Erectile dysfunction in Singapore: prevalence and its associated factors--a population-based study.

PURPOSE: To study the prevalence of erectile dysfunction (ED) in Singapore males aged 30 and above and its association with demographic, medical and other risk factors. METHODOLOGY: A population based cross sectional study of 729 men aged 30 and above in Singapore was conducted using the abridged, five-item version of the International Index of Erectile Function (IIEF-5). Presence of erectile dysfunction was defined as IIEF-5 score of less than 21. Erectile dysfunction was further categorised into mild (IIEF-5: 16-20), moderate (IIEF-5: 11-15) and severe (IIEF-5: <11). A logistic regression model was used to identify significant independent risk factors for ED. RESULTS: Overall, 51.3% of respondents (n=374) reported some degree of erectile dysfunction. Of these, 23.2% have mild ED, 8.8% have moderate ED and 19.3% had severe ED. The prevalence of ED increased from 42.8% for men in their forties to 77.4% in their sixties. The prevalence of severe ED increased from 9.1% in men in their forties to 43.5% in their sixties and 77.0% in those aged 70 and above. Age above 50 years is the single most significant risk factor on multivariate analysis when adjusted for all confounding factors. Other important risk factors include Indian ethnic group, lower household income, physical inactivity, diabetes mellitus and cardiac diseases. CONCLUSION: Erectile dysfunction is common amongst Singaporean men. Age is the single most important physiologic factor affecting erectile function. The prevalence and severity increased significantly with age after 50 years old. With an ageing population, erectile dysfunction may become a significant health problem. Health care providers should plan their resources accordingly.

Prevalence of prostatitis-like symptoms in Singapore: a population-based study.

OBJECTIVE: To study the prevalence of prostatitis-like symptoms in a generally healthy population. SUBJECTS AND METHODS: A population-based cross-sectional survey was conducted in Singapore to evaluate "prostatitis-like symptoms" (PS), lower urinary tract symptoms (LUTS),erectile dysfunction (ED), and quality of life (QoL). Respondents with pain or discomfort in the perineum, testicles, tip of penis or bladder/suprapubic region were identified as having prostatitis-like symptoms. RESULTS: Altogether, 1087 males aged 21 to 70 were evaluated. While at least 20% of them had some degree of LUTS, only 2.67% (29 out of 1087) had pain or discomfort suggestive of prostatitis. Six men had pain in the bladder or suprapubic region, two in the perineum, six at the tip of penis and 26 had pain during micturition (11 subjects had more than one location of pain). Only two men had severe pain while seven had moderate and the rest had mild pain. The mean age of subjects with PS was 43.14. In terms of racial distribution, 2.23% (18) of Chinese, 3.15% (4) of Malay, 4.49% (4) of Indians and 12.12% (3) of other ethnic origin had PS. Those who had PS had worse erectile function (International Index of Erectile Function (IIEF) 11.92 vs. 17.16, p < 0.003) and a worse QoL score (2.96 vs. 1.38, p < 0.001) than those without PS. Those with PS were more bothered and worried about their symptoms. CONCLUSION: The prevalence of prostatitis-like symptoms in a largely Chinese population is 2.67%. Prostatitis-like symptoms have a negative impact on the quality of life and erectile function.

Laparoscopic telesurgery between the United States and Singapore.

INTRODUCTION: Telemedicine is the use of electronic digital signals to transfer information from one site to another. With the advent of a telepresence operative system and development of remote robotic arms to hold and manoeuvre the laparoscope, telemedicine is finding its role in surgery, especially laparoscopic surgery. CLINICAL FEATURES AND TREATMENT: We report two successful cases of laparoscopic surgery--radical nephrectomy and varicocelectomy for a 3-cm renal tumour and for bilateral varicoceles causing pain, where a less experienced laparoscopic surgeon in Singapore was telementored by an experienced laparoscopic surgeon located remotely in the United States. Both patients recovered uneventfully and returned home on postoperative day 4 and on the day of surgery, respectively. OUTCOME: This study demonstrates that telementored laparoscopic systems are feasible and safe, between countries halfway across the world. CONCLUSIONS: As the Internet expands in utility and the cost of higher bandwidth telecommunication lines decreases, even to remote countries, telementoring systems will become more affordable and may potentially pave the way for advanced surgical and laparoscopic applications and training for the future.

