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Erectile Dysfunction: 4 Pillars of the ED problems causing

No doubt that nowadays the so- called ED or the Erectile Dysfunction would be a major concern for gentleman. It’s so surprised that this problem is happening frequently in a juvenile. I often take care of this problem for patients who are at age 20 years old. Let’s get start it! What is ED?  It is a “Persistent inability to attain and maintain the erection sufficiently in order to permit the satisfactory sexual performance”


Erectile dysfunction is common issue

The ED is more importantly than we’ve thought, it can be the indicator to evaluate the future of the cardiovascular events and the impact of the marital distress – unhappy partner which possibly drive the risk of the divorces. More than 50% of the 40 years old and elderly U.S. men were in the ED problem, lately, literature shows that  25% of new-onset ED was a group of the juvenile whose age under 40 years old.

Let’s jump to the 4 main points that cause and affect the ED.

  1. Hormonal issue

Everyone knows that Testosterone is an essential sexual hormone that stimulates the sexual characteristics. Testosterone normal level will reach the maximum at age 20 and then slowly decline by aging. There is a normal value of testosterone level changes by ages which you can easily go on Google check for more information. The symptom of low testosterone hormone can be presented with depressed mood (Emotional changes), feeling ran out of energy (Decrease strength). If this issue is suspected so the early morning blood test for testosterone level would be recommended. Generally, elderly men with ED from testosterone deficiency can get benefit from testosterone replacement therapy, but either way be careful when consider about testosterone replacement in younger age or it will be worse than that.

  1. Neurogenic issue

While our cannon – penis is under controlled by the brain itself so the neurological system must be in good structural and functional well. Brain lesions from Stroke or a Parkinson disease can extremely impact the ED. And also spinal cord lesions from a spinal dissection that caused from any trauma, literally, it will cause ED which is very difficult to fix and deal with.

Cigarette is one of major cause in ED

  1. Vasculogenic issue

Low in vascular quality affected 75% of ED cases, the history of smoking is very crucial to ED due to the Nicotine and other substances in the cigarette will damage the vessel quality all over the body especially the small vessels inside our penis. All condition that makes our blood vessels remain unhealthy and malfunction we must be concerned and be well-controlled. Obesity, Hypertension, Diabetes Mellitus and Hypercholesterolemia must be well-monitored and well-maintained.



Keep yourself in good shape is good for ED





  1. Mental issue

Such kind of this activity must be fantasy things, so joyful and happiness shall not ignorance. From your life struggling stuffs like a stress from work, taking care of kids, household daily routine job etc…, and these kinds of stuffs are distracted and harmed your mind and emotion while performing this activity. On the contrary, if you sleep well, good recreation and working out regularly it will beneficial your Mental and solve the ED issue properly.

Honestly, it is tons of information that I cannot compose in 1 topic, if you’d like to discuss with me related to this topic above. Please give me a text or PM me! See you guys with the next topic.

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


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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.



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。


  • 术后48小时才允许淋浴

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!



















Soarawee Weerasopone, MD

Andrologist/男科医生 / 男性科専門医

Royal Phnom Penh Hospital

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Should I go on the PSA screening test?

I have been practiced in Urology office so far. A simply consulting from the other departments is about-the references of PSA value from the screening test. This kind of problem made the patients suffered a lot, especially psychological harm and I spent a bunch times to explain them for what is the big deal? Let me update you guys on PSA screening program.

If we questioned that “what kind of cancer screening test is the most concern in the world?” The answer is “Cervical cancer screening program” but what about prostate cancer? The answer is “not necessarily” I will tell you why.

In 2018, there was a very famous literature from USA studying on the PSA screening test recommendation and they concluded that not everyone should go on this screening test, if you do it, a little benefit for screening in age group 55 – 69 years old. Surprise? Let me tell you for the whole deals.

PSA is an abbreviated from “Prostate Specific Antigen” which is enzyme that specifically produced in the prostate. This enzyme’s function is to liquefy semen from Gel-like into liquid after ejaculation. PSA is riched in the prostate tissue and low in concentration in the blood stream so that is mean any events that make prostate tissue breakdown, this enzyme enter the serum and was detected by the PSA blood test. The conditions for example, benign prostatic hyperplasia, prostatic infection and some minor manipulation can be raised this value which is called “False-positive” test.

