Urology & Andrology

Author: Dr. Wong Lin Ho, MD, MSc 

Sexual dysfunction refers to any physical or psychological problem that prevents you or your partner from getting sexual satisfaction. It is a common health problem amongst men of all ages, but is more common with increasing age. Treatment can often help men suffering from sexual dysfunction.

There are many different types of sexual dysfunction, they include 1. Erectile dysfunction (difficulty getting/keeping an erection). 2. Premature ejaculation (reaching orgasm too quickly). 3. Delayed or inhibited ejaculation 4. Low libido (reduced interest in sex).

Premature Ejaculation and Erectile Dysfunction

Integrative management of Andrological and Urological diseases utilizes TCM theory and clinical experience in the management of male-related disorders. Male-related Andrological dysfunction such as Erectile Dysfunction and Premature ejaculation, can be divided into psychological and functional causes. Psychological causes are frequently caused by excessive anxiety, depression, poor relationships or external stressors. These affect the emotional well-being of a person prior to sexual activity resulting in poor performance. Functional causes are usually caused by existing underlying conditions. These include conditions such as hormonal, vascular, neurological and iatrogenic causes.

Hormonal causes include hypogonadism, low testosterone and thyroid abnormalities. Vascular causes include Diabetes Mellitus, Atherosclerosis, High Cholesterol or Chronic Kidney Disease (CKD). It results in the hardening of blood vessels causing difficulties with the blood flowing to the penis. Neurological causes include Diabetes Mellitus, Vitamin B12 deficiency, Cauda Equina Syndrome, Spinal Cord Injuries, Guillain Barre Syndrome and Trauma. Iatrogenic causes refers to patients who underwent a procedure or surgery around the penile area such as radical prostatectomy for Benign Prostatic Hyperplasia (BPH) or prostate cancer where the surrounding nerves supplying the penile region is being damaged. These disorders in turn destroy the normal functioning of nerves innervating the penis, causing difficulties in the conduction of the sensory and motor systems. As the nervous system is damaged, the blood pressure within the penis is unable to be controlled, hence resulting in conditions like erectile dysfunction.

Treatment of Andrological disorders requires the proper diagnosis of underlying conditions which will be done with our medical doctors and TCM physicians. A detailed consultation will be done to understand the underlying reason for your condition. Ultrasound and blood test might be taken to understand your blood sugar levels as well as the vascular flow to the penile region. Subsequently, based on the different conditions, a variety of medications will be given to stimulate the underlying vascular flow to the penile region, increase your androgen levels as well as regenerate the underlying nervous system to the penile region. Patients will then undergo our 6-point neuro-electroacupuncture that is devised by Dr. Wong Lin Ho.

Prostatitis 

Prostatitis is the inflammation of the prostate gland which results in pain in the groin area, pain on urination or erection, cloudy urine, frequency, urgency, and blood in urine. It can be divided into 1. Acute Bacterial Prostatitis 2. Chronic Bacterial Prostatitis 3. Chronic Prostatitis 4. Asymptomatic Inflammatory Prostatitis. Risk factors include young or middle-aged adulthood, previous prostatitis, infection of the urinary or reproductive system,
HIV infection or AIDS, use of a tube inserted into the urethra to drain the bladder (urinary catheter), and diagnostic sampling of prostate tissue (biopsy). Treatment of prostatitis is dependent on whether it is a bacterial or non bacterial prostatitis.

In bacterial prostatitis, herbs with antibacterial effects are utilised. They are used to ensure that the underlying causative bacteria is being eliminated to prevent further worsening of inflammation. In the case of a non-bacterial prostatitis, the role of antibiotics or herbs with antibacterial effects can be limited. Neuroelectroacupuncture around the penile area (see 6 point acupuncture) as well as pTNS, helps with the reduction in the underlying inflammation and modulation of penile nerves to reduce the overlying symptoms such as pain, discomfort, urgency and frequency. In addition, herbs with anticholinergic effects can also be used to reduce the frequency of urination and urgency.

