Dr Christopher Chong Yew Luen

Letter from patient

2011-11-28T18:22:00.000-08:00

You have been a light at the end of my tunnel and I WILL NEVER BE ABLE TO EXPRESS the gratitude I feel towards you or what you have done for me.

From June until I met you, I was in pain every single day of my life; was depressed and hurting always. Working was a challenge, day to day life impossible!!

You have made such a difference in my life. I will never, EVER be so grateful to anyone!!

You were a Godsend and I can only thank my intuition and my gut for leading me to you because if I had gone with who SOS had referred me to, I do not think or feel I would be where I am today. In my entire life I have never hurt or suffered the way I did BEFORE I met you. That time in my life was the darkest but you made it bright again. I do not know how I will ever be able to thank you.

Really want you to know how much I appreciate you, your humor, the care and attention you are able to dole out to all of us. I could cry right now from the relief I have felt post op.!!!!!

Every single day I am counting my blessings and the good fortune I had in meeting you.

From the bottom of my heart, I thank you and wish for you everything good.

Thanks again, doc!

Much love,

VL

6 Nov Chinese Public Talk

2011-10-19T18:40:00.000-07:00

2011-09-18T17:09:00.001-07:00

Oh Baby , What a Help

2011-09-14T21:16:00.000-07:00

I DELIVERED my baby on Aug 18 at Gleneagles Hospital. The labour was tougher than expected but I was comforted by a profound experience of care which went beyond my expectation.

During labour, the intense effort to push out the baby left me totally emptied of energy. The possibility of a Caesarean operation was hovering in the air, but the resolve of the medical team - comprising Dr Christopher Chong, senior nurse manager Theresa and midwife Melita - to not settle for second best was obvious.

Their "being there" for me to cheer me on was better than any assisted delivery device. Indeed no technology can replace the human touch. I have truly experienced health care at its best.

Faith Wong (Ms)

http://www.straitstimes.com/STForum/OnlineStory/STIStory_710788.html

Testimonial from a patient

2010-10-12T22:16:00.000-07:00

July 3, 2010

One cannot imagine that a time can come when you don’t know the problem you have, who will tell you what it is and finally what should one do. I heard from various doctors in my country - India, that I had a ‘prolapse’ akin to a bladder prolapsed and that a team of doctors would undertake the surgery: a laparoscopic doctor, an obstetrician gynaecologist and an urologist. Sounds like a solution. A second opinion from a highly recommended obstetrician gynaecologist in Artemis, Gurgaon was that I didn’t have just a ‘prolapse’ but a serious ‘vault prolapse’ (prolapse of the inner wall) and that only an urogynaeocologist can undertake such a surgery. So the next question was – could she recommend such a specialist. The answer was that there is only one in India. So, my husband and I toodled off to consult with her. It was a horrifying experience of archaic methods, unhygienic environment and no disclosure that a ‘test’ was being done under local anaesthesia. More home work needed to be done. World-renowned doctors in USA were contacted – but we felt it was too far away considering that there could be post surgery complications.

We reached out to Gleneagles in Singapore and a number of names of doctors came our way. Dr Christopher Chong was the most experienced in our view and had a state-of-the-art solution, experience and skills. He confirmed that it was indeed a ‘vault prolapse’ in an advanced stage. He had to use a ’mesh’ (invented by a French company, subsequently sold to Johnson & Johnson) that was to be hooked onto the pelvic bone and ligaments so as to be able to provide support to the wall and organs. It was not only a complicated surgery but there was a risk of the mesh being rejected. Armed with confidence in Chris Chong’s expertise and advice, I was operated 2 months ago. Today, I’m back to work, quite overwhelmed by the fact that it was successful. There are many people to thank and one is humbled by the goodness of many friends, colleagues and family who supported me through this very difficult time.

If there is anyone out there who does not know what to do in any kind of ‘prolapse’ situation, my suggestion is that take an opinion from Dr Chris Chong so that you don’t go down the wrong path on some half-baked advice.

The ‘quiet efficiency’ of doctors, staff and nursing care cannot be lauded enough. It was an experience that one will never forget. I got a new life and I wish that many others will benefit from this blog report.

Do not hesitate to contact me should you feel the need to do so.

prema.sagar@gmail.com

THE USE OF MESH IN PELVIC ORGAN PROLAPSE SURGERY

2010-09-11T18:17:00.001-07:00

THE USE OF MESH IN PELVIC ORGAN PROLAPSE SURGERY - TO USE OR NOT TO USE - THAT IS THE QUESTION.

Dr Christopher Chong
Obstetrician, Gynaecologist, Urogynaecologist
Chris Chong Women and Urogynae Centre, Gleneagles Hospital
Past International Board of Directors, IUGA
Urogynae Committee, AOFOG
Visiting Consultant, KK Women's and Children's Hospital
Chairman, O & G Committee, Medical Advisory Board, Mt. Alvernia Hospital
Singapore

The lifetime risk of pelvic organ prolapse has been assessed to be 11%, with a recurrence rate of 30% for moderate to severe prolapses. Anterior compartment and apical vaginal prolapses are the most difficult to treat. Pelvic organ prolapse is a problem of the aging population. Singapore is the fastest aging population in Asia. Life expectancy has gone up to 81 - 83 for women in Singapore. The incidence of pelvic organ prolapse, being associated more with the elderly, is thus expected to rise.

Surgical treatment for pelvic organ prolapse is aimed at restoring anatomy and preserving functions, including sexual function. This can be done via the abdominal ( open or laparoscopic ) or vaginal route. When pelvic organ prolapse is severe, the existing tissues of the patient are expected to be very weak. Re-using these weak tissues for support is likely to result in a high recurrence rate. It is with this in mind that meshes are developed to try to reduce recurrence rates without compromising on restoring anatomy or function.

There are many types of meshes developed, both synthetic and non-synthetic. Non-synthetic meshes such as fasia lata from autograft or allograft are difficult to come by and to harvest. Latest studies have ventured into injecting stem cells into meshes. Synthetic meshes have the problems of rejection, infection and erosion. The advancement is then to find the best synthetic mesh to use. These meshes are classified into different grades, grade 1 being those with the least infection, rejection and erosion rates.

It is also important that we reduce complication rates other than proper selection of the mesh. Gentamicin wash of the mesh and the operative site, and antibiotics during and after surgery have been used to reduce infection rates. The mesh should be laid loose. Vaginal skin should not be cut. The use of a vaginal pack for a day after surgery should be considered. Oestrogens before and after surgery, when the wound has healed, especially in severely atrophic vaginal epithelium has helped me to prevent erosions.

The question is whether meshes should be used. In Singapore, meshes are not used as a first line of treatment - they are reserved for severe prolapses and recurrent prolapses. Only Grade 1 meshes should be used. The success rate of the modified mesh Anterior Repair with prolene mesh, and more recently the Anterior Prolift procedure is about 94%, with low complication rates ( most commonly mesh erosion and voiding problems ).

Gone are the days when women should suffer pelvic organ prolapse in silence. We are working towards improving our success rates for severe prolapses, including using meshes for selected cases. Patients need to be educated, and doctors to be vigilant to prevent pelvic organ prolapse, failing which, it is very important to seek treatment early for better success rates.

Pelvic Floor Disorders

2010-09-11T18:08:00.000-07:00

Pelvic floor disorders are common gynaecological problems that affect the quality of life of thousands of women and many of them are suffering uncomfortably in embarrassment and silence. Although this condition is not considered a life-threatening condition, it may cause a great deal of discomfort and distress.
Pelvic floor disorders are caused by weakening support of the muscles, ligaments and connective tissue in the pelvic area. Pelvic organ prolapse (POP) and incontinence are two problems women face as a result of pelvic floor dysfunction.
What is Pelvic Organ Prolapse (POP)?
Pelvic Organ Prolapse (POP) occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs - the uterus (womb), vagina, bladder, rectum and the surrounding muscles. POP is the descent or sagging of the uterus or other pelvic organ into the vagina. There are several different types of pelvic organ prolapsed.

Uterine (womb) Prolapse
The uterus can prolapse (drops) into and even outside the vagina. This condition may cause discomfort and problems with difficulty having bowel movements.

Cystocele and urethrocele
When the top (‘roof’) of the vagina is affected, the bladder and urethra (water-pipe) prolapse into or outside the vagina causing a cystocoele and urethrocoele respectively.

