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Biomedical subjects

K T Foo

Publications and source records attributed to K T Foo.

At least 37 records · Page 2Linked to original sources
PubMed1998

Idiopathic retroperitoneal fibrosis with bilateral lower ureteric obstruction--a case report with literature review.

Whilst prostatic enlargement remains the commonest cause of bilateral hydronephrosis in males greater than 50 years of age, other rarer conditions such as retroperitoneal fibrosis should be borne in mind. We report a case of bilateral hydronephrosis which was eventually diagnosed as idiopathic retroperitoneal fibrosis and treated with open surgical ureterolysis with omental wrapping.

Aged↗
PubMed1997

A comparative study of the distribution of ofloxacin and ciprofloxacin in prostatic tissues after simultaneous oral ingestion.

OBJECTIVES: To determine the levels of two quinolones, ofloxacin and ciprofloxacin, potent broad-spectrum antibiotics with very good oral bioavailability and low minimum inhibitory concentrations (MICs) for most pathogens, in the prostates of patients who underwent transurethral resection of the prostate (TURP) after oral ingestion for surgical prophylaxis. PATIENTS AND METHODS: Twenty-eight patients with BPH requiring a TURP ingested 250 mg of both drugs 2-4 h before operation. The levels of the drugs in the serum and prostate were measured using high-performance liquid chromatography and the levels of both drugs determined at the 6 and 9 o'clock positions in the prostate to examine any local variations in drug concentration. RESULTS: Ofloxacin concentrations were significantly higher in the serum and prostatic tissues compared with ciprofloxacin for the same dose, but its penetrance into the prostate was lower. This mainly reflected its higher oral bioavailability. Both drugs were present in concentrations 50% higher at the 6 o'clock than at the 9 o'clock position but both exceeded the MICs for most Gram-negative organisms except Pseudomonas. CONCLUSION: Ofloxacin has the advantage against ciprofloxacin of exceeding the MICs for Staphylococcus and Chlamydia. However, ciprofloxacin has the advantage of having prostate-to-serum ratios of unity, but for the same dose the prostatic concentrations of ofloxacin is significantly higher.

Administration, Oral↗
PubMed1996

Percutaneous nephrolithotomy--results and clinical experience.

Percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) have largely replaced open surgical intervention for the management of upper urinary tract calculi. ESWL is the preferred treatment modality for calculi less than or equal to 2 cm in diameter as morbidity is lower than PCNL and success rates are comparable. However, the morbidity of ESWL rises substantially for stones greater than 2 cm in diameter while stone-free rate is less when compared to PCNL, suggesting that PCNL is the preferred treatment modality for most larger stones. PCNL was performed on 86 patients with 87 renal calculi. The indication for this approach was either high stone burden as in 72 patients (83%) or failed previous ESWL as in 15 patients (17%). The success rate was 74.7% and this was associated with minimal morbidity which included; symptomatic urinary tract infection (9.2%), pleural effusion (2.3%) and the formation of a pseudo-aneurysm (2.3%). Blood transfusion was required in one patient (1.1%) and we had one postoperative death due to massive pulmonary embolism (1.1%). PCNL is the preferred approach to patient with difficult renal calculi at our institution.

Adult↗
PubMed1995

Transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH)--our first 100 cases.

One hundred consecutive cases treated by Transurethral Microwave Thermotherapy (TUMT) since October 1991 were analysed to assess its efficacy and safety. Out of these, 28 were in urinary retention. Patients were selected based on Madsen Symptom Score (MSS), Uroflowmetry, Transrectal Ultrasound Scanning (TRUS) plus biopsy and flexible cystoscopy. In the non-retention group, symptomatic improvement was 81%; mean MSS dropped from 13.6 to 2.6 at one year. Objective improvement was less marked: mean peak urine flowrate (PFR) (+45%), mean residual volume (-63%) and mean prostatic volume (-15%). 8.3% had failed TUMT requiring TURP. In the retention group, 79% was able to void freely after TUMT. Fourteen percent underwent TURP. Based on given criteria, the overall response rate for MSS and PFR averaged 71% at 3 months, 72% at 6 months and 84% at 1 year. Sixty-seven percent of patients who responded to a phone interview were satisfied with TUMT treatment. Minimal morbidity was encountered: temporary retention for non-retention group (24%), UTI (9%), haematuria (7%), impotence (2%) and fistula (1%). There was no treatment-related death. The results showed that TUMT is a viable alternative and safe treatment of BPH.

