Ask a Urologist: Dr Lee Fang Jann from Mount Elizabeth Orchard Hospital Singapore & Farrer Park Hospital Singapore

Ask a Doctor ForumCategory: UrologyAsk a Urologist: Dr Lee Fang Jann from Mount Elizabeth Orchard Hospital Singapore & Farrer Park Hospital Singapore
dr. Lee Fang Jann asked 9 months ago
I am Dr Lee Fang Jann, Urologist and Renal Transplant surgeon based in Mount Elizabeth Orchard Hospital Singapore and Farrer Park Hospital Singapore.

I have subspecialty focus on men’s health, male subfertility and minimally invasive kidney and prostate surgeries. I obtained my undergraduate medical degree from National University of Singapore, pursued further surgical accreditation from Edinburgh (UK), and completed my Urology training in Singapore General Hospital (SGH) before being accredited as a Urologist by the Ministry of Health and Singapore Medical Council.

I was accorded the Ministry Of Health’s Health Manpower Development Plan award to pursue a clinical fellowship in pancreas and renal transplant at Oxford Transplant Centre (UK) under Professor Peter Friend. Upon my return, I led the Renal Transplant Program and laparoscopic donor nephrectomy service at SGH as Surgical Director. I was appointed to the MOH’s advisory committee on transplantation.

While in SGH, I was Director of the Andrology and Male Subfertility services. I initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. My management strategies include a wide range of microsurgical procedures. I am currently Vice President of the Asian Andrology Association.

My belief in advanced techniques in minimally invasive surgery for better patient care has led me to pursue advanced laparoscopic and robotic training in USA, France and India. I was admitted as a Fellow of the International College of Robotic Surgeons and has a Diploma in Laparoscopic Surgery from University of Strasbourg, France. I am regularly invitated to share my experience both locally and regionally through lectures, workshops and surgical demonstrations.

During my 16 years of service in SGH, I received numerous awards for service excellence and was well liked by patients. I enjoy teaching the next generation of doctors and held academic appointments in Singhealth Urology Residency Program, Yong Loo Lin School of Medicine, NUS and Duke-NUS Medical School.

Learn more about Farrer Park Hospital here: https://www.smarterhealth.my/hospital/farrer-park-hospital-singapore/ and Mount Elizabeth Orchard Hospital here: https://www.smarterhealth.my/hospital/mount-elizabeth-hospital-singapore/

Learn more about me here: https://www.smarterhealth.my/specialist-doctor/lee-fang-jann/

I am excited to be here to share/discuss Urological Health with everyone. Ask me anything!

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13 Answers
Sam answered 9 months ago
Doctor, I feel itchy, hot, and painful every time I urinate. It has been like this for a week. Today there is a white liquid, not sperm, coming out of my penis. Is this dangerous, Doc?
dr. Lee Fang Jann
replied 9 months ago

Hi Sam,

The symptoms you have described are suggestive for urethritis. Urethritis is the inflammation of the urethra, the tube that carries pee from the bladder out of the body. It is usually caused by an infection such as urinary tract infection or a sexually transmitted infection such as chlamydia. I will advise you to seek medical attention from a sexual health clinic. Two typical tests done include a urethral swab test and a urine test. The doctor may offer you additional tests for other sexually transmitted diseases. You may discuss this with the doctor in the clinic if you wish. A course of antibiotics will treat the infection and your symptoms should improve within a week.

You should avoid having sex, including anal and oral sex, until you have finished your course of antibiotics. It is important that your past and current sexual partners are also treated to prevent any infection spreading to others.

If left untreated, the infection can progress to epididymo-orchitis, an infection of the testicles, leading to subsequent infertility. The infection can also lead to reactive arthritis (joint pain and stiffness) and conjunctivitis (eye inflammation).

Deden Ari answered 9 months ago
After urinating, there is mucus on the tip of my penis. What disease is this, Doctor?
dr. Lee Fang Jann
replied 9 months ago

Dear Deden Ari,

It is unusual to have urethral discharge after urination. It may indicate an underlying urethritis (inflammation or infection of the urethra). I will advise you to see a doctor to have the discharge sent for testing followed by treatment if warranted.

