

The Asian Congress of Urology is now set to be one of the

major regional urological meetings on par with the American and European urological meetings. The next meeting is scheduled to be from 31.10.2004 to 4.11.2004 in Hong Kong. The local organising chairman is Dr Bill Wong, Consultant Urologist at the Queen Elizabeth Hospital in Hong Kong (email: billwong@graduate.hku.hk ).

References

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Report of 6th Asian Congress Of Urology, 14-17.8.2002,

Author Information

Clarence Lei Chang Moh

Scientific Chairman

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:b520c5e7-1e8d-4976-8dca-eafc587b627f

Vaccines for Cancer!

 BOOK REVIEW ON “TOP 5 NATURAL CANCER VACCINES” BY PROFESSOR DR NOR HAYATI OTHMAN

 

I was expecting a long queue while waiting for my first dose of COVID-19 vaccine and brought another type of “vaccine”, i.e. a compact book written by my university mate, Yati.  

 

What is a vaccine?  As a pathologist and a urologist, we probably look at things from the other end, the results!  It is amazing that such simple valuable information on cancer prevention is not widely practised.  Professor Dr Nor Hayati Othman has clearly illustrated that cancer can be prevented by the simple strategies of such as reducing the risks from smoking and  obesity. Diabetes is not only the top non-communicable disease in Malaysia but a risk factor for cancer. Exercise, having a balanced diet with less processed food and more fresh vegetables/fruits are important in cancer prevention.  In the book, evidence is also presented that taking daily doses of natural honey as well as daily doses of curcumin (found in turmeric which we use for cooking frequently) reduces cancer.

 

Throughout the book, Professor Dr Nor Hayati Othman has presented data from research including many of her own research in Universiti Sains Malaysia.  However, at my age, I do find that the fonts of the many illustrations  small for comfortable reading!  The book is a small one that can fit into the pocket and it is only 41 pages.  Even without looking at the figures and tables, reading the headings and the last paragraph would convey the important messages.  Patients in the waiting room can easily read  this wonderful little book.

 

Dr Clarence Lei Chang Moh,

Consultant Urologist

 

 

Undescended Testis "Basic to Clinical Practice" updated on 15 February 2021

 Undescended Testis “Basic to Clinical Practice” 

@ Asian Congress of  Urology / Thai Urological Association 23 Aug 2012

 

By Dr Clarence Lei Chang Moh, FRCS (Urol), FEBU, Consultant Urologist

clarencelei@gmail.com; WA: +60128199880; kuchingurology.com

 

Undescended testis (UDT) is defined as a testis which has failed to descend to the scrotum and is retained at some point along its path of descent.  The gonads first appear in intra-uterine life around the 2^nd month at the lumbar area and descends under the influence of androgens and shortening of the gubernaculum.  The cause of UDT is thought to be due to hormonal or genetic defects.  Nevertheless, hormonal manipulation after delivery is of limited value in UDT.  The incidence of UDT at birth is estimated to be about 4% and 1% at 1 year of age.  Therefore, surgical treatment is recommended around 1 year of age.

 

The management of UDT depends on the following factors: unilateral or bilateral, whether ectopic, the location and size of the testis.  80% of UDT are palpable. Retractile testis may be observed. If the testis is not palpable in an obese groin, a good quality ultrasound of the groin may help to locate the testis in the groin or just at deep ring; sensitivity in identifying inguinal testis is 95%. MRI  & CT may not be useful to locate the intraabdominal position. The definitive  investigation is a laparoscopy and if only a nubbin is found, it is not necessary to excise it.  

 

Almost all bilateral intraabdominal testes would be infertile, if not operated.  Germ cell depletion is noted in 55% of testicular biopsies of intra-abdominal testes at 12 months (AbouZeid). On the other end of spectrum, fertility is almost normal if there is a unilateral descended normal  testis. 93% of UDT have absent germ cells on biopsy. There is an increased relative risk of malignancy in the UDT, 2.75 to 8 times, with an absolute risk of  1%. The risk of cancer would be when the patient is 15 to 30 years old. The peritoneal invagination of the processes vaginalis follows the course of the gubernaculum and when patent,  increases the UDT to torsion, trauma and hernia formation.  These are additional reasons for surgical treatment. Surgery is usually a one-stage orchidopexy, performed under magnification, Prentiss manoeuvre if necessary.  After orchidopexy, malignant risk is  still present, with more cases of non-seminoma.  If it is not possible to bring intraabdominal testis to the scrotum, one can do a two-stage procedure by performing a high ligation of the spermatic vessels during the first stage (Fowler Stephen). The 2^ndstage operation may be performed 6 to 12 months later, doing one side at a time.

