More than Waterworks

By SeeFoon Chan-Koppen

Urologists diagnose and treat diseases of the urinary tract in both men and women. They also diagnose and treat anything involving the reproductive tract in men. Dr Ding Chek Lang is one of these, in fact the first British Certified Urologist to practise in Malaysia.

Waxing lyrical about his time in UK where “at that time we were all one-stop urology centres, from treating newborns to the dying. There were no sub, sub specialties then, so we had to learn about all aspects of urology,” he said.

Teaching, doing research and surgery was what he loved to do best when he returned from his urology training in Edinburgh and London with stints at Harvard and UCSF (University of California at San Francisco) where he studied with dedicated teachers. But the halls of academia in Malaysia with its pretensions, soon disappointed, and he came back to Ipoh (a Sitiawan boy) for a break.

And stayed. For 31 years this August.

As Consultant Urologist at KPJ Ipoh Specialist Hospital throughout these 31 years, you might say that Dr Ding speaks from authority and on his favourite subject of Urology.

On Erectile Dysfunction (ED for short), a topic that is rarely discussed and mostly hidden in the closet, Dr Ding has this to say, “ED will come to you sooner or later. About 40% of men at age 40 and 90% by age 70 years. The underlying cause in the great majority of cases is vascular – with ageing, diabetes and primary vessel diseases contributing to it. Other causes include general poor health, nerve problems, hormonal problems and psychological causes. The PDE5 inhibitors (e.g. Viagra, Cialis, Levitra, Zydena) will take care of some of these patients but in the main these men need to discuss options with their urologist.”

Other conditions that Dr Ding treats are diseases or cancers of the bladder, kidneys, penis, testicles, and adrenal and prostate glands in men; and in women, bladder prolapse, or the dropping of the bladder into the vagina, cancers of the bladder, kidneys, and adrenal glands, interstitial cystitis; kidney stones, overactive bladder, UTIs and urinary incontinence.

In children, bed-wetting, blockages and other problems with the urinary tract structure and undescended testicles are common problems.

As one hears so often about prostate problems in men as they age, I asked whether it is necessary for men and at what age, for them to measure their PSA or Prostate-specific antigen which is a protein produced by the prostate gland. Blood levels of PSA are usually elevated in men with prostate cancer. Dr Ding replied, “It must presume a desire to know or desire to be screened for prostate cancer on the part of the patient. From age 40, if there is a family history of prostate cancer death. From age 50 years for the general population. There is no specific prostate cancer symptom.”

According to Dr Ding, prostate cancers in Asia are not common as compared to the West, which is probably related to diet. For example, a first generation Japanese moving to the USA will have the same low incidence of prostate cancer as their counterparts in Japan, but by the third generation, he will have the same chances of developing prostate cancer as the whites of the western population. The same is true in China where again prostate cancer is very low. “Treatment options are now very wide and men need not fear that their testes will be removed. In fact, the good news is that more men die at a ripe old age with the cancer than from the cancer. The task of the urologist is to distinguish the so called ‘pussy cats’ from the ‘tigers’ in the prostate,” he added.

On whether testicular cancer is one of the more curable cancers if caught early and what are the signs for a man to go to an urologist Dr Ding said, “it is regarded as a curable cancer. The sign is a swelling of the testis, regardless of whether it is painless or painful. Self-examination is the easiest, done on a warm day or after a warm shower.”

Lest we get the impression that an urologist treats primarily men, Dr Ding clears this misconception by saying that he treats many women especially for ‘voiding’ problems like UTIs or urinary tract infections and incontinence issues. His advice for women who get more than three UTIs a year or if not responding to prescribed medication, is to go to an urologist and get thoroughly assessed. The important thing, when women and especially men, get either a burning sensation on voiding, a frequent urge to void straight after voiding or in worst case scenarios, passing blood, is to go straight to an urologist.

As for kidney stones which are more common amongst men, aside from genetic tendencies, Dr Ding says the most common cause is inadequate hydration. “Water is cheap whereas kidney stones are expensive and painful,” he quips. “So drink more water! If the stone is smaller than 1.5cm we can break it up with the Lithotripter which is non-invasive and the smaller bits will pass out with the urine but larger stones will require surgical intervention,” he added.

For urinary incontinence in older people, this is addressed on a case by case basis but Dr Ding has a word of strong advice for young people who may be flirting with recreational drugs. “Do not take Ketamine! This will give rise to urinary incontinence, damage your bladder and subsequently your kidneys, and I have seen many young people suffer as a result.”

So do take heed all you recreational drug users out there. Take care of your Waterworks!

Dr Ding Chek Lang
Suite L1-20, KPJ Ipoh Specialist Hospital
Tel: +605 240 8777 ext 250
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