Let’s get back to the famous US paper, the purpose of prostate cancer screening is trying to figure out the high-risk localized cancer that can be successfully treated. Why we don’t care about low-risk cancer? The answer is very simple, literally, you will die from the other causes before this cancer harm you. Mostly, the prostate cancer has no symptoms and the autopsy studied shown up to 33% of men who died from the other causes have been found prostate cancer. If we pay attention with the high-risk cancer, it’s only around 1 from 1,000 screening men will get benefit from the screening test and has no benefit when screening in men who are 70 years old up.

Tons of harmful unnecessary PSA screening test had starting with when patients got false-positive PSA result. First of all is a psychological disturbance, next they may suffer from the complication of prostate biopsy such as a painful, a bloody urination, a bloody ejaculation and infection and it is not including complication from other prostate removal operation like erectile dysfunction and urinary incontinent.

So what should we do? If you are male and in the age group of 55 – 69 years old, you better discuss with your primary doctor and make a decision together in advance. It is your choice! If you got a problem or you have a question, please come to see me at my office.


我在泌尿科已有很多年的工作经验, 来自其他部门的常见咨讯是关于筛查测试中的PSA参考值。这种问题使患者受到很多痛苦,尤其是心理伤害。我花了很多时间向他们解释关于这个问题 “我们必要做前列腺特异抗原检查吗?。 由此我向大家介绍一下上述的问题如下。

如果我们质疑“世界上最关注哪一种癌症筛查测试?” 答案是“宫颈癌筛查”,那么前列腺癌呢? 答案是“不重要的”下面我会告诉您为什么。

2018年,美国非常有名的文献对PSA筛查测试,而建议进行了研究,他们获得结论提示,并不是每个人都应该进行PSA筛查测试。如果您做PSA筛查的活,就于55-69岁年龄组筛查是有点好处的。 惊讶吗? 让我告诉您全部的关键问题。

PSA是“前列腺特异抗原”的缩写,它是一种在前列腺中特异性产生的酶。 这种酶的作用是在射精后将精液从凝胶状液化为液体的。 PSA富含在前列腺组织和低浓度的血液中。因此,意味着任何事请使前列腺组织分解的,该酶进入血清,并被检测到,通过PSA血液检查。 例如,良性前列腺增生症,前列腺感染和一些轻微操作等情况均可提高该值,称为“假阳性”测试。

那么,我们回到美国著名的报纸,前列腺癌筛查的目的就是试图弄清楚癌症高风险,并可以治疗成功的。 为什么我们不在乎低风险的癌症? 答案很简单,从字面上看,在这种癌症伤害您之前,您将死于其他原因。 大多数情况下,前列腺癌没有任何症状,经过尸检研究出现,33%因其他原因死亡的男性被发现患有前列腺癌。 如果我们关注高危癌症,那么在1,000名筛查男人性中只有1名会从筛查测试中受益,而对70岁以上的男性筛查则没有任何益处。

大量有害的不必要PSA筛查测试始于患者获得假阳性PSA结果时。 首先是心理障碍,接下来他们可能会遭受前列腺穿刺活检的并发症,例如疼痛,血尿,射血和感染,并且还不包括其他前列腺切除手术,如勃起功能障碍和尿失禁的并发症。

那我们该怎么办呢? 如果您是在55-69岁年龄组之间的男性,您最好与您的主治医生讨论并事先共同做出决定。 这是您的选择! 如果您有任何问题或疑问,请来曼谷皇家医院找我。



私はこれまで泌尿器科で診療経験を積んできました。 他の診療部門からは、PSAスクリーニングテストのPSA値について診断の依頼があります。 そして何が診断、治療のために大事なのかを説明するためにたくさんの時間を費やしました。このPSA値の問題により、患者は多くの苦痛を受けました。その中にはとりわけ心理的な害もあります。 以下、PSAスクリーニングプログラムについてお話しします。

「どのようながん検診が世界で最も重要視されているのか?」と質問がある場合、答えは「子宮頸がん検診プログラム」です。では、「前立腺がんはどうですか?」 と尋ねられれば、答えは「必ずしも必要ではない」です。次にその理由を説明します。