 

Updated 14 February 2021

 

References: 

AbouZeid et al Intraabdo testes Biopsy J Urol 2011, 185- 269-274

Fowler Stephen J Urol 1996, 156:802

Jack Elder J Urol 2009, 181: 452-461

Prentiss, J  Pediat Urol 2012 (8): 488

 

 

Surgical Points of Technique URETERIC RE implantation etc Made Easy by Dr Clarence Lei on 10 Nov 2020

 

RATIONAL USE OF ANTIBIOTICS IN SURGERY for final year medical students, by Dr Clarence Lei, FRCS Urol

RATIONAL USE OF ANTIBIOTICS IN SURGERY

 

INTRODUCTION:

 

When antibiotic is properly used in surgery, it has a beneficial impact and is life-saving.  However, if it is wrongly used or abused, it can cause severe side effects and in the long term, give rise to unwarranted antibiotic resistance. 

 

WHICH ANTIBIOTIC TO USE?

 

Ideally, the antibiotic used should be according to the culture and sensitivity of the pathogen.  However:

 

(1)        The bacterial culture often takes time, usually a few days.

(2)        The culture of the pathogen may not be possible or the pathogen is not cultured from the specimen collected.

(3)        The patient or location of the pathogen may not allow the correct antibiotic to be used, e.g. when there is allergy, when there is a barrier e.g. in an abscess or in the brain or the prostate where there is a blood organ barrier.

 

There is therefore often empirical use of antibiotics, i.e. when a “best guess” antibiotic is used, starting with the least broad spectrum and cost effective antibiotic. The “best guess” is often based on the antibiotic pattern for pathogens in that geographical locality for the organ system.  

 

ANTIBIOTICS FOR THE DIFFERENT ORGAN SYSTEM PATHOGENS:

 

Broadly, the main groups of antibiotics are as follows:

 

(1)        The Penicillins which are again divided into many groups with their own efficacy e.g. 

a)    crystalline Penicillin is often used for meningococcal infection and for syphilis.  It is also very effective for streptococcal infection.  The intravenous Piperacillin is often used together with tazobactam (to block the action of resistance by beta lactam, the beta lactamase inhibitors) and it is called Tazocin. However, this has to be given 3 to 4 times intravenously.

b)    Cloxacillin would be useful for staphylococcal infection, although there is now an increase of MRSA or methicillin resistant staphylococcus aureus. 

c)     Ampicillin or bica-ampicillin has been widely used in the community and therefore, there is a high rate of resistance.  Now, it is often used together with Clavulanic Acid (the trade being Augmentin)  or combined with sulbactam (Unasyn).  Augmentin also has some anti-anaerobe activities as well as against Enterococcus faecalis; hence Augmentin is also widely used in surgery.  

 

(2)   The next group of antibiotics are the Cephalosporins which are may be in various “generations”. The earlier generations e.g. Cefazolin are often used as the first line prophylaxis for any surgery involving a skin incision.  The 2^nd generation would involve the Cefuroxime (trade name Zinnat).  However, in the Kuching locality, Cefuroxime has been grossly overused. There is also a crossover hypersensitivity of cefuroxime with Penicillin.  Therefore, Cefuroxime is less used now. The injectable cephalosporin, Ceftriaxone, has the advantage that it can be given intramuscularly as well as a daily dosage.   Other 3^rd generation Cephalosporin includes Ceftazidime (trade name Fortum).

 

(3)        The next group of antibiotics are the aminoglycosides (injection only)  e.g. Gentamycin and Amikacin. These are  nephrotoxic and the dosage has to be titrated according to the renal function and the drug level monitored.  