Adult↗
PubMed1995

Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones.

OBJECTIVE: To define a subgroup of staghorn stones that is amenable to extracorporeal shockwave lithotripsy (ESWL) monotherapy and review the need for prophylactic ureteric stents. METHODS: Fifty-eight renal units with staghorn calculi in 56 patients (30 males and 26 females) were treated by ESWL monotherapy on the EDAP LT-01 lithotripter. The stones were grouped as complete staghorn (11, 19%), partial staghorn (34, 59%) and borderline staghorn (13, 22%). Results of treatment were analysed in relation to subgroup and calyceal dilatation. Post-treatment complications were studied and the influence of prophylactic ureteric stents examined. RESULTS: The average number of ESWL sessions was 3.1 (range: 1 to 8). The mean follow-up period was 13 months. Stone-free rate at 10 months was 52%. When clinically insignificant residual fragments less than 4mm were included, the overall clearance rate was 75%. Favourable factors influencing treatment outcome included smaller stone burden, peripheral distribution of stone mass and absence of pelvicalyceal dilatation. The overall complication rate was 39% with urosepsis being the commonest. Complications were related to stone burden. More than half of the renal units with complete staghorn stones developed one or more complications. Auxiliary procedures were required in 18% of the renal units. Twenty of 39 renal units with a stone burden (sum of length and width) greater than 50mm had pretreatment ureteric stenting using the double-J (DJ) siliastic stent. A urosepsis rate of 50% was noted in those with ureteric stents compared to 26% in those not stented. The stents did not offer any advantage in preventing post-treatment obstruction by fragments. Six of 7 renal units with post-treatment obstruction had in-situ stents. CONCLUSIONS: ESWL monotherapy is suitable for selected staghorn stones. Prophylactic ureteric stents do not offer any advantage and may predispose to urosepsis.

Adult↗
PubMed1995

An overview of acute scrotal pain.

Acute scrotal pain requires immediate medical attention to determine the underlying cause and to treat accordingly. The diagnosis may not be straightforward and in some patients, immediate surgery may be necessary in order to treat torsion of the testes early to achieve good results. The aim of this retrospective study is to evaluate the underlying causes and the outcome of acute scrotal pain. It includes a total of 116 patients over a period of 18 months who were admitted to the general urology ward. Seventy-six percent of the patients complained of pain only, 13% complained of pain with fever, 7% complained of urinary symptoms and 4% a combination of the three. After evaluation, 44 patients were diagnosed to have torsion of the testes and all of these patients were below 20 years old. Thirty-eight of the patients complained of pain only and 2 had pain with fever. Two patients were thought to have torsion and exploration was performed. They were found to have infection. The rest had orchidopexy done and only 2 had orchidectomy due to infarction. Fifty-two patients had acute epididymo-orchitis, 50 of these were above 20 years old and half (n = 25) of this group of patients admitted to having had exposure to sexually transmitted diseases, 11 patients had a history of instrumentation and 14 had no known causes. From this study, age appeared to be the main differentiating point between torsion and epididymo-orchitis. for equivocal cases, new technology such as the Doppler ultrasound and testicular scan may be useful in future to improve the diagnosis of this urogenital emergency.

Acute Disease↗
PubMed1995

Use of prostate specific antigen (PSA) and transrectal ultrasound (TRUS) in the diagnosis of prostate cancer--a local experience.