Rectocele and Enterocele
Similarly, the rectum (lower end of the large intestines/bowels) and small intestines can protrude into the bottom (‘floor’) of the vagina causing a rectocoele and enterocoele respectively.

Procidentia
This is the most serious form of prolapse of the uterus and vagina, whereby the whole uterus is situated outside the vagina, pulling/dragging the bladder and rectum along with it. This usually results in a large cystocoele outside the vagina and a large rectocoele just inside the vagina.

Causes and Symptoms
POP is caused by pregnancy, vaginal delivery, aging, menopause and congenital weakness of the pelvic floor muscles, ligaments and fascia. Obesity, chronic cough, constipation and occupations requiring heavy lifting are also contributory factors.
POP patients may experience the following symptoms:
 A bulge or lump on the outside of the vagina
 Feeling as though something is bulging inside or outside the vagina
 Difficulty in walking
 Stress incontinence
 Difficult or painful sexual intercourse
 Difficulty urinating or bowel movements
Patients often feel embarrassed and depressed by this condition, and because of this, it may even cause a strained marriage.
Dr Roy Ng, Gynaecologist at Mount Elizabeth Hospital cautions that one should consult their doctor or gynaecologist for treatment if they have any of the above symptoms as the outcome of conservative and surgical treatment for POP is excellent.
Treatments
There are a number of treatment options available, the choice of treatment depends on a variety of factors such as the type of prolapse, the severity of symptoms, patient’s age and other health issues, whether or not patient want to have children in the future, and patient’s personal preference.
Patient may be treated conservatively with insertion of vaginal pessary (a small plastic or silicone medical device) into the vagina to support the prolapsed. However, they must be changed every 2-3 months to prevent ulceration and infection of the vaginal skin leading to abnormal vaginal discharge and/or bleeding. Oestrogen (female hormone) cream and tablets can also be applied / inserted into the vagina to improve the thickness and blood supply of the vagina. However, if you’re experiencing major discomfort or inconvenience, surgery is the only definitive way to relieve symptoms and improve your quality of life
Surgery
The goal of surgery is to reposition the prolapsed organs and secure them to the surrounding tissues and ligaments. Surgery can be reconstructive, which corrects the prolapsed vagina while maintaining or improving sexual function and relieving symptoms, or obliterative, which moves the organs back into the pelvis and partially or totally closing off the vaginal canal. Surgery may also involve repairs to any pelvic organs.
Hysterectomy
In significant prolapse of the uterus, the uterus can be removed from the vaginal route; this operation is known as Vaginal Hysterectomy. After the uterus is removed vaginally the back of the vagina is then sutured to the ligaments of the pelvis to support it and also to prevent a vault prolapse (prolapse of the back of the vagina).
In Vaginal Hysterectomy, there are no incisions on the tummy. Hence, compared to an open or even laparoscopic (‘key-hole’) hysterectomy, post-operative pain is much less or negligible; recovery would be ‘smoother’ and faster. Dr Ng shares that patient can resume their daily activities like drinking, eating and walking faster. However, it is important that such patients do not exert physically, avoid constipation and abstain from sexual intercourse for at least 6 to 8 weeks to prevent any damage to the tissues repaired and suffering a recurrence of their uterovaginal prolapse.
Dr Ng says, “A vaginal hysterectomy is a relatively safe operation with a very low incidence of injury to the neighbouring organs.”
So, What Exactly is Stress Incontinence?
Stress Urinary Incontinence (SUI) is one of the most common types of urinary incontinence that affects women. It is the uncontrollable leakage of urine on exertion, such as running, jumping, sneezing, laughing and coughing – that puts pressure (stress) on your bladder. Associated causes include child-birth, menopause, obesity, chronic lifting of heavy loads, chronic cough and constipation. While for some women it may just be a few drops while coughing or running, others may experience a sudden and strong urge to urinate prior to eliminating a substantial amount of urine. The effects of urinary incontinence can range from being mildly bothersome to being completely debilitating.

A national survey on 3500 females in Singapore by Dr Christopher Chong, obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital revealed that 13.5% suffered from SUI and a shocking 35.6% in the above 50 age group; that is more than 1 out of 3 females above 50 years old suffer from SUI. This equates to about 190 000 females in Singapore. It is estimated that less than 30 000 have seeked treatment for this problem. Also from the survey, the reasons for this low treatment level were that majority of the females were too embarassed to talk about it (even with close friends or relatives), did not know that it is a problem, how it can be treated, and where to seek treatment. Many, sadly, accepted it as part of growing old.

How can Stress Incontinence be Treated?

Usually, the first line of treatment involves strengthening the muscles of the pelvic floor by doing pelvic floor exercises. In some cases, apart from the exercises, medication may also be advised. If these treatments do not provide the results and if the problem continues, then surgery may be required.

The surgical methods are used to support or tighten the structures and muscles under the bladder. There are many surgeries for SUI hence, it is very important to select the correct and best surgery for SUI. This is especially so as the success rate for SUI surgery falls with each subsequent surgery.

In Dr Chong’s practice, it is mandatory to perform a computer test of the bladder, called Urodynamics Studies, before any incontinence surgery in order to properly assess the bladder problem, select the best and correct surgery for the patient.
According to Dr Chong, the Tension-free Vaginal Tape (TVT) is now the accepted surgery of choice in the treatment of SUI. The latest technique using the same tape is called TVT_O (TVT-Obturator) and has been used in Singapore for more than 4 years. It uses a polypropylene mesh tape placed around the middle part of the baldder neck (" door" or outlet pipe of the bladder) without any tension or stitches. The exit point is not through the abdomen but through the inner thigh. When a person strains, the bladder neck pushes onto the tape and closes, thus preventing leakage of urine. This tape is left permanently in the body.

The new technique has advantages over the older techniques where there is less risk of bleeding and injury to the bladder, and cystoscopy to check for bladder damage and perforation need not be routinely done. This surgery can be done as a day procedure and the patient can be up and about the same day.

AD:
Don’t Suffer In Silence.
Pelvic floor disorders affect thousands of women and many of them suffering uncomfortably in embarrassment and silence. Today, treatment of female pelvic floor disorders is readily available and helping women of all ages regain their health, confidence and quality of life. If you think you are suffering from pelvic floor disorders, talk to your obstetrician/gynaecologist.

As one of Asia’s largest healthcare providers, ParkwayHealth has an international reputation for its high quality clinical outcomes, and service excellence in various multi-disciplinary specialties including Obstetrics & Gynaecology. We have more than 70 obstetricians and gynaecologists under one roof, specialised in obstetrics, gynaecological, Onco-gynaecological and Uro-gynaecological conditions.

Chinese Paper on Big Baby

2010-09-11T18:04:00.000-07:00

Doctor in THE NEW PAPER

2010-09-11T17:55:00.000-07:00

Chris Chong Clinic Pte Ltd

2009-09-12T18:10:00.000-07:00

Gleneagles Hospital
6A Napier Road
Annexe Block
#02-35
Singapore 258500
Tel :(65) 6474 3031

Bishan 8 Clinic for Women (Tuesday night only)
Blk 501 Bishan st 11
#01-362
Singapore 570501
Tel :(65) 6474 3031
Consultation Hours : 6pm to 9pm

妇产科与泌尿科 (华语讲座)

2009-03-14T08:11:00.000-07:00

日期: 4月18号2009
星期六时间: 1点到5点
地点: Conrad Centennial Hotel, Level 2, The Ballroom
主持人: Violet粉樱

钟耀伦医生,周彩云物理治疗师以及辛学伟医生将为你解答以下问题:

1) 为什么我无法享受性爱? 与更年期有关吗?

2) 漏尿,泌尿与子宫下垂有得救吗?有什么新治疗方法?

3) 子宫下垂与漏尿可以预防吗?

4) 如何做骨盘收缩运动?

5) 了解子宫肌瘤及卵巢瘤问题以及它们会影响月经吗?

