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COVID-19 in Urologic Aspect: Q&A

During this period of time, I think ain’t body don’t know the COVID-19 or SARS-COV-2. The novel pandemic of the respiratory infection which is originated contagious virus from Wuhan, Mainland China. There have been many patients asked me that; does this virus impact urinary tract system? Well, let’s take a look together in Q&A (Updated April 29, 2020)

  • Can the virus attack our urinary tract system?

Answer Yes, it can! Due to SARS-COV-2 attack the human receptor named Angiotensin-converting enzyme type 2 (ACE2) which located at lung, heart, esophagus, ileum, urinary bladder and kidney.

  • What symptoms after urinary tract system have been infected?

Answer It’s been caused probably from mild to severe acute kidney injury. Protein or blood in urine can be detected. Remarkably, kidney involvement during SARS-COV-2 infection will significantly increasing mortality rate.

  • Can SARS-COV-2 be detected in urine or semen?

Answer After several PUBMED’s literatures appraisal, the SARS-COV-2 very little to detect in urine and there’s no evidence of viral loaded in semen. This is proving that the SARS-COV-2 cannot transmit through sexual activities. (But you still need to keep the Social Distancing during this activity, Surprise??)

  • Can SARS-COV-2 will cause the UTI?

Answer No any evidence that it capable to transmit through the urine.

  • Can we go on routine urologic procedure?

Answer Due to SARS-COV-2 is a novel virus with very limited data on transmission as we have learned. Then if there have been benign urological surgeries came up during this period of time it better to postpone until this kind of pandemic over. It will prioritize if there’s emergency and life-threatening oncologic conditions occurred. And it is possible to get it done with a strictly preoperative screening if there is a suspected on the SARS-COV-2 patient.

In my opinion, there have been not only global health care systems that being challenged during this pandemic. But both global economic and supply chain as well as a lifestyle will be challenging and impacting. I do hope that people around the world will be stayed safely from the SARS-COV-2. All right! So please stay safe you guys!

 

泌尿器科の側面からCOVID-19について:  Q&A

この時節、COVID-19やSARS-COV-2(新型コロナウイルスの医学的名称)を知らない人はいないと思います。中国武漢から伝染した新型呼吸器感染症のパンデミックです。このウイルスは尿路系に影響があるのか?では、Q&Aで一緒に見ていきましょう。(2020年4月29日更新)

1) ウイルスは私たちの尿路系を攻撃することができますか?

回答/
イエスです。SARS-COV-2は、肺、心臓、食道、回腸、膀胱、腎臓にあるアンジオテンシン変換酵素2型(ACE2)というヒトの細胞の受容体を攻撃するためです。

2)尿路系に感染した後の症状は?

回答/
軽度から重度の急性腎障害が原因と考えられています。尿にタンパク質や血液が検出されることがあります。驚くべきことに、SARS-COV-2感染時に腎臓が侵されると死亡率が著しく上昇します。

3)SARS-COV-2は尿や精液から検出できるか。

回答/
いくつかの文献の評価を行った結果、SARS-COV-2は尿中に検出されることはほとんどなく、精液中にウイルスが存在している研究結果はないです。これは、SARS-COV-2が性行為を介して感染することができないことを証明しています。(しかし、感染予防のためにこの行為の間、社会的距離を保つ必要があります。驚きますね!‐ジョークです‐)

4) SARS-COV-2はUTI(尿路感染症)を引き起こす可能性がありますか?

回答/
尿を介して感染するという証拠はありません。

5) 定期的に泌尿器科で検査を受けてもいいですか?

回答 /
SARS-COV-2は新しいウイルスであるため感染に関するデータは非常に限られています。もし良性の泌尿器科手術がこの期間に実施されてきている場合は、この種のパンデミックが終わるまで延期した方が良いでしょう。緊急性があり、生命を脅かすような腫瘍の状態が発生した場合には、優先順位をつけ実施を検討することができます。またSARS-COV-2の疑いがある患者さんの場合、術前の新型コロナウイルスのスクリーニングを厳密に行います。

 

私の考えでは、このパンデミックの間、世界的な医療システムだけでなく、世界的な経済とサプライチェーンの両方が試練を受けています。残念ながら世界的な経済やサプライチェーンと同じくライフスタイルにも試練と影響を受けることになるでしょう。世界中の人々がSARS-COV-2から安全に守られることを願っています。
それでは 皆さん、どうかお気をつけて!