Overactive bladder

Overactive bladder also known as OAB refers to a frequent and sudden urge to urinate that might be difficult to delay. It occurs in 11-22% of adults in Singapore, aged 40 and above, and the incidence increases along with age. There are many different causes of it, but it can be divided into physiological, psychological, pharmacological, endocrinological and pathological.

Physiological: excessive drinking of caffeine, tea, fluids and alcohol.

Psychological: Mental health conditions such as anxiety or stress.

Pharmacological: Drugs which increases the urine output such as diuretics.

Endocrinological: Diabetes Mellitus, Diabetes Insipidous

Pathological: Urinary tract infections, urinary stones, cyst and tumours.

Management of OAB requires the understanding of the underlying cause. Conservative treatment involves the reduction of coffee, tea, fluids as well as pelvic floor exercises (Kegel exercise). If conservative management fails, patients be started off with herbs which help to reduce the sensitivity of the bladder, such as Sinapis Albae Semen and Stemona japonica, which have anti-cholinergic effects. [1] Medical management can also be accompanied by neuromodulation via electroacupuncture to increase the efficacy.

Neuromodulation via electroacupuncture

1. Sacral Nerve Stimulation: Sacral nerve stimulation involves the placing of needles around the lower back of the spine where the foramina (holes in the spine) are located. The sacral nerve exits from the spinal forma and supplies the urinary bladder, bowels and lower limbs. Success rate of Sacral nerve stimulation is around 75% and can be increased with the use of medications. [2]

2. Percutaneous Tibial Nerve Stimulation (PTNS): involves the placing of needles around the location of sanyinjiao acupoint (see below). It is a technique that was picked up by the medical community with reference to the TCM acupoint. It is a minimally invasive procedure that has been shown to improve the symptoms of OAB. [3] The success rate ranges from 37-82% and averages around 70% for both male and females. [4]

What is 6-point Neuro-electroacupuncture?

Traditionally, Chinese Medicine do not have acupoints located near the penile region. Combining both the neuroanatomical knowledge with Chinese medical treatment modality, Dr. Wong Lin Ho devised a 6-point neuro-electroacupuncture area which targets both the sensory and motor nerves (including dorsal penile and ilioinguinal nerves) which supplies the penile region. With the aid of electrical currents, the technique helps to modulate the underlying nerves to resume their normal activities. This technique has successfully been used for the management of diseases such as Erectile dysfunction, Premature ejaculation, Retrograde ejaculation, Overactive bladder and Prostatitis.

Phyto Vitality: Ong Fujian’s oral supplement for male vitality

“Phyto Vitality” is a Health Sciences Authority (HSA) registered, in-house production medication developed by our esteem Prof. Wong Pang Ong that is suited to improve male’s vitality. It is suitable for males with erectile dysfunction as a result of hormonal and vascular causes as it will improve the androgen within our body as well as dilate the blood vessels around the penile area. 

Commonly encountered conditions include:

Prostate disorders: Prostatitis (Bacteria/Non-bacterial), Prostate Cancer, Benign Prostatic Hyperplasia (BPH)

Urinary disorders: Urinary Tract Infection, Urinary Incontinence (stress/urge/mixed), Overactive Bladder (OAB), Renal and Bladder stones 

Sexual disorders: Premature ejaculation and Erectile dysfunction

References

1.Zhang M, Vrolijk M, Haenen GRMM. The Screening of Anticholinergic Accumulation by Traditional Chinese Medicine. Int J Mol Sci. 2017 Dec 21;19(1):18. doi: 10.3390/ijms19010018. PMID: 29267212; PMCID: PMC5795969.

2. Kaaki B, Gupta D (2020) Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study. PLOS ONE 15(7): e0235961. https://doi.org/10.1371/journal.pone.0235961

3. de Wall LL, Heesakkers JP. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Res Rep Urol. 2017 Aug 14;9:145-157. doi: 10.2147/RRU.S124981. PMID: 28861404; PMCID: PMC5565382.

4. Cristina Palmer, Bilal Farhan, Nobel Nguyen & Gamal Ghoniem (2019) Clinical outcomes of percutaneous tibial nerve stimulation in elderly patients with overactive bladder, Arab Journal of Urology, 17:1, 10-13, DOI: 10.1080/2090598X.2019.1590032

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