你可以以以下方式预先报名:

1) SMS: 输入EVENTS<<空格>>WOMEN<<空格>>全名<<空格>>人数, 发送到 8127 8006) 拨电话: 6584 6692 传真: 6854 66674)
电邮: events@parkway.sg
报名费: 每人$10 - 包括茶点,礼品

Better than a women

2009-03-12T19:17:00.000-07:00

For generations, women have regardedincontinence and pelvic floor problems asinescapable costs of motherhood. 47-year oldFikawati Suhadi, a mother of four childrenbetween the ages of 13 and 23 years of age wasno different. She had for a long time, silently accepted herloss of control and self-confidence.As far as possible, she would shy away from socialfunctions and unnecessary outings, in the process curbingher once-outgoing lifestyle.“I tolerated the discomfort and inconvenience but when Istarted bleeding and feeling sharp pains in my abdominalarea in July this year, I decided that I needed to see a doctor.I could walk but if I exerted myself, it would hurt,” recountsFikawati, a businesswoman dealing in fashion garmentsin Jakarta.The doctor she consulted in the Indonesian capitalinitially told her that she had stress incontinence andproblems with her uterus. A second opinion from anotherdoctor drew a similar conclusion although, this time thedoctor proposed having her uterus removed withoutoffering much explanation.Fikawati concedes, “I wasn’t convinced or comfortablewith the medical services at home. The doctors may bewell-trained but they do not have advance equipment to helpthem with diagnosis and treatment.”Although Fikawati and her businessman husband of 24years, Suliono Alidjurnawan, also 47, had initially consideredAustralia for treatment, they subsequently decided against it.“We felt that the different culture there would not suit us.It wouldn’t be easy to communicate with doctors and nursesthere. Fortunately, a friend of mine recommended a doctorin Singapore who had treated her a while back. She had a lotof good things to say about him,” recalls Fikawati.

DEFINITIVE DIAGNOSIS

The Singaporean doctor was Dr Christopher Chong,Consultant Obstetrician, Gynaecologist andUrogynaecologist at Chris Chong Women and UrogynaeClinic located at the renowned Gleneagles Hospital in theisland-state.Sitting on the board of the International UrogynaeAssociation, Dr Chong is a well-known sub-specialist in the field of urogynaecology both in Singapore and globally.Outlining his examination of Fikawati sometime inAugust 2007, the affable Dr Chong elaborates, “I carried outa urodynamic study of her bladder. It’s essentially acomputer test where we monitor and measure the flow rateof her bladder (via a tube inserted into the vagina up to theopening of the bladder) to determine the presence andextent of any obstruction to the flow.”The urodynamic study assesses the function of thebladder and the bladder outflow tract (urethra). During thetest, the bladder is filled and then emptied while pressurereadings are taken from the bladder and the abdomen. Theidea is to replicate symptoms, then examine them anddetermine their cause.According to Dr Chong, the urodynamic study has beenaround for several years but being a test utilising hightechnology, one must know how to use it. Moreover, theremust be a patient load to justify purchasing the equipment,which is costly. Presently, not many countries use this test.In Fikawati’s case, the test showed that she had a leakagein her bladder. A subsequent ultrasound scan confirmed it.Besides stress urinary incontinence (SUI), she also had apelvic floor prolapse and a lax vagina.“Since the bladder and womb are connected andsupported by the same muscles, the pelvic floor muscles,when there is one problem with one organ, another willusually have a problem too, like it was with Fikawati, “explains Dr Chong.A pelvic floor prolapse is a condition in which organs,which are normally supported by the pelvic floor muscles,namely the bladder, bowel and uterus, herniate or protrudeinto the vagina. This occurs as a result of damage to orweakening of the muscles and ligaments making up thepelvic floor support.

EXPERT TREATMENTAlthough there were several conditions Fikawati had, DrChong was unfazed. He subsequently carried out a two-hoursurgery to treat them in phases.To treat her SUI, Dr Chong used a relatively new methodknown as the Tension-free Vaginal Tape Obturator(TVT-Obturator) sling procedure. This is an improvement ofthe older conventional technique in that the exit points of thesling are not in close proximity to blood vessels.There is also no need to check for any perforation in thebladder. Thus, unlike the old procedure, here the risk ofinfection is reduced.“It’s a wonderful improvement but the TVT-Obturatorprocedure is what I would call a blind procedure becauseyour only guide is your experience. If you don’t do it oftenenough, it is hard to get it right. If you hit the wrong area,you may hit blood vessels and this could cause a haematoma(blood clot) and lots of bleeding,” discloses Dr Chong, whois also a pioneer in prolapse, incontinence and pelvic floorreconstruction surgery in Singapore.

Singapore was the first country in Asia to use this newmethod of treatment for stress urinary incontinence withsuccess rates of around 94 percent, currently the highest inthe world. Dr Chong, who is actively teaching this method todoctors in the region, has himself performed more than 500such procedures.Following the ten-minute procedure to insert theTVT-Obturator, Dr Chong then repaired Fikawati’sprolapsed bladder wall by performing a pelvic floor reconstruction.But she also had to have her womb removed(hysterectomy).He explains, “The lining of her womb had cells that hadchanged. It could possibly turn cancerous so to be safe, Iremove her womb.”Lastly, a vaginaplasty was performed, where Fikawati’slax vagina, was tightened. Fikawati was discharged aweek later.“We are lucky in Singapore to have sub-specialists - urogynaecologistswho can handle specific gynaecological problems.Added training is necessary and not many countriescan boast of this kind of expertise,” declares Dr Chong.As for Fikawati, she returned to Singapore in October,about a month after her surgery, for a follow up.“I can now walk properly so this time I went sightseeingand shopping too. There is no more pain. Dr Chong was sopatient, polite and professional. We asked many questionsbut he took the time to answer them all,” shares Fikawati,who has since regained her mood to read, watch moviesand sketch.She expresses, “I’m so glad I came to Singapore for treatment.Now, I feel like a new woman, actually betterthan new.”

A healthy you, a healthy baby!

2009-02-20T06:05:00.000-08:00

DATE : Saturday 21 Feb 2009, 2pm to 5 pm
Place : Suntec International Convention & Exhibition Centre
Cost : $10 per person / $18 per couple.
Closing date : 12 Feb 2009

Join Young Parents Baby in an afteroon of sharing as our experts show u how to make the most of your pregnancy, as well as how to care for and bond with your newborn. Get your pressing questions answered and mingle with other expectant parents at the seminar.

All Participnts will also receiv a fabulous goodie bag worth over $20!

OUR SPEAKERS

SUPER PREGNANCY DIET

What foods are best for you and your growing baby? Find out how to nourish your bump and bounce back into shape right after labour.
Speaker : Rehana A Wahid, clinical dietitian, Parkway Hospital Singapore.

WORK OUT WITH YOUR BABY

Bond with your child and get fit at the same time. Learn simple exercise routines that any busy mum master in minutes!
Speaker : Michelle Wee, occuptional therapist,pilates and yoga instructor.

GROWTH PROBLEMS IN BABIES AND YOUNG CHILDREN

Why is my baby losing weight? What's the normal growth pattern in infants? When should i worry? Let our expert enlighten you.
Speaker : Dr Warren Lee Wei Rhen, Consultant paediatrician.

IS THIS NORMAL

What am i supposed to look like at the six-month mark? Why do i need to go loo every half hour? Can i prevent stretchmarks? Get the lowdown on the questions you've always wanted to ask.
Speaker: Dr Christopher Chong, consultant obsterician & gynaecologist.

WHAT YOU NEED TO KNOW ABOUT CORD BLOOD BANKING

Find out what cord blood stem cells are and the benfits of banking your newboard's cord blood.
Speaker : Dr Andrew Wu from Codlife.

Letter FromPatient

2009-02-18T07:07:00.000-08:00

Hi Dr. Chong, Keith and Felicia:

I am doing very well thank you. I intended to write a short note but once I started writing I could not stop.

Keith / Felicia : I have to thank the STB for alerting me to the existence of a Uro-Gynaecological speciality and Dr. Chong. I refer to an advertisement in the Silk Air flight magazine, Feb. 2008. I called Dr. Chong and made an appointment the day I got back to Singapore. I have gone into some detail below, so you may not need to interview me, however, I would like to see the final copy you intend to use before you use it.

Unlike most people with stress incontinence I had sought treatment before visiting Dr. Chong. I had discussed my problem with an Urologist at Gleneagles and his suggestions were unconvincing and far from satisfactory – he suggested narrowing the urinary tract exit by injecting collagen or similar material, he further suggested that the TVT was a new, untried, procedure. I also noticed that all his patients were male and his secretary and nurse were quite surprised to see me. Dr. Chong – Do most Urologists tend to be Andrologists?