 

Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist

Royal Phnom Penh hospital

 

Address: No. 888 Russian Confederation Blvd. Sangkat Toeuk Thla, Khan Sen Sok, Phnom Penh, Cambodia

Hospital Hotline Call: +855 (0) 23 991 000/ +855(0)12991000

Email: info@royalphnompenhhospital.com

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International standard One stop services for Mother and Child care at Royal Phnom Penh Hospital

International standard One stop services for Mother and Child care at Royal Phnom Penh Hospital

Phnom Penh, 29th Feb 2020, Royal Phnom Penh Hospital (RPH), which is a tertiary care hospital managed and operated by Bangkok Dusit Medical Services Public CO. LTD (BDMS) has been in service since 2014.

The Official Grand Opening of the Pediatric Ward is focused on “One stop services for mother and child care”.

Royal Phnom Penh Hospital (RPH) has been recognized internationally for using state of the art medical technology and also efficiently leveraging the hospital’s professional network while adhering to the highest international standards and professional ethics, the hospital is committed to continuously improving their services to benefit patients and society. In these two and a half years of operation, the Royal Phnom Penh Hospital (RPH) is the first hospital in Cambodia to have the international accreditation from the Joint Commission International (JCI) which ensures an international medical standard and healthcare services to Cambodia and international patients. The accreditation is awarded to the hospital for providing quality medical service standard to patients and gaining the trust from International Insurance company, corporate company and government agencies around the world.

With the rising of middle-class in Cambodia, there is a need for better medical care and treatment and the Royal Phnom Penh Hospital has been playing an important role in providing a World-Class service and treatment to every Cambodian, tourists and expatriates.

To respond to the increased number of mother and child patients, especially in maternity services, the hospital has been investing in strong medical professionals, nursing team and medical equipment that focuses more on children emergency service, so with the setting up of new 24 hours pediatric ward, NICU and PICU together with a strong Pediatrics, obstetrics & gynecology team, the Hospital aims to ensure that all mother and child gets the highest level of care and patient safety.

“To celebrate the opening of our new pediatric ward, NICU, PICU and facility for mother and child care service at Royal Phnom Penh Hospital (RPH), and on behalf of the management and staffs of the hospital and our BDMS network, I would love to take this opportunity to extend our sincere thanks and appreciation for the support from the Royal Government of Cambodia, who are always very supportive and welcoming.

It is our honor and pleasure to be in Cambodia,” said Dr. Thanarat Samupet, deputy hospital director

“At the same time, we also would like to extend our appreciation to all our patients, business partners, suppliers, and other friends who had provided support to the high-quality venture over the past-four-year since we opened. Without your support, we will not be here today,”

“we are committed to pursue our mission by bringing in more high-tech medical equipment and delivering the most outstanding level of medical services and healthcare to the community.

So, if you are considering getting health care services abroad, please consider Royal Phnom Penh Hospital in future, as we can provide the same if not better medical services locally, thus saving your time and money for traveling abroad for medical care”

Because maternal and child’s health is important, our clinic provides an excellence care from prenatal stages, through adolescence and women’s health. Our highly skilled staffs including pediatricians, obstetricians and gynecologists, we are here to assist you and your family.

Children’s health also plays an important role in growth and development process. Frequent well visits, assessments of growth and development, physical exam and immunizations are essential to quality of care. Our clinic provides a comprehensive pediatric healthcare from birth to adolescence. We are committed to providing high quality medical care for healthy and sick children and supporting their families. No matter how big or how small the problem, we are always here to help.

 

Obstetrics & Gynecology and Pediatric services:

  • Mother and child Emergency and Trauma services 24/7
  • Full service for outpatient for pediatric and obstetrics & gynecology patient
  • Full service for pediatric vaccination program and women vaccination program
  • Hygiene pediatric ward
  • International standard for NICU and PICU services
  • Ambulance service 24/7
  • Hygiene delivery room

About the Royal Phnom Penh Hospital (RPH, which is a tertiary care hospital managed and operated by Bangkok Dusit Medical Services Public Co., Ltd (BDMS), opened in Cambodia since October 2014.