2018年に、アメリカで、PSAスクリーニングテストについて、非常に著名な研究論文がありました。彼らは、すべての対象者について、このスクリーニングテストに参加する必要はない、と結論付けました。もし実施するなら、55歳から69歳のグループに多少のメリットがあるという結果でした。 驚きますか? では、その全体の概要について お話ししましょう。

PSAは、前立腺で特異的に産生される酵素である「Prostate Specific Antigen」の略語です。この酵素の機能は、射精後に精液をゲル状から液体に液化することです。 PSAは前立腺組織に多く存在し、血液中では濃度が低いため、このPSA酵素が血清中に入り、血液検査で検出されることは、前立腺組織が損傷されている状況を意味します。たとえば、良性前立腺過形成、前立腺の感染、および若干の軽微な触診などの条件は、「偽陽性」と呼ばれる程度に、この検査値を上昇させます。





Dr. Soarawee Weerasopone

Minimally invasive Urologist / 微创泌尿科医生 / 低侵襲性医療 泌尿器科専門医

Royal Phnom Penh Hospital / 曼谷皇家医院

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Trauma Brain Injury (TBI)

Head injury mean complex mechanical loading to the head and/or the body that causes the injuries to the scalp, skull, brain and cranial nerve. As a result, it causes patient’s brain’s function disorder which may affect to physical disability, consciousness, thinking process, mental and emotional changes as well as behavior

How to Avoid Traffic Accidents

1. Keep your eyes on the road
2. Never use your cell phone
3. Don’t change CD’s, radio tuner
4. Never, ever drink or sleepy and drive
5. Avoid construction areas
6. Follow speed limits
7. Follow the rules of the road
8. Ignore aggressive drivers

Diseases that causes your risk of falling down

1. Visual Impairments
2. Neuropathy
3. Cardiovascular Disease
4. Dementia and Alzheimer’s Disease
5. Parkinson’s Disease

How to Avoid Accidents from falling stairs

1. Ensure that all stairwells conform to safety standards
2. Keep stairways clear to prevent accidents
3. Mark the edge of the steps a different color so as to avoid stairway accidents
4. Install handrails on both side of the stairway
5. Post notices on oddly designed stairwells
6. Make sure that the stairway is well lit during the day and the night
7. Inspect the stairway regularly and make sure that it is maintained
8. On rainy days, make sure that the stairwells are dried off
9. Make it a house rule to hold the handrail when using the stairs and make it natural to remind those who do who forget
10. Short step. A short step does not provide adequate support for the ball of the foot for safe forward-facing descent
11. Irregular step. An irregular step is longer and shorter than the other steps in a flight
12. Surprise step. A surprise step is not clearly visible or expected.
It could be at the bottom of a flight or a single unexpected step

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Do oysters improve libido?

Have you guys ever experienced when someone orders oysters, and friends joke saying, “Do you have plans with your wife or your girlfriend tonight?” I have heard that sentence so many times. So I wonder, do oysters have scientifically proven effects on libido?

So I searched through literature. I could not find any scientific evidence about oysters improving libido. But, if we talked about animal products that might increase libido, there are mentions in Eastern medicine wisdom. From the belief of “We consume the power from what we eat.” So if we want to improve our penis, we eat a mammal’s penis.

Unfortunately, there is still no scientific evidence to support these ideas.
There is one well written study from New Zealand about whether Deer velvet shows any positive effect on erections or in male or female sexual function? The answer, there are still no significant answers. If we take a closer look at the nutritional facts on oysters. Oysters are rich in Vitamin B12, Zinc, Selenium, Vitamin D and Iron.

100 grams of oysters (6 medium size) contain:

  • Vitamin B12 : 324% of the daily recommend amount
    • Essential for nervous system maintenance
  • Zinc : 605% of the daily recommend amount
    • Essential in immune system health
  • Selenium : 91% of daily recommend amount
    • Antioxidant
  • Vitamin D : 80% of daily recommend amount
    • Essential in immune system health
  • Iron : 37% of daily recommend amount
    • Essential in hemoglobin production

However, oysters are loaded with fat, cholesterol and sodium, so be careful with that.