My gynaecologist at Mt. Elizabeth, who I have been seeing since 1996, had earlier suggested I do kegle exercises, and that my condition could be easily resolved by exercise especially since I had not had any children. She is a good gynaecologist but made the above suggestion without doing any test or examination. Neither my Gynaecologist of 13 years nor the Urologist I first visited alerted me to the existence of Uro-Dynamic Studies, tests which could determine the severity of my stress incontinence and help determine the course of treatment. So learning about the Uro-Gynae specialty was a godsend. Thanks again STB.

It seems to me that the Uro-Gynaecological speciality is not common nor well-known and that neither Urologist nor Gynaecologists are knowledgeable in this dual specialty space – at least this is my observation. Neither set of specialists, Urologist or Gynaecologists, seem to be able to give helpful advice on the issue of stress incontinence, even to a patient like me who was motivated to find answers.

Dr. Chong you are only listed under gynaecology on the Gleneagles website, perhaps a cross-listing in urology indicating your dual specialty will be helpful
http://www.parkwayhealth.com/DoctorSearch/?txtSpecialty=Urology&txtHospital=Gleneagles&postback=true&txtName=&Go=Search

In light of the above I am happy to help educate stress incontinence sufferers in any way I can, except I don't want my name to be revealed. I have been a professor for the last 20 years in the US and Singapore and have taught a few thousand students – I would not like them to know the details of my private life. Perhaps you should just describe me as "a busy, 40+ business professional who travels extensively."

Having said this, it is precisely the crux of the matter. Stress incontinence is socially embarrassing! In fact, I think many sufferers see incontinence as a sign of physical and mental deterioration and social and personal failure, something that happens to old bedridden people with Alzheimer's or dementia NOT to active, successful professionals who travel the world. Most people with whom I have spoken do not know that there is a difference between urinary incontinence and stress incontinence with different origins and treatment.

Since my operation I have raised the issue with 5 close female friends who are 40+ and moderately overweight . Four admitted that they have had stress-incontinence for at least 2 years or more. All were well educated professionals but none of them had discussed the issue with any one till I raised it with them using my surgery as a starting point. They were relieved that there was a simple "relatively painless" solution, even if the solution was in Singapore and they were in India. There appear to be a few uro-gynaecologists scattered around India (Google hits) but it was not clear what was their experience in treating stress incontinence they seemed more focussed on reconstruction of the vagina and surrounding areas.

Finally, a few nosy individuals were surprised that I was going from India to Singapore for surgery. Don't people come from Singapore to India for surgery? These were not people with whom I wanted to discuss my private life so I didn't satisfy their curiosity.

Pls. feel free to use details from this email for purposes of informing and educating the public BUT please ensure that my name is not used, also, I would like to see the final copy you intend to use before publication

About pelvic organ prolapse

2009-02-18T07:05:00.001-08:00

This is a condition where one or more organs normally supported by the pelvic floor muscles, namely the bladder, bowel, rectum, urethra, uterus and vagina, herniate or protrude outside the body.
Pelvic organ prolapse is most often linked to strain during childbirth. Normally, the pelvic organs are kept in place by the muscles and tissues in the lower belly. However, during childbirth, these muscles can get weak or stretched and if they do not recover, they will become unable to support the pelvic organs. While older women are more likely to have pelvic organ prolapse, it is also known to run in families.
A prolapse can be fairly mild but it can also become serious. Common symptoms include lower back pain, a sensation of ‘something falling out’, stress incontinence, constipation or painful sex.
In cases where symptoms are mild, doctors will usually recommend keeping to a healthy weight, doing exercises to strengthen pelvic muscles and avoiding lifting heavy objects.
In serious cases, surgery involving the repair of muscular tissues supporting the affected pelvic organs is performed. Where recurrence or a very bad prolapse occurs, a mesh can be used to replace the weak tissue.

Monique Hull and Maria Martinus Wenas - prolapse surgery

2009-02-18T07:01:00.000-08:00

A mesh solution to a woman’s problem

Recurrence is common after treatment for pelvic organ prolapse. However, a Singapore urogynaecologist offers a way to significantly lessen the probability. Two women from across the globe are set to benefit from it.
It’s mostly a condition affecting women and one that is rarely spoken aloud, let alone brought to anyone’s attention, at least not until the situation becomes unbearable.
Pelvic organ prolapse is a relatively common condition, particularly among women above 40. It is estimated that half of all women who conceive will experience some form of prolapse in later life. However, Dr Christopher Chong, a renowned obstetrician, gynaecologist and urogynaecologist at Singapore’s Gleneagles Hospital feels it is merely the tip of the iceberg.
He says, "Many who come in to see me appear to have suffered the condition for quite some time. Worse still, many often don’t seek help at all. Some think it’s a natural thing while others are just too shy, and so they live with the discomfort."
Dr Chong adds, "It’s one of those problems you unfortunately don’t hear a lot about and that’s unfortunate because it is a very treatable problem."
Pelvic organ prolapse is characterised by a tear or weakness in a woman’s pelvic floor muscles, allowing one or several of her internal organs supported by them to prolapse (herniate or fall) outside the body through a body opening. Although prolapse is not considered a life-threatening condition, it may cause a great deal of discomfort and distress.

"I pushed it to the back of my mind"

47-year old Monique Hull who hails from Stockholm, Sweden, had successfully battled breast cancer in 1989. Just over four years later, she gave birth to her only son. However, soon after, her doctor told her that her pelvic floor muscles were weak and suggested Kegel exercises to strengthen them.
"I did them for a while and although I did feel that something was weak down there, it did not disrupt my life at all. There was no pain. So I pushed it to the back of my mind," recounts the sales representative for a Scandinavian design company.
Over the years, Monique began to feel some discomfort, notably during her regular jogging and gym workouts. Although she braved the long waiting lines for non-emergency medical care in Sweden, the gynaecologist she consulted could not find any clear symptoms to indicate a problem, other than some fibroids, which he did not expect to grow any further.
Monique’s work had taken her to Singapore and it was in early 2008, when she decided to go for a health screening check-up. To her surprise, she was told that she had a prolapse. On a recommendation, she saw Dr Chong at his clinic in March.
"She presented with a prolapse of the bladder and womb which quite bad. She also had a 6cm fibroid, a broad ligament type which was not in the usual area. Besides having to remove the fibroid and womb vaginally, I needed to fix her weak pelvic tissues to correct her prolapse," relates Dr Chong.

"I wanted a doctor I could trust"

In March 2007, Maria Martinus Wenas, a 54-year homemaker from Indonesia, felt some discomfort in her vagina. She subsequently consulted a gynaecologist in Jakarta who examined her but somehow, his behaviour did not instil any confidence in her.
She explains, "He did not appear happy when my husband and I asked him a lot of questions. He seemed very impatient with us."
As there were no other symptoms to worry about, Maria left the clinic hoping that her condition would sort itself out. But it didn’t.
In March this year, Maria’s husband Wijono Chandra, 57, decided to search the Internet for a doctor who could treat his now, distraught wife, someone who could offer her not just a favourable outcome but confidence as well.
"I wanted someone I could trust," she says.
The couple found one such doctor in nearby Singapore and quickly flew down to meet him.
"We were impressed with what we read about Dr Chong and his penchant for new technology. We were pleasantly surprised to find him easy to talk to. More importantly, he explained his plans slowly and answered all our questions. We trusted him," declares Maria, whom together with husband, have three children aged 20, 24 and 25.
Dr Chong outlines, "Besides her bladder and womb which were quite badly prolapsed, her rectum too had experienced quite an advanced prolapse. Like Monique, Maria’s pelvic tissues were almost atrophic, meaning that there was no tissue to hook or stitch up. It was really bad."