Edi Nursandi answered 9 months ago
There are small lumps like acne on my left testicle. What are they, Doctor? Are they dangerous?
dr. Lee Fang Jann
replied 9 months ago

Dear Edi,

It is not possible to accurately diagnose the condition without a physical examination. Little raised painless bumps on the scrotum can range from benign conditions like sebaceous cysts, prominent hair follicles and angiokeratomas; to sexually transmitted diseases like genital warts and molluscum contagiosum.

A common condition that I see in the clinic that is often mistaken for sexually transmitted disease is Fordyce spots.

https://commons.wikimedia.org/wiki/Category:Fordyce%27s_spots_on_scrotum

They are visible sebaceous glands found commonly along the shaft of the penis, scrotum, outer edge of lips and inside the cheeks. They are whitish-yellow painless bumps and are harmless. No treatment is necessary for this condition. However, some patients do request for their removal for cosmetic reasons. Treatment options include topical ointment like bichloracetic acid and tretinoin, laser treatment and micro-punch surgery.

Reno DF answered 9 months ago
Doctor, why do I wake up every night, 3 or 4 times, just to urinate?
dr. Lee Fang Jann
replied 8 months ago

Our body naturally reduces urine production when we turn in for the night, allowing us to get at least 6-8 hours of uninterrupted sleep. The medical term for excessive urination at night is nocturia. Nocturia affects our sleep cycle leading to fatigue, mood changes, impaired productivity, and increased risks of accidents.

The first thing to exclude is recent changes in lifestyle that may have played a part. You may have been drinking too much or too close to bedtime. Omit fluids 2 hours before you go to sleep. Caffeine and alcohol are known diuretics. Don’t have them late in the day. Have you been started on a new blood pressure medication? Some of these medications lower your blood pressure by making your kidneys produce more urine.

If you noticed that your feet and ankles are often swollen in the day, that may be edema. Underlying heart, liver, or kidney failure can lead to trapping of fluid in the dependent body tissue. Once you lie down to sleep, gravity no longer holds the fluid in your legs. It can re-enter your veins and be filtered by your kidneys, producing urine. If you are passing a large amount of urine day and night, you may have untreated diabetes.

Nocturia can also occur when you are not able to empty your bladder fully at every void. In men, this can be due to prostate enlargement or prostate cancer that obstructs the flow of urine. In women, this may be due to pelvic organ prolapse.

Nocturia can also be due to reduced bladder capacity from bladder cancer, bladder stone, recurrent bladder infection, or bladder overactivity.

It is important to remember that nocturia is often a symptom pointing to an underlying medical condition. Many are urological in origin, with some more serious than others. Unfortunately, I am still seeing patients who suffered from bothersome nocturia for years before seeing a doctor, only to be diagnosed with late-stage prostate cancer.

Consider seeing a doctor for a thorough evaluation and diagnosis.

Umar Hadi answered 8 months ago
I have a throbbing pain above my penis, below my navel, that can be felt after urinating. Why is this so, Doctor?
dr. Lee Fang Jann
replied 8 months ago

Dear Umar,

Pain in the lower abdomen at the end of urination can indicate a problem with the bladder or prostate. In some men, the pain can affect the penis too.

A common cause of the pain is cystitis (bladder infection). The urinary tract is normally sterile, but sometimes bacteria can sneak in through the urethra, which connects the bladder with the outside of the body. There may be additional symptoms if you have a bladder infection. These include burning pain in the penis during urination, urgent need to urinate, frequent need to urinate, cloudy urination, blood in the urine, and occasional fever. A bladder infection can easily be diagnosed by analysing a specimen of your urine to look for white blood cells, red blood cells and the presence of bacteria. Treatment is a course of appropriate antibiotics.

As men have longer urethras than women, they are less prone to bladder infections because bacteria need to travel a longer distance to reach the bladder. Additional checks are recommended after treatment to look for risk factors. The doctor will need to rule out underlying diabetes, bladder stones, an enlarged prostate or abnormal narrowing of the urethra that may affect your ability to empty the bladder completely.

If the cause of the pain is not a bladder infection, the doctor may recommend additional tests like imaging scans, blood tests, urine tests and a cystoscopy to rule out prostate infection, prostate cancer and bladder cancer.

Because bladder pain can have many possible causes, it is always a good idea to make an appointment with your doctor to have it checked out.

