Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia gravis (MG) on steroid therapy and non-insulin dependent diabetes mellitus (NIDDM) who developed cryptococcal meningitis and in whom a search for a persistent focus by...

Urogenital fistulas are a known but uncommon complication of gynaecological surgery, especially those involving a malignant process. Its incidence does not exceed 2%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at high risk for local recurrence after radical hysterectomy. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The above article highlights the insensitivity of urine microscopy compared with the Combur 9 test for detecting haematuria associated with urinary calculi. In the article, the equivalent microscopic RBC values for the Combur 9 are given as 5/ml (typo? it should be 5/µl) and 10 /ml (?10/µl) for intact...

Significant technological advances have been made in the management of ureteric calculi. The newer semirigid, fibreoptic ureteroscopes can now be passed with minimal trauma and in many cases without dilatation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run over by a wagon resulting in bilateral suprapubic dislocation of his testes. This article is available only as a PDF. Please click on “Download PDF” on...

Patients with renal or ureteric colic are commonly seen at our Emergency Department. We routinely check their urine for haematuria using the Combur 9 test (Boehringer Mannheim, Germany) alone without doing urine microscopy unless the patient shows pyuria on the Combur 9 test. This article is available only as a...

Staging of disease is important. It serves as a guide for further management and also for comparing the results of treatment. Traditionally this has been used for malignant disease. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Acute retention of urine (ARU) is the commonest urological condition requiring emergency admission to hospital and is usually managed by urethral catheterisation. Previously, patients with long-standing bothersome symptoms and who present with first episode of ARU were offered transurethral resection of prostate (TURP). This article is available only as a...

Dunnil and associates first described the association of renal cell carcinoma (RCC) with acquired cystic kidney disease (ACKD) and end stage renal disease. The incidence of ACKD in dialysis patients ranges from 10% to 90% depending on the duration of dialysis. This article is available only as a PDF. Please...

A characteristic feature of renal cell carcinoma is the development of tumour thrombus extending into the inferior vena cava (IVC). This takes place in 4% to 10% of cases. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The management of the non-functional tuberculous kidney is controversial and ranges from surgical intervention to conservative treatment. Intra-renal scarring with stricture formation is common in the late stages of renal tuberculosis and results in greater loss of renal function than direct involvement by tuberculosis alone. This article is available only...

The treatment of urinary calculi has changed tremendously since the introduction of extra corporeal shockwave lithotripsy (ESWL), percutaneous nephrostolithotomy (PCNL), and ureteroscopy over the past decade in our hospital. Patients previously requiring open surgical procedure are now treated successfully with these new therapeutic modalities. This article is available only as...

Haematuria of any degree should never be ignored and, in adults, it should be regarded as a symptom of urological malignancy until proven otherwise. Mariani et al, in their evaluation of 1000 consecutive patients, revealed life-threatening lesions in 9.1% of cases. This article is available only as a PDF. Please...

Nitric oxide (NO) has been recognised as a nonadrenergic noncholinergic (NANC) inhibitory neurotransmitter at various sites in the nervous system. Its function as a NANC inhibitory transmitter has been documented in muscular and sphincter relaxation in the cardiovascular, digestive and urogenital system. This article is available only as a PDF....

Castleman’s disease (CD) was first proposed by Castleman in 1954. It is usually found in the mediastinum, but other sites have been described. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

As the population is growing older and the society getting more affluent, people are aiming for a better quality of life. This has resulted in greater awareness of erectile dysfunction (ED), thus increasing the number of patients approaching the doctor for consultation. This article is available only as a PDF....

Telemedicine is the use of telecommunication technologies to provide medical information and healthcare services. Early applications include medical use of the telephone and facsimile. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Vesico-ureteric reflux (VUR, OMIM #193000), the name given to reflux of urine from the bladder into the ureter and towards the kidney, is believed to be due to a developmental abnormality of the ureteric bud during embryogenesis. Ureteral reflux has been known for centuries; in the 15th century Leonardo...

Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of these tumours that direct electrical stimulation of the obturator nerve occurs. This article is available only as a PDF. Please click on “Download PDF” on top...

It is well known that T1 carcinoma of the prostate has varying biologic behaviour. Attempts to identify those at higher risk of progression have led to the subclassification into T1a (focal, low grade) and T1b (diffuse, high grade). This article is available only as a PDF. Please click on “Download...

Bladder cancer is the sixth most frequent malignant disease in the world. Superficial stages of the tumour are found in 75% to 85% of cases upon first diagnosis. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Oncocytomas are neoplasms characterised by large epithelial cells with finely granular eosinophilic cytoplasm called oncocytes. They were first described by Zippel in 1942 and have subsequently been identified in the thyroid, parathyroid, salivary and adrenal glands. This article is available only as a PDF. Please click on “Download PDF” on...

The typical ureteric calculus presents with an acute onset of flank pain which may radiate to the groin. Intravenous urography (IVU) has classically been the gold standard for the diagnosis of urinary calculi. This article is available only as a PDF. Please click on “Download PDF” on top to view...

The introduction of extracorporeal shockwave lithotripsy (ESWL) in the 1980s revolutionised treatment of renal and ureteric calculi. Progress in the field of extracorporeal lithotripsy was paralleled by the introduction of smaller caliber ureteroscopes and various intracorporeal lithotripters. This article is available only as a PDF. Please click on “Download PDF”...

Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the quality of intraoperative anaesthesia, tourniquet pain and lack of adequate postoperative analgesia. This article is available only as a PDF. Please click on “Download PDF” on...

Prostate cancer is the most prevalent cancer among men in the United States. In Singapore, it is the sixth most common incidence of cancer among males and the age-adjusted rates have risen from 8.2 to 9.6 per 100,000 per year between 1987 and 1992. This article is available only as...

Many medical schools worldwide have made the shift toward problem-based learning (PBL) medical education. Some of them employ these new techniques in only part of their teaching, and usually in the pre-clinical phases, to make basic sciences easier and more attractive. This article is available only as a PDF. Please...

Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore. This article is available only as a PDF. Please...

Open surgical removal had been the standard treatment for urolithiasis till the early 1980s when introduction of percutaneous techniques and extracorporeal shock wave lithotripsy (ESWL) revolutionised stone management. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Adrenal myelolipoma is a rare, benign tumour, usually an incidental finding. Spontaneous retroperitoneal haemorrhage resulting from this tumour is rare. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cystoscopy, supplemented by urine cytology, remains the gold standard in detecting primary and recurrent bladder cancer. Urine cytology, although highly specific, detects only 29% to 45% of bladder tumours and is subject to considerable inter- and intra-observer differences. This article is available only as a PDF. Please click on “Download...

Penile colour flow Doppler imaging (PCDI) is a non-invasive, accurate and cost-effective technique. It has better patient acceptance as compared to cavernosometry and cavernosography, and it does not involve any ionising radiation. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Percutaneous nephrostomy (PCN) is a well-established technique in the armamentarium of an interventional radiologist when dealing with urinary obstruction. It provides temporary relief in obstructive uropathy and stabilises the patients for subsequent definitive treatment. This article is available only as a PDF. Please click on “Download PDF” on top to...

Over the last 70 years, transurethral resection of prostate (TURP) has been used in the surgical treatment of benign prostatic hyperplasia (BPH) and is still considered the gold standard. With improvements in operative techniques, video endoscopy, anaesthetic care and intraoperative monitoring of fluid and electrolytes, rates of intraoperative and...

Urodynamics or pressure flow studies (PFS) are defined as a functional assessment of the lower urinary tract (LUT) to provide a pathophysiological basis for urinary symptoms and signs. Advocates of PFS deem it a necessary investigation if continence surgery is contemplated, stating that the “bladder is an unreliable witness”...

The presence of more than 2 testicles is called polyorchidism. It is a rare anomaly. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Leiomyomas of the urinary tract are exceedingly rare. They can, however, arise from almost any site within the genito-urinary tract, most commonly in the renal capsule and bilateral tumours are very rare. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The introduction of extracorporeal shockwave lithotripsy (ESWL) by Chaussy and his co-workers in 1980 revolutionised the management of urinary calculi. Since then, ESWL has become the modality of choice of many urologists for proximal ureteric calculi. This article is available only as a PDF. Please click on “Download PDF” on...

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections. This article is available only as a PDF. Please click on “Download PDF”...

A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth, his parents were informed that he had a “bilobed scrotum and a deep perineal skin pit” that may pose hygiene and cosmetic issues. They had...

A 60-year-old previously healthy man with unremarkable medical history presented with a complaint of intractable flank pain for one day. The laboratory test results were within normal limits except for microscopic haematuria on urinalysis. This article is available only as a PDF. Please click on “Download PDF” on top to...

Cancer data can be abstracted manually by cancer registrars or extracted automatically from the electronic medical systems. There may appear to be nothing in common between a manual Cancer Registry dealing with a few hundreds of new cases a year, and a large, highly computerised Cancer Registry as both...

Fournier’s gangrene is a surgical emergency. Treatment consists of fluid resuscitation, intravenous broad spectrum antibiotics and immediate surgical consultation with a view for early wound debridement and drainage. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Benign prostate hyperplasia (BPH), one of the most common diseases of ageing men, affects the quality of life by interfering with normal daily activities and sleep patterns. The current treatment options for patients with lower urinary tract symptoms (LUTS) suggestive of BPH mainly depend on the severity of the...

Overactive bladder (OAB) is characterised by feelings of urgency to urinate, with or without incontinence and is usually accompanied by frequency and nocturia. These symptoms are due to involuntary contractions of the detrusor muscle. This article is available only as a PDF. Please click on “Download PDF” on top to...

Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that presents acutely with multiple organ failure. Although defined classically as a syndrome with a pentad of features, it is accepted now that a diagnosis can be made with the dyad of microangiopathic haemolytic anaemia and thrombocytopenia. This article is available only...

Prostate cancer is now the third most common cancer among Singapore males, with a world age-standardised incidence rate (ASIR) of 23.9 per 100,000 from 2003 to 2007. The average annual rate of increase between 1968 and 2002 was 5.6%, with a steeper increase seen in the last 10 years. This...

Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fistula formation may occur as the inflammation becomes chronic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS) that affect quality of life and it causes structural and functional changes in the bladder. Previous clinical guidelines had emphasised on managing symptoms; however current...

As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...