All new

After carrying out an urodynamic study to assess how the bladder and urethra of both women were coping with storing and releasing urine, Dr Chong then shifted his attention to treating their respective pelvic organ prolapse.
He reveals, "There was no incontinence in either woman but their prolapses were my main worry. I was concerned with the likelihood of a recurrence, which is always a problem with pelvic organ prolapse."
So Dr Chong decided on solving the problem by using a relatively new method involving a polypropylene mesh designed to replace old tissue and recreate their function.
"Essentially, scarring will occur over the tension-free mesh which then forms a permanent layer. The mesh is held up by attaching itself to tissue. It works from the anterior of the bladder and behind the rectum," explains Dr Chong, one of the pioneers in Asia of mesh use in 2006. He has so far done close to a hundred such procedures.
Since both women did not want to have any more children, Dr Chong also removed their wombs during the two-hour surgery, which according to him, would bring better results.
He says, "If they follow instructions; no carrying heavy loads or engaging in vigorous activity for three to six months, the scarring will set and they will avoid recurrence. It’s a crucial period."
Although the concept seems easy, Dr Chong stresses that it takes a lot of training and experience to do it.
"It’s a blind procedure and you need to know where and how deep to go in to place the mesh, otherwise you may cause more damage in there. Technique alone is not enough. You have to do it many times over to perfect it."
Singapore is one of the first few countries to use this method and continues to be the leader in the procedure in terms of most number of procedures done.
A week after surgery, Maria is feeling energetic and upbeat, a far cry from the depressive state she was in when she first came to Singapore.
"I was initially so scared of the pain but there was none at all. I’m so relieved and happy that I found Dr Chong. He’s improved my quality of life."
As for Monique, she proclaims, "It’s like I’m a brand new woman, and much lighter inside."
For more information about Chris Chong Women and Urogynae Clinic at Gleneagles Hospital (www.gleneagles.com.sg), call (65) 6474-3031.

About Polycystic Ovarian Disease

2009-02-17T06:59:00.000-08:00

A woman's ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. Although about 20 eggs start to mature every month, only one usually becomes dominant and fully matures. At this point (ovulation), the follicle breaks open to release the egg for fertilisation.
In women with PCOD, the follicles instead grow into fluid-filled cysts and no mature egg is released. Ovulation as such, does not occur. Thus with each menstruation cycle, these cysts accumulate and facilitate hormonal imbalances, which result in more cysts, thus sustaining a vicious cycle.
Although some cysts will subside, many remain inside the ovaries. Such hormonal imbalances create irregular (or no) menstruation in women, making them susceptible to infertility problems.
Diagnosis usually encompasses a history of menstrual cycles and a vaginal ultrasound to look for enlarged ovaries. Blood tests are also helpful in measuring the levels of hormones, in particular androgen (male hormone) and oestrogen. Excessive levels of the former can lead to acne and an abnormal amount of body and facial hair, among other symptoms.
Though there is no cure for PCOD, it can be managed. Treatments depend very much on the symptoms of each patient and their desire to conceive, in which case, fertility medication may be prescribed to enhance ovulation. Care however, must be taken to ensure that a woman’s ovaries are not over-stimulated to an extent which is detrimental to her health.
Since many women with PCOD tend to have a weight problem, a healthy diet and increased physical activity to lose weight may help restore a normal period. PCOD, sometimes referred to as PCOS (Polycystic Ovarian Syndrome) is the most common hormonal abnormality in women of reproductive age and is a leading cause of infertility. Not much is understood about the causes of PCOD though many suggest a strong genetic link. An estimated five to 10 percent of women of childbearing age are believed to have the condition.

True story on David Ditto and Linta

2009-02-17T06:54:00.000-08:00

Made in Singapore

They wanted a baby but something was wrong. Several doctors, two years later and still with no bundle of joy to show, a couple from India decided to turn to a Singaporean specialist for help.
Across much of modern-day India today, starting a family immediately after marriage remains very much the number one priority. Any delay, as one couple discovered, only serves to illicit pressured reminders from relatives and friends.

"When we were married in 2006, everyone wanted to know when our baby was arriving. Of course we too desired a child and were trying hard but somehow, my wife couldn’t conceive," reveals 33-year old technical specialist Ditto David.
Hailing from the city of Kerala, on the tropical Malabar Coast of south-western India, Ditto’s 23-year old wife Linta Davis saw several doctors, initially for her failure to conceive and later, for another problem that emerged.
Ditto informs, "She was experiencing irregular periods for about three months and then it stopped completely. After some tests, one doctor diagnosed polycystic ovarian disease and gave her some medicine. It appeared to help but three months later, her period stopped again."
Polycystic ovarian disease (PCOD) is a condition where patients have immature eggs and because of this, do not ovulate regularly. Under such circumstances, conception is not easy to achieve.
Determined, Linta, a homemaker, kept to every appointment and took her medication religiously but by early 2008, after almost two years, her condition had not improved.
As both sank into desperation, Ditto admits he was finding it increasingly difficult to hold back his emotions each time his wife wept over her inability to bare him a child.

A lucky posting

Although the couple continued to try for a baby, it was getting harder as time went by.
"One day when I went to see my company doctor, I brought up my wife’s problem. He sensed my desperation and suggested I bring her to Singapore to see a top specialist whom he knew."
The specialist was Dr Christopher Chong, a well-respected obstetrician, gynaecologist and urogynaecologist from the renowned Gleneagles Hospital.
After doing some research, Ditto was highly impressed not only with Dr Chong’s credentials but also by the high standard of medical care in the island-state. It did not take long for him to make the necessary arrangements and on 4 February 2008, Ditto walked into Dr Chong’s clinic with a hopeful Linta by his side.

An expert’s strategy

Outlining the mechanics of conception to help the couple understand their situation, Dr Chong also explained his plans for them.
He discloses, "It was not unlike a counselling session because it was important to cover the psychosocial aspect of helping them reduce the stress factor which is an important cause of sub-fertility."
Investigations were then carried out to uncover the cause of Linta’s oligomennorrhoea or lack of periods. On top of the test results from the Indian doctors, additional blood tests for hormonal profiling and ultrasound scans were done. Dr Chong then prescribed his own concoction of medication.
He shares, "The idea was to get her to ovulate, monitor her ovulation and to provide a medium for better swimming of the sperm to meet the eggs. The medication was designed for this, with the added advantage of helping her lose a little weight since she was on the obese side."
Besides an ovulation kit, Linta was given fertility pills to take during her stay in Singapore. Dr Chong also prescribed some vitamins for Ditto to promote healthy sperm production.

Sooner than expected

During her check-up a month later, Linta had still not had her period. She was disappointed and close to giving up, thinking that the latest treatment had also failed to work. Not surprisingly, she needed some coaxing before agreeing to take a pregnancy test. However, unlike on numerous occasions previously, the news this time was pure delight.
Dr Chong recounts, "It was a touching moment when the test showed positive for pregnancy. Both husband and wife sobbed in my clinic and for me, it was another reason why my job can be such a fulfilling and satisfying one."
Ditto, who is the oldest son in his family, emotes, "It was a miracle. We could hardly believe it. We immediately called home to tell our parents and they were overjoyed. It was an amazing moment."
"Dr Chong was very calm, patient and sympathetic. He gave us confidence when all the other doctors back home failed to and he made us feel comfortable. The equipment and expertise in Singapore is really world-standard."
Eighteen weeks later, Linta was given a clean bill of health to return to India to deliver her baby.
"We used to cry often because she could not get pregnant. Nowadays, we cry whenever we talk about our baby," confesses Ditto.
"Though our baby will be born back home in India, we can proudly say that he (or she) was made in Singapore."

For more information about Chris Chong Women and Urogynae Clinic at Gleneagles Hospital
(www.gleneagles.com.sg), call (65) 6474-3031.

Dr Chris Chong Radio Schdule

2008-11-23T05:31:00.000-08:00

Dr chris chong will be on radio on these fews dates :-

1) 12th December 2008 at 10.30am ( Friday)

2) 17th December 2008 at 10.30am ( Wednesday)

3) 31st December 2008 at 10.30am (Wednesday)

All on 97.2 fm . Remember to tune in .

