Benign Prostatic Hyperplasia (BPH)
The prostate gland is a male reproductive organ located between the bladder neck and the urethra. It is shaped like a walnut and surrounds the urethra. The normal size of the prostate gland is similar to that of a walnut. Benign prostatic hyperplasia is a common condition in men over the age of 40, where the enlarged prostate compresses the urethra, causing urinary problems. About half of men over 50 years old experience symptoms of prostate enlargement, including slow urine flow, weak urine stream, urgency, frequency, and nocturia.
Doctors will examine the prostate gland to assess the degree of obstruction, which may include uroflowmetry to measure urine flow rate, ultrasound to evaluate the size of the gland, and tests to assess bladder and kidney function.
In the early stages, medication can be used to alleviate symptoms. If the condition
worsens or complications such as persistent hematuria, urinary tract infection, bladder stones, or acute urinary retention due to severe prostate obstruction occur, surgical treatment for benign prostatic hyperplasia may be necessary. Various transurethral resection procedures for prostate enlargement are available, including traditional transurethral resection of the prostate (TURP), bipolar prostate resection, Holmium
laser enucleation of the prostate (HoLEP), and Thulium laser prostate vaporization. These procedures are suitable for patients with different prostate volumes. In recent years, there have been innovative minimally invasive surgical approaches introduced in Hong Kong, including Urolift, Rezum, and Aquablation, which allow patients who are not suitable for general or regional anesthesia to undergo surgical treatment.
Prostate Cancer
Prostate cancer is the third most common tumor in men in Hong Kong, with over 2,500 new cases diagnosed each year. Risk factors include advancing age (>50 years) and genetics. Prostate cancer can be categorized into early-stage and advanced-stage. In the early stages, prostate cancer may not exhibit noticeable symptoms, and patients may experience similar symptoms to benign prostatic hyperplasia, such as urgency, frequency, slow urine flow, or nocturia. In advanced stages, patients may experience fatigue, bone pain, weight loss, or even hematuria, and it is crucial to seek medical attention promptly.
Doctors will conduct a digital rectal examination to assess the prostate gland, perform a blood test to measure Prostate Specific Antigen (PSA) levels, and utilize magnetic resonance imaging (MRI) scans to evaluate the locations and staging of prostate tumors. Prostate biopsy may be required to confirm the malignancy and provide moreinformation on the staging of prostate cancer.
Based on the patient’s age, physical condition, and stage of prostate cancer, urologist will formulate an appropriate treatment plan. Early-stage prostate cancer patients may undergo surgery or radiation therapy for curative purposes. Late-stage prostate cancer patients may receive hormone therapy in combination with novel oral hormone medications or chemotherapy to effectively control the disease.
Minimally invasive surgical options are available for early to mid-stage prostate cancer, where urologists utilize robotic assistance for more precise prostatectomy. Compared to traditional surgery, this approach significantly improves outcomes in terms of bleeding, pain, and recovery.
Men often prioritize work and tend to overlook their health. Men over 50 years old should undergo regular prostate health check-ups. Those with a family history of prostate cancer or high-risk factors such as smoking should pay attention to any changes during urination and seek medical attention promptly if any abnormalities are noticed.
(Staging of prostate cancer)
(Robotic surgical system)
Kidney Stones
Kidney stones are a common urban disease and are prevalent in Hong Kong, particularly among men aged 30 to 50 years old. The causes of kidney stones include genetic factors, inadequate water intake, excessive consumption of salt, sugar, or food high in oxalate such as strong tea, chocolate, nuts, or spinach. Common types of kidney stones include calcium oxalate stones, calcium phosphate stones, and uric acid stones.
When kidney stones are small, they may not cause any symptoms. However, as the stones grow or descend from the kidneys into the ureters, they can cause obstruction, leading to severe pain in the lower back, nausea, and vomiting. The movement of stones within the urinary tract can also cause scrapes and result in hematuria (blood in urine) or even symptoms such as fever and chills.
Doctors will arrange computed-tomography scans (CT) to accurately assess the condition of the stones and conduct blood and urine tests to evaluate kidney function and the acidity or inflammation of the urinary tract.
The treatment of kidney stones depends on their size and location. If the stones are
larger than 5 millimeters, extracorporeal shock wave lithotripsy (ESWL) can be used to break them into smaller pieces by transmitting shock waves through the skin. This procedure has a success rate of 70-80% for stones measuring 1 centimeter or less.
When kidney stones drop into the ureters, ureteroscopy with laser lithotripsy (URSL) can be performed. The urologist inserts a ureteroscope through the urethra into the ureter and uses laser energy to break the stones. The success rate of this surgery can reach 90%.
For kidney stones larger than 2 centimeters, percutaneous nephrolithotomy (PCNL) can be considered. Under the guidance of X-ray or ultrasound, the doctor punctures the skin with a needle to access the kidney and then creates a channel through which a nephroscope is inserted to break and remove the stones. This procedure has a stone clearance rate of over 90%
(URSL procedure)
Renal Cancer
In the past decade, the number of renal cancer cases has been increasing annually.
According to data from the Hong Kong Cancer Registry, the number of newly diagnosed cases of renal cancer rose from 498 cases in 2010 to 878 cases in 2019. With the
increasing popularity of body imaging, many cases of renal cancer can be detected at an early stage. The majority of new patients are aged 40 and above, with the highest peak occurring between 65 and 75 years old. Risk factors for renal cancer include smoking, genetics, hypertension, obesity, and long-term dialysis.
Urologists use computed-tomography scans (CT) to assess the stage of renal cancer and develop surgical plans. In early-stage renal cancer, surgical resection has a cure rate exceeding 90%. Surgical options include total nephrectomy or partial nephrectomy. Total nephrectomy involves the complete removal of the entire kidney along with the tumor, while partial nephrectomy involves removing only the tumor while preserving the remaining normal kidney tissue. Studies have found that if the renal tumor is 7 cm or smaller, both total nephrectomy and partial nephrectomy have similar cure rates.
Furthermore, partial nephrectomy allows for the preservation of more normal kidney tissue, reducing the chances of future chronic kidney failure and the need for dialysis. It also improves long-term cardiovascular function and survival rates for patients.
Currently, partial nephrectomy can be performed through minimally invasive
laparoscopic or robot-assisted approaches, significantly improving the precision of resection and enhancing postoperative recovery time for patients.
(Partial nephrectomy for renal caner)
