What you need to know about Urodynamic Studies

What is this test?

This is a test to assess bladder function and will involve the evaluation of the bladder during the filling, storing and emptying of the urine.

Why is it needed?

This test will provide information about your urinary problems and may help identify the cause. This will also help the doctor in choosing the best therapy for you.

How to prepare for the test?

You may eat or drink or take your regular prescribed medications prior to the test. The test is performed with a full bladder. There is no need to empty your bladder just before the test unless instructed by the nurse. Inform the nurse if you are unable to hold your full bladder any longer while waiting for your turn. The test can be done even if you are having your period unless it is very heavy on the day of the test. Please discuss this with your doctor. Please be punctual.

How is it done?

The test is done in a private room and your privacy will always be maintained. It will take approximately 30 – 45 minutes. At the start of the procedure, you may be asked to empty your bladder while sitting in a special chair (with a special collecting system for the urine) to measure your urinary flow. Following this, a small catheter is inserted into the bladder. Another catheter is also inserted into the rectum. Both catheters are then connected to a monitor, which can record the pressure within the bladder and rectum. The bladder is then filled with normal saline via the bladder catheter. During filling, you will be asked about bladder sensation and also to perform the cough or straining maneuver to demonstrate urinary leakage. After filling, you will ask to empty your bladder. The two tubes will then be removed and the test is completed. It is not painful but some women may find it a little bit uncomfortable during the test.

What to do after the test?

Following the test, you may drive or return to work. Some women may find passing urine to be slightly uncomfortable and more frequent for 1 to 2 days. You should increase your fluid intake during this period. It is best to avoid drinks containing caffeine as they can aggravate these symptoms. Some women may develop urine infections after the test. Antibiotic is not routinely given before or after the tests.

Consult your doctor immediately if you think you may have a urinary infection or the following symptoms:

  • Burning sensation on passing urine for a few days.
  • Blood in the urine.
  • Fever and/or feeling unwell.
  • Lower abdominal or back pain

 

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What is maskne?

Article contributed by Dr Ch’ng Chin Chwen
Consultant Dermatologist, Subang Jaya Medical Centre

1. What causes maskne?

Maskne is acne caused by the mask, due to the heat and dirt trapped under the mask and the friction between our skin and mask as we talk and as we take the mask up and down.

2. How does acne impact our daily life?

Acne is uncomfortable, it is not only unsightly but can be itchy or even painful as well.

3. What will happen if we don’t treat acne?

If left untreated, acne leaves pigmentation and scars. Some of these scars can be permanent, affecting a person’s self-esteem, giving poor self-image, and is associated with anxiety, depression and even suicidal risk. Acne is not a trivial problem, studies have shown that it impacts the quality of life as great as chronic illness such as diabetes or heart disease.

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Sunscreen – what you need to know……..

Article contributed by:
Dr Ch’ng Chin Chwen
Consultant Dermatologist
Subang Jaya Medical Centre

1. Why is applying sunscreen important?

Sunscreen is the most important skincare product. If you can only afford one skincare product, choose a good sunscreen. Sunscreen protects our skin from harmful sun rays and reduces skin cancer risk. It reduces the flare-up of most skin problems from acne, eczema to rosacea. Not to mention when skin damage is reduced, we are reducing pigmentation, wrinkles and skin sagging.

2. Do I still have to apply sunscreen while indoors?

Yes, particularly if you have large windows or indoor fluorescent lighting.

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Post-menopausal bleeding

Postmenopausal bleeding is defined as unexpected vaginal bleeding that occurs during the menopausal years. Menopause is the permanent cessation of menstruation and is normally diagnosed after 1 year of absent menstrual flow.

Symptoms and signs

  • Vaginal bleeding, which may be a light-brown discharge or heavy, red bleeding (with or without clots). Mucus may accompany the bleeding. Bleeding episodes may vary in length.
  • Women who are on hormonal replacement therapy may have some bleeding and this can be normal, depending on the type of hormone that she is taking. Please consult your doctor about the types of bleeding to be concerned about.
  • Presence of excessive bleeding, progressive abdominal distention, pain and feeling
    unwell usually signify a more serious problem.

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Cervical cancer screening (Pap smear, Thin Prep)

The cervical cytology smear was previously referred to as Pap smear. It is a test carried out to detect pre-cancerous and cancerous cell changes in the cervix.
Worldwide, cervical cancer is the fourth most common cancer in women. In Malaysia, cervical cancer is the third most common cancer among women and the seventh-highest among the entire population (Malaysia National Cancer Registry report (MNCRR), 2007 – 2011). The good news is that it can be prevented via widespread vaccination with Human Papilloma Virus (HPV) vaccine among the younger age groups and regular screening for precancerous lesions of the cervix with cervical cytology smear. Pre-cancerous lesions of the cervix can be treated easily and this will prevent further development into cancer and can save lives.

Reasons for the test

  • As part of routine cancer screening.
  • Investigate the cause of abnormal vaginal bleeding or discharge.
  • Bleeding after sexual intercourse

How is it done?

It is a simple and relatively painless office procedure. Sometimes, some discomfort or pain may be felt and you should tell the doctor who is performing it so that the speculum can be adjusted to ease the discomfort.
The examination is performed in the clinic. It usually takes about 10 minutes. You will need to lie on your back on the examination bed, with knees bent and legs are apart. The external genital will be examined visually for abnormalities (abnormal lumps, sores, skin discoloration or inflammation)
A well-lubricated speculum is placed inside the vagina and opened. The speculum is an instrument that holds the vaginal walls apart and allows the examiner to see the cervix and vagina and check for inflammation, infection or growths. There may be some feeling of pressure on the bladder or rectum with the speculum in place. With A small brush, a collection of cells is taken from the cervix and transferred to a small container with a preservative fluid. This type of collection is called liquid-based cytology (LBC). This has replaced the old conventional method of smearing the collection onto a slide. Currently, the LBC cervical cancer screening method is better and more accurate compared to the conventional Pap smear test.
If you have an infection or there are signs of infection present, a sample of vaginal or cervical discharge may be taken for laboratory analysis at the same time.