Women's Sexual + Wellness Forum

2008-11-13T10:07:00.000-08:00

22 November 2008, Saturday
Park Hotel (Next to Paragon) Empress Ballroom,
Level 3,270 Orchard Road

Event Host
Daniel Martin,
Presenter of
Body and Soul,
938 Live

Program :
1.00pm : Registration
1.45pm : Welcome speech by Chairperson (Dr Chris Chong)
2.00pm : Let's Talk About Pressure & Pleasure of Sex. Why Don't i Enjoy Sex. ( Dr Chris Chong)
2.30pm : Fibroid & Ovarian Cyst - Their Management & Effect on Fertility. ( Dr Seng Shay Way)
3.00pm : Q & A Session 1
3.25pm : Light Refreshments
3.55pm : Prolapse & Urine Leakage in Every Stg of Womenhood. How it may effect you (Dr chris chong)
4.25pm : Can We Prevent Prolapse & Urine Leakage? (Ms Chooi Sue Ling)
4.55pm : Q & A Session 2
5.20pm : End

To Sign up:
SMS : Send Events SEXFull Name
No. Of Persons to 81278006 (e.g Events Janice Tan 2)

Phone : 6854 6692 (Mon - Fri : 0830am - 1800pm)
Fax : 68546667
Email : events@parkway.sg

You can also refer to http://www.parkwayhealth.com/
for more information.

For more information or access to our 24-Hour medical
and specialist services, please call out Patient Assistance Centre
Helpline: 67355000, email: ipac@parkway.sg or visit our website http://www.ipac.sg/

I was a surgeon's nightmare (True Life Story)

2008-11-13T04:50:00.000-08:00

Dr Christopher Chong, a consultant uro-gynaecologist at Gleneagles Medical Centre, said the condition is caused by weakness in the muscles and ligaments of the pelvic floor, leading to loss of uterine support.

Pregnancy, childbirth, obesity, and chronic coughing and lifting of heavy objects are some of the factors that predispose a woman to developing the condition,' he said. 'It worsens if not treated.'

For Madam Chin, the problem began in early 2004.

Her regular gynaecologist told her that she was all right, that it was 'just a part of ageing, and that I have to live with it'.'But who could live with the inconvenience of constantly searching for toilets and not being able to control my urine every time I coughed or sneezed?' said Madam Chin.

Her gynaecologist was reluctant to remove her womb because Madam Chin has a history of thrombosis - the formation of clots within the blood vessel.

But Madam Chin, who also suffers from allergic rhinitis, a condition in which the nasal passages are inflamed, often sneezes violently in the morning. That aggravated the incontinence.
A second gynaecologist she consulted, who was willing to take on her case, ordered some blood tests, including cancer markers, before deciding to operate.

Unfortunately, the results came back showing yet another problem - cancer in her left kidney.
Madam Chin had to postpone the correction of her prolapsed uterus for the time being so the cancer in her kidney could be addressed.

My left kidney was removed in November 2004. The cancer was in its early stages so I did not have to go through chemotherapy or radiotherapy after the surgery,' she said.
But the prolapse and incontinence still needed attention and Madam Chin went through another year without solving those problems.

In December 2005, she attended a public forum in Kuching on the treatment of incontinence by Dr Chong.

By then, I was at my wit's end, so I decided to go for the talk. I cornered Dr Chong and told him about my problem,' she said.

He assured her that she could be treated, and Madam Chin and her husband came to his clinic in Singapore three months later.

I presented him with a two-page written medical history and asked a whole lot of questions,' said Madam Chin. 'Dr Chong got a colleague, an anaesthetist, to sit in.

He said the thrombosis was not a problem and that he would carefully monitor it during the surgery. With all my problems, I was considered a surgeon's nightmare but seeing how confident the two young doctors were, I thought it was safe enough to proceed with the surgery,' she said.
She had her operation in April 2006.

Dr Chong removed my uterus, including the ovaries, corrected the incontinence and fixed my prolapsed bowel in a two-hour long surgery,' she said.
She could walk a few hours after surgery and was warded for only three nights.
The surgery put an end to her discomfort. And the relief showed on her face.

When I got back to Kuching and my friends saw me, they said I looked like I had just returned from a holiday abroad,' she said, laughing.

Shots Of Doctor Chris Chong With Patients

2008-11-13T04:33:00.000-08:00

RELATIONSHIP BETWEEN INCONTINENCE AND ORGASM

2008-11-05T18:26:00.000-08:00

Orgasm is a beautiful end or climax of sexual intercourse and most people are not satiated till this is achieved. not many studies have been done on this subject as this is a very intimate and private affair, and it is difficult to get subjects for the studies. over the years, the physiology of orgasm has changed from it coming from the clitoris alone to that involving many factors, including the uterus, bladder, urethra ( the opening of the bladder ) and contractions of the pubococcygeus muscle ( the muscle surrounding the vagina and supporting the pelvic floor, going into spasm during an orgasm ).

Orgasm can include many full-body experiences such as tingling in the fingers and toes, spasm of arms, legs, face and lower abdomen, emotional outburst and feelings of relief and ecstasy. incontinence is any leakage of urine. the 2 most common reasons are stress incontinence and urge incontinence. stress incontinence is leakage of urine from exertion such as coughing, sneezing, jumping and laughing. this is due to a weakness of the support of the door of the bladder, such that it does not close tight on exertion, leading to leakage. urge incontinence is due to the bladder wall muscles contracting, involuntarily, squeezing urine out before one can reach the toilet.

Orgasm is pleasurable but when associated with urinary incontinence, many may be frightened or turned off by sexual intercourse. urinary incontinence during sexual intercourse is a poorly understood and infrequently volunteered problem. this is different from female ejaculations which can occur at orgasm. urinary incontinence may be from mechanical reasons such as the penis striking on a prolapsed ( dropped ) bladder, pushing urine out of a weakly supported urethra, or bladder contractions / spasm occurring at the same time as orgasm, or both of these reasons. some women lose muscle control throughout their bodies during an orgasm, including the muscle keeping the urethra closed, causing incontinence. a study done some years back in the united kingdom on 324 women found that 79 ( 24% ) experienced urinary incontinence during intercourse, two-thirds of whom had incontinence on penetration ( 70% of them had stress incontinence ) and one-third from orgasm ( 42% had stress incontinence and 35% had urge incontinence from and overactive bladder ).

There is another school of thought that sine contractions occur during orgasm, these contractions caused the bladder to contract as well ( overactive bladder ), leading to incontinence. a person with urinary incontinence should seek medical advice from her gynae, urogynae or her doctor, otherwise the condition may worsen, reducing the success rate from treatment, and affecting their sex life and relationship with her partner. certainly the reason should be sought after as there may be many factors involved. for incontinence occurring just once or twice, when it had never happened before, the reason could be simply a urinary tract infection, which can usually be easily cured with antibiotics.

Other than a physical examination, i will offer my patients a urodynamic study ( computerised assessment of the bladder ). this will help us with the diagnosis of stress and urge incontinence. in simple terms, stress incontinence is treated with pelvic floor ( kegel's ) exercise ( mild cases ) or surgery ( moderate or severe cases ), and urge incontinence is treated with medication and not surgery. hence, making the correct diagnosis is of utmost importance as the treatment is totally different.

Kegel's exercise is useful in not only helping people with stress incontinence, it also helps in strengthening the pubococcygeus muscles. if the pubococcygeus muscle is weak, it may be difficult to go into spasm ( orgasm ) when there is an object in the vagina. it has been also found by another study that females with stronger pubococcygeus muscle ejaculate ( just like the males ) better ( not urinary incontinence ) and have stronger orgasm.

Certain simple measures may be useful. one can pass urine before intercourse as an empty bladder will not leak. medication called minirin can be taken a couple of hours before intercourse to reduce urine formation. for people with overactive bladder, medication such as detrusitol can reduce contractions of the bladder.

A person should be properly assessed before starting medication.urinary incontinence may be more common than we think. help is certainly at hand and can be easily assessed and treated in most cases. sufferers must not suffer in silence otherwise sex life and relationship may be affected.

UTERINE FIBROIDS

2008-11-05T18:21:00.001-08:00

Fibroids are common in women and occur in 20% of females. they are fibrous growth occurring almost always in the uterus ( womb ) of females. there is no known cause for fibroids. most people pass through life without knowing they have fibroids and without any complications from the fibroids

Majority of the people having fibroids do not have symptoms. they are discovered on routine health checks and on ultrasound of the pelvis. majority of them do not need surgery or treatment. the size of fibroids can remain the same, enlarge but rarely strink unless in the menopause

Signs and symptoms of fibroids include : ( the 5 ' p 's )

1. period problems - heavy menses, sometimes with blood clots. the patient can feel giddy, tired and breathless due to anaemia ( low blood count )

2. palpable lump - on examination, the womb can be felt to be enlarged. usually the womb is small and behind the pelvic bone and cannot be felt from the abdomen. once this can be felt, it is considered large, and large enough to consider even surgery

3. pressure symptoms - they can press on the bladder, causing one to want to pass urine frequently, if the compression is severe, the patient may have difficulty in passing urine and even inability to pass urine. they can compress on the rectum giving the sensation of wanting to pass motion often.