Address: No. 888 Russian Confederation Blvd. Sangkat Toeuk Thla, Khan Sen Sok, Phnom Penh, Cambodia

Hospital Hotline Call: +855 (0) 23 991 000/ +855(0)12991000

Email: info@royalphnompenhhospital.com

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What factors affect the success rate for vasectomy reversal procedure?

What factors affect​​ the success rate for vasectomy reversal procedure?

Nowadays, the proportion of the couple’s divorcement significantly going high, men who used to be done for the vasectomy is now changing their mind and seeking for the vasectomy reversal procedure. Some survey in the US recently reported that 2% – 6% of vasectomized men they need to do the reversal procedure.

Let’s talk about the vasectomy procedure first! The day-care operational for male permanent contraception. This sort of procedure will start with the infusion of the pain killer direct to scrotal skin. After that the surgeon will make 1-cm for the incision then catch both Vas deferens then cut, tie and cauterize them as in the picture shown up. Some surgeons are performing the called “No-scalpel Vasectomy” which is no incision required. This special technique has pros on the less pain and less operational times but we still questions related to the effectiveness on the results. Literally, once I discuss with the patients related to the “Contraception procedure”, they have anticipated 100% success rate ever (I have reviewed the latest literature about those questions would had launched since 2014 – but it remains questionable).

So back to the vasectomy reversal procedure! It is not just a minor operation like the vasectomy one. To do this we required the patients access procedure under the general anesthesia several hours in the operational duration, when the job done the patients need to stay overnight in the hospital.

After the operation, the patients must strictly follow the doctor’s advices as following:

  • Taking shower or bathing will be allowed after 48 hours passed by
  • All-time wear scrotal support (except in taking shower only) do this for 6 weeks
  • Scrotal support still need to wear while you performing the heavy activities or sports, unless you’re getting know the sing of pregnancy confirmed
  • Desk works can be resumed in 3 days
  • Avoid any kind of sports for 3 weeks
  • No ejaculation for 3 weeks
  • Semen analysis shall repeat as scheduled the 1st , 3rd  and 6th  of the month after the operation

With the microscopic surgery and to obtain the superior outcome so it might needs the well-trained Urologist or Andrologist to perform this operation. Once the reversal procedure has done, 70% – 95% of the patients  will getting sperms as well as their ejaculated fluid ,and finally getting pregnancy naturally from 30% – 75% of the couple.

Anyway, there still a magic number on this operation! Well! Will you make the decision to undergo the reversal procedure just because for 5 years vasectomy and plan to get young wife to become more fertility? Is it better when you get divorced too early and finding another younger wife at the same time in order to gain more beneficial from that? Just little joke. If you need more information on this stuff, come and see me at the office please.

 

哪些因数会影响到输精管复通术的成功率?

在现代,离婚夫妻的比率越来越高有些男性做过结扎手术的人开始改变心意想要做输精管复通术。依美国的数据近期有 2%-6%的男性要求做输精管复通手术。

让我们先来谈到结扎术!他是男性永久避孕的当日回手术。 这个所述的做法是从阴囊皮肤直接注入止痛药开始。再来医生从会从阴囊表皮开一公分的切口然后抓住两边的输精管进行切割跟绑断如图所示。 有些外科医生正在执行所谓的 “无创的输精管结扎 术”,它不需要切开皮肤。 这种特殊的技术可以减轻痛苦和减少手术时间,但我们对术后的效果仍然存在疑问。 一旦我与患者进行讨论关于“避孕计划”,他们就有期望着会获得100%的成功率(我已经查阅了最新的文献有关这些问题,从2014年以来就出现这些问题的最新文献,但仍然值得怀疑)。

那么我们回到输精管复通手术! 这不仅是输精管结扎术那样的小手术。 为了做这个手术,我们需要患者在全身麻醉下进行数小时的手术,手术完成后,患者需要住院一天观察。

手术后,患者必须严格遵循医生的建议如下:

  • 术后48小时才允许淋浴
    2)长期使用阴囊托(仅在洗澡时去除阴囊托),进行6周
    3)进行体力劳动的活动或运动时,还是需要使用阴囊托,除非您知道已确认怀孕
    4)注意多休息,如果您在办公室上班,那3天后可照常工作
    5)3周内避免任何运动
    6)术后3周内应避免性生活
    7)术后1个月、3个月、6个月复查精液

通过显微外科输精管复通术,为了获得更满意的效果,需要经验丰富的泌尿科医师或男性科医师来执行此手术。 一旦输精管复通了,会有70%-95%的患者展现精子在精液里面,最终这些夫妇会有30到75%自然地怀孕。

无论如何,此操作还有一个魔幻数字! 就是! 您是否在五年内进行输精管结扎术并计划与年轻妻子结婚,为了增加生育能力,而决定做输精管复通手术? 如果是那样您该尽早离婚而且同时找到年轻漂亮的妻子才可以让这个手术的成功率更高? 开玩笑的!

如果您想了解更多相关讯息,请到曼谷皇家医院找我。

 

精管結紮術(パイプカット)後の精管再建術の成功に影響する要因とは?

今日、夫婦の離婚が著しく多くなり、精管結紮術(パイプカット)を行った男性も、永久避妊の決意を変え再建術を求めるようになってきています。米国の最近の調査では、精管結紮術を行った2-6%の男性が、再建術が必要になっていると報告しています。

まず初めに、日帰り手術による男性の永久的な避妊である精管結紮術についてお話しましょう。まずは、陰嚢の皮膚に局所麻酔薬を注射します。次に1センチの切開を行い、両方の精管を左の図のように、切断、結紮(手術用の縫合糸でしばる)、切断の端を焼灼します。一部の執刀医は、切開を必要としない「メスなし精管切除」と呼ばれる手術を行っています。この特別な手法には、痛みが少なく、手術時間が短いという長所がありますが、完璧に結紮できているという結果の有効性には疑問が残っています。「避妊法」について患者と話し合うと、まさにみな100%の避妊の成功を期待しています。(しかし、これらの質問に関する最新の文献は2014年以降に発表されていますが、100%の避妊率は疑わしいままです。)

それでは、精管再建術に戻りましょう!これは、精管結紮術(パイプカット)のような単なる小さな手術ではありません。この手術は数時間の全身麻酔のもとに実施することが必要なため一晩の入院が必要になります。

手術後、患者は次のように医師のアドバイスに厳密に従う必要があります。

1)48時間経過後にシャワーまたは入浴が許可されます。

2)常時着用の陰嚢サポート(シャワー時のみ除く)を6週間行います。

3)妊娠の兆候が確認されたことがわからない限り、激しい身体活動やスポーツを行う間は陰嚢サポートを着用する必要があります。

4)デスクワークは3日で再開できます。

5)3週間はあらゆる種類のスポーツを避けます。

6)3週間は射精は禁止されます。

7)精液分析検査は手術後1か月、3か月、6か月と予定どおりに繰り返されます。

顕微鏡手術を行い優れた結果を得るには、この手術を行うために十分に訓練された泌尿器科医または男性科医師が必要になるでしょう。精管再建術が完了すると、患者の70%-95%が射精液とともに精液を得て、最終的にカップルの30%-75%から自然に妊娠します。

いずれにせよ、確実に妊娠するには、まだこの手術には不確定の要素があります!では!ちょうど5年間精管結紮をしていることや受胎するための若妻を得る計画を立てているという事柄があなたに精管再建術を受けることを決意させるでしょうか?精管再建術から受胎の良い結果を得るためには、より早く離婚をして同時に別の若い妻を見つけるということが良策でしょうか?ちょっとしたジョークです。
(精管結紮後5年以上は再生術の成功率が低くなります。また女性の年齢も妊娠には重要な要因です。)

この治療のさらに詳しい情報をお聞きになりたい場合は、わたしの診察室にお越しください。

 

Soarawee Weerasopone, MD

Andrologist/男科医生 / 男性科専門医

Royal Phnom Penh Hospital

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