Prostate specific antigen (PSA) and transrectal ultrasound (TRUS) are two new modalities added to improve our ability to diagnose prostate cancer at an early stage. We reviewed our own experience of 100 cancers among 579 men from August 1991 to October1994. The detection rate was 17.3%. Digital rectal examination (DRE) alone had a positive predictive value (PPV) of 39.9%. The PPV for PSA was 23%. The combination of PSA and DRE gave a PPV of 47.2%. TRUS had a PPV of 30.6%. Features of cancer on TRUS may be both hypoechoic or hyperechoic nodules which appeared to have almost equal proportions associated with cancer. The addition of age-specific ranges did not affect the PPV of PSA. The PPV of the combination of TRUS and DRE was 53%. With all 3 modalities combined, the PPV was 58.8%. An interesting finding from the study was the higher average PSA for benign and malignant disease in the local population and cases of acute retention of urine. There was a higher incidence of prostatitis and lower incidence of cancer in cases with retention of urine.

Adult↗
PubMed1995

Radical prostatectomy for prostate cancer--an experience of fifteen cases in Singapore.

Radical retropubic prostatectomy as a viable option for patients with localized prostate cancer hinges on the morbidity associated with the surgery. We assessed a group of 15 patients operated between February 1992 to September 1994 by a single surgeon to gauge the severity of short-term morbidity. Their mean age was 66.7 years (range, 40-76 years). While most of them had obstructive urinary symptoms, 4 were asymptomatic and were diagnosed by screening. Their median preoperative prostate specific antigen (PSA) was 25.9 ng/dl. The mean operative time was 110 minutes and the mean blood loss was 450 ml. One patient developed postoperative pulmonary embolism which delayed his discharge from the hospital despite routine prophylactic physical measures. The median length of hospital stay was 7 days. Eight patients had immediate total continence, while the remainder attained day-time and nocturnal continence within 1 to 3 months. Three patients had adjuvant orchidectomy. Most patients had high grade and margin positive (T3) disease but none were node positive. With a median follow-up of 7 months, none of the patients developed local or systemic recurrence. With the minimum surgical morbidity, short hospital stay and excellent continence achieved, the option of radical prostatectomy can be offered to suitable patients for curative treatment of localised prostate cancer.

Adult↗
PubMed1995

Bacillus Calmette-Guerin (BCG) in the treatment of superficial bladder cancer.

We evaluated the efficacy of immune and scarification Bacillus Calmette-Guerin (BCG) in the treatment of carcinoma in situ and prophylaxis against recurrence in patients with superficial transitional carcinoma of the bladder. A single-blind, randomised, comparative trial involving 43 patients with a median follow-up of 39 months was analysed. The end points were progression to muscle invasive disease or recurrence. The overall response rate was 93% after one to two courses. There was no difference between the two preparations and no statistically significant difference between the response or progression rates of the carcinoma in-situ or prophylactic groups. However, the response to BCG was found to be a significant prognostic indicator in a multivariate analysis.

Adult↗
PubMed1995

Current assessment and proposed staging of patients with benign prostatic hyperplasia.

With better understanding of the natural history of benign prostatic hyperplasia (BPH), and recent advances in ultrasound and the many new modalities of treatment, the assessment of BPH has undergone rapid changes in the past few years. A system of staging of patients with BPH, to assist in the tailoring of treatment to the severity of the disease is proposed. The initial assessment consists of the International Prostatic Symptoms Score (IPSS) and the Quality of Life Index, digital rectal examination (DRE), urinalysis, prostate specific antigen (PSA) estimation, and subsequently, assessment with ultrasound of the urinary system and estimation of residual urine and uroflow done at the same sitting. Patients with no bothersome symptoms and no significant obstruction are classified as stage one, and they can generally be watched. Stage 2 patients are those with bothersome symptoms but no significant obstruction and they can be treated with pharmacotherapy in the first instance, failing which other less invasive therapies such as thermotherapy are advised before considering transurethral resection of the prostate (TURP). Stage 3 patients are those with significant obstruction and defined as patients with significant residual urine of more than 100 ml, generally with a maximum flow rate of less than 10 ml. This group of patients would be advised TURP first, then thermotherapy, or pharmacotherapy in descending order, taking into account the age of the patients, their co-morbidity and preferences. Stage 4 patients are those with complications resulting from significant obstruction by BPH such as retention of urine, bladder stone and recurrent urinary infection; they would be strongly advised to have TURP. With proper assessment and staging, it is hoped that patients with BPH will not be over or undertreated, and treatment outcome will be improved.