(4)        The next group of antibiotics are the  Carbapenems (injection only): Imipenem and Meropenem.  These are very broad spectrum antibiotics. Most hospitals would have an antibiotic policy and the usage of  such “high end antibiotics” would require approval by the infectious disease, ID physician. 

 

(5)        The next group of antibiotics are for the anaerobes. In fact, there is only one outstanding one, i.e. Metronidazole (trade name Flagyl). These are often used in abscesses affecting the bowel or even the genitourinary tract.  

 

(6)   SULPHUR DRUGS:

These are seldom used nowadays as there is a high level of resistance.  However, when it (sulfamethoxazole) is combined with Trimethoprim (Co-trimoxazole, trade name Bactrim or Septrin), it is effective.  Moreover, the sulphur drugs have a significant level of serious skin allergy, namely, Steven Johnson Syndrome.  There is still a high level of bacterial resistance as this has been used in the community for many decades.  Sulphur drugs are also contraindicated in young babies. Hence, a popular drug to be used in most western countries is just to use Trimethoprim alone.  Trimethoprim can also be used for antibiotic prophylaxis, i.e. the patient takes a tablet at night for many years to prevent recurrent urinary tract infection. 

 

(7)   The macrolides, e.g. a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin. They are useful in treating respiratory, skin, soft tissue, sexually transmitted, H. pylori and atypical mycobacterial infections

 

(8)   Nitrofurantoin is also widely used in the cystitis; it is a narrow spectrum and cost effective. It is more widely used overseas. However, it has significant side effects of skin, GI, liver toxicity & peripheral neuropathy.  

 

(9)   TETRACYCLINES:

These are bacteriostatic  but is useful for certain types of infections e.g. by the microplasma or chlamydia.  A  useful formulation is that of Doxycycline 100 mg given once or twice a day, depending on the indication.  Daily dose is often used for months to control acne.

 

(10)                 QUINOLONES eg ofloxacin, ciprofloxacin, levofloxacin are often used for the urinary and respiratory tract. It is also widely used in veterinary and so there is often a high level of resistance. There is a definite risk of toxicity to the tendons (including rupture) and also contra indicated in children (seizures). 

 

(11)                 ANTIBIOTICS for special infections:

 

In special infections e.g. tuberculosis, resistance develops very fast if only 1 antibiotic is used. Therefore, tuberculous infections are usually treated with a combination of 4 antibiotics, namely, INH, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin.  These also have to be given over a prolonged period of time, usually 4 to 12 months, depending on where the infection is.

 

Other infections e.g. melioidosis, also requires a prolonged course of antibiotics, usually in combination, e.g. intravenous Ceftazidime followed by Augmentin.  

 

Antibiotics for infection in special locations require special & prolonged course, eg levofloxacin is in high concentration in the prostate but still need to be given for a month. 

 

(12)                 Antifungals, can be important esp in immunocompromised patients.

(13)                 Anti virals

 

ANTIBIOTIC USAGE TOGETHER WITH SURGERY:

Where there is collection of pus or where there is less chance of the antibiotic reaching the bacteria, surgery may have to be considered.  This includes the drainage of abscesses, removal of non-viable tissue e.g. necrotic tissue Surgery is important.  Where there are foreign bodies e.g. catheters, these may have to be removed as the antibiotics would not reach foreign bodies if they continue to be harbouring the organism. 

 

PROPHYLACTIC ANTIBIOTICS. 

 

In “clean” surgery there is only one dose of intravenous antibiotics, typically given by the anaesthesiologist at induction. These include cefazolin for clean skin surgery eg radical orchidectomy, gentamycin or Augmentin or ceftrazone for endourology. The ID nurse will typically check medication charts of postoperative patients that the prophylactic antibiotics are not continued.

 

by 

Dr Clarence Lei, FRCS Urol, Adjunct Professor, UNIMAS.

1^st Draft for  Final Year Students in the Surgical Posting

20 Oct 2020.

 

 

 

 

Paediatric Renal Transplantation: what is difference & limitations, edited. Mal Soc Transplant, Annual Meeting 20 Sept 20