4. pain - fibroids can cause severe pain if they are twisted ( those occurring on the surface of the womb ) or if they enlarge too fast over a short period.

5. pregnancy related - if the fibroids blocks the fallopian tubes or occupy the area of implantation of the pregnancy, or if they occupy a large area of the womb, causing fertility problems, then surgery may have to be considered.

the fuel or cause of growth of the fibroids is the hormone, Oestrogen from the ovaries. this hormone will only disappear after the menopause. this goes to say that when a patient is still having monthly periods, there is a higher chance for the fibroids to grow, and when she goes into menopause, there is usually strinkage of the fibroids by at least 50%. if the patient does not have the above signs and symptoms, the fibroids just need monitoring by regular ultrasound and examination. this is especially so if the patient is near the menopause age ( average 51 - 53 years of age ).

fibroids being cancerous is in the region of 0.03%. these are usually more than 6cm in size.

unfortunately, there is no medication to treat fibroids. there is an injection that can strink fibroids up to 50% in size over 3 - 6 months. this injection cannot be given for more than 6 months as it can cause side effects, especially brittle bones leading to fractures. once the injection is stopped, the fibroids will grow again.

When surgery is considered, the question is whether to remove the fibroids ( myomectomy ) or to remove the whole womb ( hysterectomy ). if fertility is desired or for whatever reason that the patient wishes to retain the womb, then myomectomy is done. the risk of fibroids occurring again is about 15%, and this can be from the same site or from new areas. myomectomy can be done by the open abdomen method or by key-hole surgery. key-hole surgery cannot be done for very big fibroids and may not be able to remove small fibroids embedded deep into the womb. if the surgeon is skilled and in selected cases, myomectomy can be done through the vagina. fibroids in the lining of the womb can be removed by hysteroscopic resection ( through a scope through the vagina and the cervix , opening of the womb ).

Hysterectomy can be done by the open method, by keyhole surgery and through the vagina. the advantage of vaginal surgery, if it can be done, is that there are no abdominal scars, recovery is very fast, hospital stay is short ( 1 day in some cases ) and pain is very much less than the other methods.

Complications of surgery include anaesthetic risks, bleeding, infection and injury to surrounding structures such as bowel or the urinary system. newer methods include embolisation of the arteries ( blood vessel ) supplying the womb, and MRI guided destruction of the fibroids. these

Newer methods may not be used for people desiring fertility. for large fibroids, the procedures can take many hours and the patient may complain of pain after the procedure. also, for larger fibroids, as we do not have the histology ( microscopic examination of the specimen ), we may miss the unlikely case of cancer. for smaller fibroids, treatment may not be needed. as of now, the newer methods are for selected cases, that is, not everyone is suitable and we await eagerly for more data and results on our patients.

My advice to my patients is always, " see a doctor when you are well, and not when you are unwell ". do not wait for signs and symptoms from fibroids before seeking treatment. best wishes for good health!

FEEL FREE TO LAUGH AGAIN - STOP THE LEAK IN 10 MINUTES ( THE LATEST SURGERY )

2008-11-05T18:18:00.000-08:00

Stress Urinary Incontinence ( SUI ) is the uncontrollable leakage of urine on exertion, such as running, jumping, sneezing, laughing and coughing. Associated causes include child-birth, menopause, obesity, chronic lifting of heavy loads, chronic cough and constipation.

A national survey on 3500 females in Singapore by Dr Christopher Chong revealed that 13.5% sufferred from SUI and a shocking 35.6%in the above 50 age group; that is more than 1 out of 3 females above 50 years old suffer from SUI. This equates to about 190 000 females in Singapore. It is estimated that less than 30 000 have seeked treatment for this problem. Also from the survey, the reasons for this low treatment level were that majority of the females were too embarassed to talk about it ( even with close friends or relatives ), did not know that it is a problem, did not know that it can be treated, and did not know where to seek treatment. Many, sadly, accepted it as part of growing old.

The Tension-free Vaginal Tape ( TVT ) is now the accepted surgery of choice in the treatment of SUI. The latest technique using the same tape is called TVT_O ( TVT-Obturator ) and has been used in Singapore for more than a year. It uses a polypropylene mesh tape placed around the middle part of the baldder neck ( " door " or outlet pipe of the bladder ) without any tension or stitches. The exit point is not through the abdomen but through the inner thigh. When a person strains, the bladder neck pushes onto the tape and closes, thus preventing leakage of urine. This tape is left permanently in the body.

The new technique has advantages over the older ones in that there is less risk of bleeding and injury to the bladder, and cystoscopy ( putting a TV system into the bladder ) to check for bladder damage and perforation need not be routinely done. This surgery can be done as a day procedure and the patient can be up and about the same day.

Complications, though minimal, include voiding problem ( less than 1% ), erosion of the mesh through the vagina, infection, bleeding, bladder injury and thigh pain.

In my personal series of the first 100 cases, the short-term success rate is 94%.

People with SUI should seek treatment early. A Screening ( to check if one is prone to or has SUI ) and Prevention Clinic for SUI is available so as to tackle the problem early in order to prevent progression to surgery. This is important as the more severe the condition, the lower the suceess rate from surgery.

There are many surgeries for SUI, ranging from 30 - 40% success rate for some old surgeries, to over 90% for some newer ones. Hence, it is very important to select the correct and best surgery for SUI. This is especially so as the success rate for SUI surgery fall with each subsequent surgery.

It is mandatory to perform a computer test of the baldder, called URODYNAMICS STUDIES, before any incontinence surgery in order to select the best and correct surgery for the patient. Life expectancy has gone up to 81 - 83 and people now have many more good years to live.

Ladies, do not suffer in silence for a lot can be done to improve or cure the problem of urinary leakage. On top of the" 5Cs " that people strive towards, we should add one more " C " . . . . . CONTINENCE.

A Story to Share

2008-11-05T18:16:00.000-08:00

I always love telling this true story : When i was working and subspecialising in Urogynaecology in Australia, a patient turned up at my clinic 3 weeks after surgery by my colleague. She had a tape inserted through the vagina for treatment of her urine leakage.She complained that the tape had eroded through the vagina as her husband felt the pain while having sex with her the night before. On examination, she was found to be absolutely right. I snipped of the tape and gave her vaginal hormones to thicken the vaginal skin over the cut surface and her husband was happy ever after.

Now, the story i want to tell is that she was 76 and her husband was 80 years of age. In the public hospital where i practised, we usually review our patients 6 weeks after surgery to give them the go-ahead to resume normal activities. This elderly couple could not wait and were having at 3 weeks after the operation! It is really so nice to see an elderly couple still so intimate and so in love. Isn't this a beautiful story?

To reiterate, it is not uncommon for people not being bale to enjoy sex. Fortunately, there are many ways to help them, including the use of sexual tools / toys. Couples should make it a point to set aside themselves even though they have a busy work schedule. It is useful to have the correct environment and ambiance. Those with kids may want to consider going off for a " dirty weekend " once in a while. Foreplay is of utmost importance and one should not jump straight into coitus. Change of position, medication and a positive and correct outlook towards sex will help in achieving sexual satisfaction.

Life is short and unpredictable - the journey will be wonderful if we can have a great emotional and sexual relationship with someone we love . .. . . . . . . . . .

From last title

2008-11-05T18:12:00.001-08:00

FEAR

Fear of intercourse, especially the first time round, may affect one's outlook towards one's future sex life. If the first penetration proves to be extremely painful and traumatic, phobia of intercourse may result. Fear can also be of pregnancy, infection and guilt to name a few.

SUGGESTION : A couple should try to find out more about sex before starting, especially concerning contraception, hygiene and prevention of infection. Enough foreplay and lubrication is important.

TIGHT INTROITUS ( VAGINA )

Some people are born with tight pelvic bone and vagina. While one cannot do much about bones, a tight vagina can be treated easily. Many such patients have a thickened band on the floor of the vagina, giving rise to pain during intercourse, resulting in the female refusing penetration ( Vaginimus ).