Humans↗
PubMed1994

Transurethral resection of the prostate for benign prostatic hyperplasia--a local review.

There has been a recent resurgence of interest in the role of transurethral resection of the prostate for benign prostatic hyperplasia in view of the introduction of new modalities. We have conducted a retrospective analysis of 175 cases operated from October 1988 to June 1989 with an aim to ascertain the present mortality and morbidity rates associated with this procedure. The main presenting symptoms were acute retention of urine (54%) and bladder outlet obstruction (33%). The average weight of the prostate resected was 24.2 gm and 3% of specimens revealed malignant changes on histology. Seventy-five percent of the patients have post-operative stay of 5 days or less. Urinary tract infection was the commonest complication (16%). Clot retention requiring re-scope occurred in 2% of our patients. Twelve percent (12%) of our patients developed acute retention post-operatively but only 2% required re-scope as the rest resolved conservatively. We had one mortality in our series as a result of post-operative pneumonia. After 6 months follow-up, 4% complained of mild urinary incontinence and another 4% noted retrograde ejaculation. Six percent developed urethral strictures which required surgical treatment. Three years after the procedure, we retrieved the case notes of our cohort to analyse long-term results. We note that ninety-eight percent of our patients were discharged after nine months follow-up. This includes the 4% who complained of mild stress incontinence at 6 months follow-up. The remaining 2% was discharged after 24 months because of recurrent urethral stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A case of localised ureteric amyloidosis.

We describe a case of localised amyloidosis of the distal ureter in a 66-year-old lady who presented with intermittent haematuria. Ureteric transitional cell carcinoma was strongly suspected from the clinical and radiological features, and subsequent nephroureterectomy was performed. Histology revealed nodular eosinophilic deposits in the ureteric wall, with the staining characteristics of amyloid. The literature is reviewed, and conservative surgery is advocated, based on a greater awareness together with improved intraoperative diagnosis of this rare lesion.

Aged↗
PubMed1994

Laser lithotripsy for ureteric stones.

The use of laser is a relatively new modality of treatment in urology. With the advent of the pulse-dye laser lithotripter and a finer 7.2 ureteroscope (miniscope), we found that it was more effective for treating ureteric stones than the conventional ultrasound lithotripsy. Between May 1989 and December 1991, 239 patients (162 males, 77 females) with 259 ureteric stones were treated endoscopically by this modality. Their ages ranged from 19 to 81 years (mean 46.3). The stones were mostly of 5 to 10 mm in their transverse diameters. They were situated in the upper ureter in 59, middle ureter in 39, and lower ureter in 161 cases. The miniscope was inserted into the ureter without prior dilatation and under direct vision. Stone fragmentation was performed using the 504-nm pulse-dye laser of 30 to 60 mJ energy. Complete fragmentation of the stone using the Candela laser lithotripter was achieved in 202 patients (85%). The average hospital stay was two days. Of the 37 unsuccessful cases, 11 were due to failed ureteroscopy, ten due to poor visibility from bleeding, 14 due to stone migrating up to the kidneys and two were monohydrate calculi which did not fragment with laser lithotripsy. Open ureterolithotomies were necessary in 14 patients (5.9%). Significant morbidity was perforation of the ureters which occurred in three patients (1.3%). This was due to ureteroscopy rather than the laser lithotripsy itself. With the availability of the new shockwave lithotripter (ESWL) which can treat ureteric stones in even less invasive ways, without anaesthesia and as outpatient, we are now reserving laser lithotripsy for those who failed ESWL. Generally they are the stones which cause severe obstruction to the ureter.

Adult↗
PubMed1993

Extracorporeal shockwave lithotripsy using Storz Modulith SL20--the Singapore General Hospital experience.