Mulky Rahmaniar answered 8 months ago
Doctor, every time I feel nervous, I want to pee. Is this normal?
dr. Lee Fang Jann
replied 8 months ago

Yes. Apprehensive feeling (worry, nervousness, fear) activates the stress response, which causes the body to secrete stress hormones into the bloodstream to enhance the body’s ability to deal with a threat.

Specific to urination, the stress response increases autonomic nervous system (the nervous system under involuntary unconscious control) activity, which can cause the brain to sense an urgent need to urinate.

This sudden urge to void is common and often experienced by stage performers and public speakers just before they are about to perform or present.

Ludy answered 8 months ago
Hi Doctor, I’m male, 23 years old. I often urinate once every 30 minutes, sometimes even in shorter periods of time. Is there any problem with my body? Is it normal?
dr. Lee Fang Jann
replied 8 months ago

The average adult bladder holds between 400 and 700mls of urine. The average 24-hour urine output is 1200 to 1500 mls. Normal patterns of urination differ between individuals but adults generally void 5-6 times daily with no more than one night time void. Your urinary frequency is much greater than the average and may indicate a problem. Urinary frequency can occur because of increased urine volume or reduced bladder capacity (ie. less than 200mls)

Increased urine volume can result from excessive fluid intake, undiagnosed diabetes or diuretic medication.

Decreased bladder capacity can result for anxiety, bladder outlet obstruction with resulting residual urine, bladder scarring from chronic infection or inflammatory conditions that increased bladder sensitivity (stone, tumour, infection)

Filling up a bladder diary (https://www.mhcs.health.nsw.gov.au/publications/ahs-9545-bladder-diary/ahs-9545-bladder-diary-indonesian) before consulting your doctor will allow him or her to better appreciate your problem, aids in the diagnosis and decide on how best to help you.

Moch Zaenuri answered 8 months ago
Doctor, I want to ask about my wife. After surgery, why is it her lower abdominal bladder still hurts, she frequently urinates, the urine stream is minimal & she feels sore? She entered the operating room on 20 July 2020, and released the catheter on 4 August 2020.
dr. Lee Fang Jann
replied 8 months ago

Dear Moch,

Without more information on the indication, nature and outcome of the operation involved, I can only share with you some thoughts that cross my mind.

I assume she had an operation on the urinary bladder. If part of the bladder has been removed, the capacity will now be smaller. She will be passing urine more frequently and with smaller volume at each void. The urinary frequency will usually improve after 4-8 weeks. Wound pain can be expected after any major operation. How soon one recovers after an operation varies. Most patients can expect to make a full recovery by 4-6 weeks after surgery. She had an indwelling catheter in-situ to drain her urine for more than 2 weeks. If that has resulted in a bladder infection, that can explain for her soreness when she urinates.

I will suggest you get in touch with her surgeon who will be in the best position to advise you on the appropriate steps that need to be taken.

I wish her all the best in her recovery.

Albert answered 8 months ago

What are the general symptoms of urethral stricture?

dr. Lee Fang Jann
replied 8 months ago

Hello Albert,

A urethra stricture causes narrowing of the urethra and the most common symptoms are related to urination. You may experience slow urinary stream, pain during urination, the sensation of incomplete bladder emptying and post-void dribble. If left untreated, a urethral stricture can give rise to recurrent infections and irrecoverable kidney and bladder damage.

Seto answered 8 months ago

Doctor, what is the cause of foamy urine? Thank you

dr. Lee Fang Jann
replied 8 months ago

Hi Seto,
Thank you for the question. Normal urine is clear, with a yellowish hue, with no blood or foam. The appearance of a single layer of large bubbles upon voiding, that quickly dissipates, can be considered normal. Foamy urine, on the other hand, is characterized by the appearance and persistence of multiple layers of small to medium bubbles in urine voided into a container, such as a toilet bowl.

Foamy urine is a sign of excessive protein in the urine, which in turn, indicates kidney disease. Kidney disease cause damage to the kidneys’ filters, allowing proteins to leak into your pee. The proteins in the pee has a soapy characteristic that cause them to bind together, causing a foamy appearance. Diabetes and high blood pressure are major causes.

If you think your foamy pee is a sign that something is wrong with your kidneys, see your doctor. They will do a physical exam and run blood and urine tests to figure out what’s going on. They may also do an imaging test like an ultrasound to see the physical state of your kidneys. Once your doctor is able to determine what’s behind your foamy urine, they should be able to help treat it.

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