How frequent?

It is recommended that women should go for a cervical cytology smear once they are above the age of 21 and already sexually active. The interval is every 3 to 5 years. A more frequent screening (every 6 to 12 months) may be necessary if the women are at high risk of developing cervical cancer or had an abnormal smear in the past. Some doctors still recommend annual smears as a routine. The basis for a 3 to 5 years smear is that cervical cancer is a slow progressive condition and usually takes 10 to 15 years to transform into full-blown cancer. Therefore, a 3 to 5 years smear will be sufficient to detect the pre-cancer stage. The cost-benefits ratio is also taken into consideration for this extended recommendation. Those who favour a once-a-year smear argue that the test is not 100% accurate and it depends on so many factors such as the person taking the sample and the laboratory which analyses the sample. Yearly smear can minimize the risk of inaccurate results since it is rare to get a false negative test 2 or 3 years in a row. Furthermore, once-a-year testing makes it easier for women to remember. Many women will find it difficult to remember when the last time smear was done, was it 2, 3 or even 5 years ago. This increases the risk of skipping the test and missing out on the early diagnosis.
In the future, the inclusion of the HPV DNA testing into the cervical cancer screening program will make the testing more accurate to pick up precancerous change of the cervix. Studies have shown that if the cervical cytology smear is normal and/or there is no HPV infection, then the risk of pre-cancerous or cancer of the cervix is extremely low and the screening interval can extend for as long as 3 to 5 years.

How to prepare for the test?

Women should not be menstruating or have sperm present in the vagina from recent intercourse. Therefore, women should avoid sexual intercourse within a period of 24 hours prior to the procedure.
Do not douche, use tampons, or use vaginal medications for at least 24 hours before having the test.
The smear can be done during pregnancy. However, it is not routine and only done when there is an indication for it.

What to expect after the test?

  • There may be some slight bleeding or discharge following the test. Use a tissue to wipe or wear a panty liner.
  • The results of the smear testing may take a few days to two weeks to be available to you.
  • A positive test may indicate that there are some cells changes that need further investigations but do not necessarily indicate a pre-cancerous or a cancerous condition of the cervix. Further testing or a colposcopy or even a biopsy may be indicated to confirm the abnormality.
  • Sometimes the smear report may indicate the presence of infection and treatment may be given.
  • One must be aware that the cervical cytology smear is not 100% accurate and the need for regular repeat smear as per recommended interval is important to ensure that the precancerous changes are not missed in the future.
  • You can drive or return to work immediately if you wish.
  • There is no dietary or activity restriction.

To print a pdf copy, click HERE

 

Menopausal Hormone Therapy (MHT)

Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as nearly age 60s. The average age of menopause is usually about 49 to 51. It is normally diagnosed in females after 1 year of absent menstrual flow. Menopause does not occur suddenly. It is a slow transition and peri-menopause usually begins a few years before the last menstrual period. Menopause is only one event in the transition period involving changes in the female body between the mid or late 40’s, when the production of female hormones (estrogen and progesterone) begins to decline. Most of the signs and symptoms of menopause arise from this decrease in estrogen production. Therefore, MHT (referring to both the EPT and ET) is often given to women who have significant symptoms that have an impact on their daily activities.

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Menopause – symptoms and treatment options

Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as nearly age 60s. The average age of menopause is usually about 49 to 51. It is normally diagnosed in females after 1 year of absent menstrual flow. Menopause does not occur suddenly. It is a slow transition and peri-menopause usually begins a few years before the last menstrual period. Menopause is only one event in the transition period involving changes in the female body between the mid or late 40’s, when the production of female hormones (estrogen and progesterone) begins to decline. Most of the signs and symptoms of menopause arise from this decrease in estrogen production even before periods stop altogether. Menopause occurring before age 40 is termed premature and may need medical evaluation for the cause. However, if menopause is delayed beyond the age of 55 (meaning a woman is still experiencing menstrual bleeding), there is an increased risk of breast, ovarian, and uterine cancer. This is due to the increased amount of time a woman’s body has been exposed to the estrogen. Therefore, regular mammograms and gynaecological review by specialist is important for women experiencing late-onset menopause.

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Loop Electrosurgical Excision Procedure (LEEP/LLETZ) for CIN

Loop electrosurgical excision procedure (LEEP), also known as large loop excision of the transformation zone (LLETZ), is a procedure for further diagnosis and treatment of cervical intraepithelial neoplasia (CIN). CIN lesion is an abnormal growth in the cervix. The CIN lesion is usually diagnosed during a routine Pap smear (or called Thin Prep) test. LEEP is a very safe way to remove abnormal tissue from the cervix that might otherwise progress to cancer. It minimizes the amount of tissue removed in order to preserve childbearing ability.

Reason for the procedure

• Presence of CIN lesions from the colposcopy evaluation and confirmed via cervical biopsy. Some types of CIN can progress to cervical cancer if not treated. This can be used as a treatment for CIN lesions.
• Unsatisfactory colposcopic evaluation whereby the whole transformation zone cannot be visualized or the cervix appeared abnormal and requires a bigger tissue specimen for a more accurate diagnosis to exclude cancer changes.

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