The Storz Modulith SL20 is a third-generation lithotripter which was installed in our hospital in March 1991. The aim of this paper is to evaluate our results in the management of renal calculi using this machine. We report our experience in the treatment of the first 215 renal units (118 renal and 83 ureteric) in 190 patients with a minimum follow-up period of three months. Success for renal stones was defined as stone-free or with insignificant residual fragments of less than 4 mm in size post therapy. Success for ureteric stones was defined as stone-free after therapy. The success rate for renal calculi was 88% and for ureteric calculi 71%. The mean number of sessions to achieve these results for renal calculi was 1.6 and for ureteric calculi 1.4. Of the failures, only 1.9% required open surgery whilst the remainder were dealt with using minimally invasive procedures like intracorporeal laser lithotripsy. There was no mortality in our series. Complications occurred in four patients, who required hospitalisation for renal colic (n = 1), urinary tract infection (n = 1) and obstructive uropathy (n = 2).

Aged↗
PubMed1993

Clinical profile of stage D carcinoma of the prostate--a ten-year experience.

Carcinoma of the prostate has become one of the top ten malignancies in Singapore but to date, there has been little local clinical data available on the disease. This study aims to establish the clinical profile of Stage D carcinoma of the prostate in the local population. Forty-seven patients with Stage D disease treated by the department over a ten-year period, 1981-90, were studied. The majority (47.7%) fell in the age-group 66-75 years and the most common presenting symptom was bone pain (36.2%). Both acid and alkaline phosphatases were found to be poor diagnostic markers of the extent of the disease. Acid phosphatase was not elevated in 25.0% and alkaline phosphatase not elevated in 39.1% of our patients. Forty of these patients had orchidectomy and of these, ten were also treated with oral stilbesterol. Five-year survival for the orchidectomy group was 22.7% and that for the orchidectomy-plus-stilbesterol group was 23.0%. This compares well with other studies done in the West. Eight patients died within the first year of diagnosis but of those who survived, all remained symptom-free within this first year. The proportion of those who remained symptom-free fell to 25.0% of the survivors for subsequent years.

Acid Phosphatase↗
PubMed1993

Third chapter of surgeons lecture: revolution in urology and its evolution in Singapore.

Urology has been an evolving specialty since the time of Hippocrates. The itinerant surgeon was known to go from town to town to remove bladder stones in the early middle ages. In this century, urologists had been at the forefront in pioneering minimally invasive surgery with the introduction of transurethral resection of the prostate more than 50 years ago in the United States. This could be considered the first revolution in urology and this has influenced the evolution of urology in Singapore. Transurethral surgery had proved to be far superior to open surgery for most lesions of the lower urinary tract. This technique was introduced to Singapore in the early 1970s by Dr N E Wong. Because of the need for special instruments, skill and training, there was a need for a Department of Urology. This was not to be until after the second revolution in urology. The second revolution saw the introduction of endoscopic surgery of the upper urinary tract and Extra-corporeal Shockwave Lithotripsy in the early 1980s. This had truly revolutionised the treatment of urinary stones and today almost 95% of patients can be treated with these non to minimally invasive techniques. These new modalities of treatment were rapidly introduced in Singapore in the mid 1980s. The need for the establishment of urology as a specialty was more urgently felt. The Singapore Urological Association was formed in February 1986 and in March 1987, a Division of Urology was formed at the Singapore General Hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗
PubMed1992

Management of severe chronic radiation cystitis.

Chronic radiation cystitis complicating pelvic irradiation can occasionally result in massive bleeding difficult to control with conventional means. Between 1986 and 1989, we managed 42 cases of chronic radiation cystitis of which nine (21%) were of this severe type based on the necessity for repeated cystodiathermy, massive transfusions and open surgical intervention. We found early cystodiathermy and alum bladder irrigation beneficial in early cases, but six (67%) patients required emergency bilateral percutaneous nephrostomies for proximal urinary diversions to help stop the bleeding. Despite aggressive treatment, two patients (22%) died during their admissions and two others (22%) died shortly after discharge. Three patients eventually required elective ileal conduit diversion for their contracted defunctioned bladder. Thus this group of patients suffered relatively high morbidity and mortality for an essentially benign condition. Increased physician awareness and timely percutaneous nephrostomies may improve results.

Aged↗