SUGGESTION : A simple surgery, which can be done as a day procedure, can be done to either release the tight band ( using laser or burning called diathermy ), or to make a small cut to widen the outlet of the vagina ( called Fenton's operation ).

RETROVERTED UTERUS

Retroverted uterus ( womb ) occurs in about 10 to 15 % of patients, naturally. In such cases, the womb rests on the back or the spine area. Some will complain of pain during intercourse.

SUGGESTION : A change in the sexual position may be all that is needed. The rear entry ( doggy style ) tends to move the womb away from the spine and relieve much of the backache. Surgery is available to correct this problem but this is a major surgery and is used only as a last resort.

ENDOMETRIOSIS

This is when menstrual blood back flow out of the lining of the womb to implant on the ovaries, womb or outside the womb. Endometriosis is associated with painful periods, painful intercourse, heavy periods and subfertility.

SUGGESTION : Please consult your gynae regarding further management. A laparoscopy ( key-hole surgery ) where a scope ( TV ) is put through the naval to look at the womb may be necessary for diagnosis. Treatment can be with medication or keyhole surgery depending on the severity.

VAGINAL INFECTION

This often presents with vaginal discharge which could be white and curdy ( fungal infection ) or yellow / green ( bacteria or parasite infection ). If left untreated, the patient may experience lower abdominal pain and of course painful sex.

SUGGESTION : See your gynae to clean off the infection, send the discharge for examination and for medication.

MENOPAUSE

This covers one large group of patients. In my practice, i routinely ask my patients about their sexual health. It may be due to the Asian culture, but the sad truth is that many menopaused women will divulge that they have little or no sex after menopause. There are many reasons , but a common one given is that of feeling old and tired. This may one reason for us reading reports of older men going over to Batam in search of sex. This has led some to believe that " WOMEN MENOPAUSE, MEN NO PAUSE ". Well, men actually has andropause, but this comes much later than women's menopause. The menopause is associated with loss of hormones called Oestrogen as the ovaries stop working and stop producing hormones when a patient is menopaused. This results in vaginal dryness, clitoris losing its protective covering, loss of tissues elasticity and the vaginal lining becomes thin. There is also a decrease in sexual responsivity and decreased libido. All these will lead to painful sex.

SUGGESTION : Vaginal hormones will help to improve vaginal dryness, thicken vaginal tissues and improving the elasticity of the vagina. The men have Vigra, Levitra and Cialis. Now a product approved for use in females in the USA, has been brought to Singapore. This is " ZESTRA ", a cream manufactured to help in lubrication and increasing libido in females. Application of Zestra to the vulva and vagina area 5 to 10 minutes before intercourse can leak to improving sexual arousal for the females.

From Last Title

2008-11-05T18:11:00.000-08:00

STRESS

This is probably the most common complaint, especially for the younger and pre-menopausal age group, as the greatest sex organ lies between the ears. It is not uncommon for my patients to reveal that they have sex at most once a month. The stress is mainly from working and over-working. Of course the home environment plays a part as well. It is absolutely unnatural to tell your partner that it is a safe period or the time of the month to have sex rather than it happening spontaneously.

SUGGESTION : Try to set aside certain days to relax, even when work is heavy. A good ambiance, dim lighting, light sexy music, aroma therapy will all help in setting the stage right. Give each other sensual massages, a longer period of foreplay and enough lubrication ( natural or applied ) such that both parties are absolutely wet before penetration usually gets the desired effects and results.

WHY DON'T I ENJOY SEX? - IN FEMALES

2008-11-05T18:10:00.000-08:00

Sexual intercourse is one of the simple pleasures in life. To be able to have pleasurable sex and achieve orgasm is the aim of all couples. It is often said that a healthy sex life is essential in a couple's relationship and emotional growth. Sexual intercourse unfortunately is not simply about penetration of the penis into the vagina. Many factors are involved in pleasurable sex and orgasm. We will now embark on a journey to examine the more common reasons as to why some people do not enjoy sex.

Labioplasty

2008-11-05T18:08:00.000-08:00

Apart from vaginoplasty, I'm seeing more patients requesting for Labioplasty (reduction of the labia). Some patients, especially those below 40 years old, are very upset by their enlarged labia. Some complained that penetration was more difficult and they felt a pain when their partner searched for the point of entry.

Others felt depressed when their partners looked at their vulva and got turned off by the sight. Labioplasty is a simple surgery involving the excess labia skin being cut away using a straight or a zigzag interlocking cut. Stitching is done using very fine sutures and these are removed within a week. Labioplasty can be done as a day procedure with excellent results.

A Tight Fit

2008-11-05T18:01:00.000-08:00

Standfirst:
Vaginoplasty, a surgery done to tighten the vagina, has made medicine cross over to the realm of aesthetics in recent years. Dr Christopher Chong gives you an insight on this trend. I'm certainly seeing more patients requesting for vaginoplasty these days.

Some of them do it for themselves, while others do it for their partners. Understandably, if sex reaches the "no fun" stage, their relationship can be affected. Many of these patients have prolapsed pelvic organ.

Let me share with you an interesting finding: a search on "vaginal cosmetic surgery" on internet portals Yahoo and Google revealed hundreds of websites dedicated to this topic. Yet, a similar search on Medline – for online medical journals and research – turned up none. This may simply be a matter of different terminologies, but the objective and outcome are likely to be the same.

Before you learn how vaginoplasty is done, you need to know what drives it. The pelvic floor muscles in women control the three organ systems – namely the bladder, womb and bowel, which are lined up in this order. When one organ system is damaged, it's likely that the neighbouring organs are affected as well. The three main culprits behind damaged pelvis floor muscles are pregnancy /childbirth, menopause and obesity. On the other hand, some women are born with weak collagen muscle tissues and have a lax vagina even at a young age and without having gone through childbirth.

Culprit:

Childbirth The usual damage is, of course, from pregnancy and childbirth. The baby's head going through the vagina can cause overstretching and tearing of the pelvic floor muscles. It's even worse for patients who do not do Kegel's exercise during pregnancy and post delivery. Many women are unaware that this exercise can reduce or prevent pelvic floor damage. To find out if damage has been done, a doctor may put an index finger into the vagina and a thumb into the anus, and pinch them together. If there's a hollow in between, it's likely to be due to the damage in the pelvic floor muscles and in the "perineal body" tissue located in the region. This is a common problem caused by poorly healed or poorly cut (episiotomy) vagina after childbirth. It gives that open vulva/vagina feeling to the patient and her partner, which is why complaints like "looseness", "no strength", "no sensation" and "no fun" are often heard.

Relatively safe In Vaginoplasty, I repair the perineal body tissue and join the pelvic floor muscles with sutures. The vaginal skin will be fashioned according to preferred tightness of the pelvic floor muscles. This surgery can be done as a day procedure, with minimal pain and complications, and with a good success rate under skilled hands.

Generally, I do not cut away vaginal skin unless it's excessive, because the complication that comes after it is that of painful intercourse. Any prolapsed problem must be corrected at the same time. This is an attempt at achieving "a tight fit" to improve stimulation of the vulval and vaginal tissues. It's not far fetched to get her partner to go for "fitting", but very often, he's not willing to do so. Vaginoplasty can be done with or without the use of laser but the principles of surgery remain the same. Complications like bleeding and infection are rare. Some women may get scarred, and coupled with the over tightening or cutting of the vaginal skin, sex can end up becoming a nightmare instead of a pleasure.

Measuring success

The success of vaginoplasty is personal and subjective – to the surgeon, the patient or her partner. The true measure of success would be the three parties are happy. I always abide by my teacher's wisdom of treating a patient as "a whole, not a hole". It's important to be sensitive to the psychological and emotional aspects of the patient and her partner. It helps manage expectations and improve the chances of a successful outcome. The majority of my patients, who have sought vaginoplasty, are in the pre-menopausal stage and a significant number is in their 30s. They have certainly reported better sexual satisfaction – and relationship – after the surgery.

But the greatest sex organ is truly what's between the ears – the brain. Stimulation of the clitoris and vulva, which can be achieved through foreplay, sends positive signals to the brain, which in turn gives sexual satisfaction. However, a satisfactory vulval/vaginal stimulation still requires a "good fit". While vaginoplasty is not the one-size-fits-all solution to enhancing sex life, it cannot be denied that a proper fit does matter in bed.