Phyllodes tumour: an update of 40 cases.

This is a retrospective study of 40 cases of phyllodes tumour treated at the National University Hospital since 1985. The mean age of presentation was 37.8 years, with a range of 15 to 58 years [standard deviation (SD) 11.22 years]. Ninety per cent of the patients were premenopausal. The mean size of tumours was 52 mm, with a range of 10 to 220 mm. Preoperative diagnosis was correct in only five patients, the lesion most commonly being mistaken as a fibroadenoma. Initial surgical treatment was by simple excision in 80% of cases. Histologically, the ratio of benign, intermediate and malignant tumours was 82.5%, 12.5% and 5% respectively. Recurrences occurred in only four patients (10%), all of whom were initially treated by simple excision. The diagnosis of phyllodes tumour continues to be difficult even with newer modalities of preoperative investigations, resulting in simple excision as initial treatment of these tumours. Expectant follow-up should be continued for these patients, with wide excision of future recurrences.

Surgical Nutritional Team and its impact on total parenteral nutrition in The National University Hospital, Singapore.

The Surgical Nutrition Advisory Team (SNAT) of our hospital, formed in October 1992, decided to study the impact of such a team on the six months before and after its formation on catheter care and nutritional support in total parenteral nutrition. Our study showed that with a dedicated nutritional team, catheter sepsis was reduced from 35.1% to 15.4%. The median lifespan of central catheters was increased from 7 to 11 days. Mechanical complications were reduced from 11% to zero. Better patient selection resulted in more severely malnourished patients receiving preoperative nutrition and fewer postoperative patients being started on total parenteral nutrition. Better monitoring of nutritional requirements, electrolyte and metabolite levels and consequently faster correction of abnormal blood levels, were also obtained.

Use of iontophoretic anaesthesia in urologic surgery: a preliminary experience.

Iontophoretic anaesthesia involves the active transport of lignocaine into underlying tissues, by means of an electric field, for anaesthesia. Its use in urology in transurethral operations on the bladder and prostate have been well documented. We present a preliminary experience of its use in the following cases: a transurethral resection of a bladder tumour, a transurethral resection of bladder cysts and incision of the bladder neck and a transurethral resection of the prostate. In the few cases that we did, we found that patient selection and patient preparation is of utmost importance as unlike a complete anaesthesia, the patients can feel deep pressure and heat if diathermy is prolonged. It is also important not to oversedate the patients with midazolam as an uncooperative patient may render any procedure impossible. The greatest drawback of this procedure is that the degree of anaesthesia tends to vary from person to person. As such, it is difficult to predict who would or would not respond to this from of anaesthesia. However, with improvements in protocols, current delivery systems and different anaesthetic agents used, one may see a proliferation of this form of anaesthesia in urology in the not too distant future.

Abdominal trauma--a review.

Trauma is a leading cause of death in the 1-44 age group. In our study, the most common cause is road traffic accidents followed by stab wounds and falls from height. Blunt abdominal trauma accounted for 79% of the cases. The spleen and liver were the most common organs involved in blunt abdominal trauma. Clinical assessment of blunt abdominal trauma is unreliable. The diagnostic peritoneal lavage is a useful triage tool in the initial assessment.

Fournier's gangrene.

Fournier's gangrene was traditionally thought to arise spontaneously. More recently, cases with urological, perianal or systemic predisposing causes have been reported. This report describes four cases of Fournier's gangrene, all associated with a predisposing cause: two with diabetes mellitus, two secondary to urinary tract pathologies, and one secondary to an infected wound after an inguinal herniorrhaphy.