From my opinion, I think oysters are just one kind of nutrient-rich food whose appearance is like female genitalia, juicy with a fresh scent. So it possibly make us think about that kind of activity, what do you think?

Dr. Soarawee Weerasopone
Royal Phnom Penh Hospital



我们男生有没有经验过,当有任何人订了蚝以后 ,而你们的朋友已提说到“你们今晚有没有跟您对象约炮吗?”听说过很多次了,蚝会加强性欲,所以我想知道,蚝是否能加强性欲,它的作用有科学证据吗?



  • 维生素B12:每日推荐量是324%(保养神经系统为主)
  • 锌:每日推荐量是605%(对免疫系统健康至关重要)
  • 硒:每日推荐量是91%(抗氧化剂)
  • 维生素D:每日推荐量是80%(对免疫系统健康至关重要)
  • 铁:每日推荐量是37%(对产生血红蛋白有重要作用)。





そこで、文献を検索しました。 牡蠣が性欲を改善するという科学的証拠を見つけることができませんでした。しかし、性欲を高めるかもしれない動物性製品について、東洋医学の知見では、「我々は食物から、力を 吸収する」と言われており、ペニスの能力を改善したい場合は、哺乳類のペニスを食します。










Dr. Soarawee Weerasopone

低侵襲性医療 泌尿器科専門医
Royal Phnom Penh Hospital

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Fever and Temperature Measurement in Children

General Information:

Fever is an abnormal elevation of body temperature that occurs as part of a specific biologic response. The temperature elevation that is considered “abnormal” depends upon the age of the child and the site of measurement. The temperature elevation that may prompt clinical investigation for infection depends upon the age of the child and the clinical circumstances.

Measurement method Normal temperature range
Rectal 36.6°C to 38°C (97.9°F to 100.4°F)
Ear 35.8°C to 38°C (96.4°F to 100.4°F)
Oral 35.5°C to 37.5°C (95.9°F to 99.5°F)


Age Recommended Technique
Birth to 2 years
  1. Rectal (definitive)
Over 2 years to 5 years
  1. Rectal
  2. Tympanic
Older than 5 years
  1. Oral
  2. Tympanic
  3. Axillary

How to measure the temperature from different areas of the body

  • Wash your hand before and after the procedure.
  • Clean the thermometer with alcohol before and after use.

Rectal Temperaturerectal

  • The child or infant should lie down on his or her stomach across an adult’s lap.
  • Apply a small amount of petroleum jelly (eg, Vaseline) to the end of the thermometer.
  • Gently insert the thermometer into the child’s anus until the silver tip of the thermometer is not visible (1/4 to 1/2 inch inside the anus)
  • Hold the thermometer in place. Digital thermometers need less than one minute or until it alarms.

Oral Temperature

  • Do not measure the temperature in a child’s mouth if he or she has consumed a hot or cold food or drink in the last 30 minutes.
  • Clean the thermometer with cool water and soap. Rinse with water.
  • Place the tip of the thermometer under the child’s tongue toward the back. Ask the child to hold the thermometer with his or her lips.
  • Keep the lips sealed around the thermometer. Digital thermometers need less than one minute.

Axillary or Armpit Temperature

  • Place the tip of the thermometer in the child’s dry armpit.
  • Hold the thermometer in place by holding the child’s elbow against the chest for four to five minutes.

Ear Temperatureear

Ear thermometers are not as accurate as rectal or oral thermometers. If the child has been outside on a cold day, wait 15 minutes before measuring the ear temperature. Ear tubes and ear infections do not affect the accuracy of an ear temperature.

  • To measure temperature accurately in the ear, the parent must pull the child’s outer ear backward before inserting the thermometer
  • Hold the ear probe in the child’s ear for about two seconds.

Changes in Body Temperature


Management of Fever

  • Drink a lot of fluid. Call or see the doctor if your child won’t or can’t drink fluids for more than a few hours.
  • Bed Rest
  • Give sponge baths using plain water then dry immediately with towel
  • Paracetamol or Ibuprofen can help lower the temperature
  • If you do not know how best to handle your child’s fever, see a doctor


RPH 20102016

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