I am a Scientist
Q: Why did you choose to do surgery and urology in particular?
My father passed away when I was 11, and I have four younger sisters, so my mother had to work. I saw how my dad was comatose for a week before he passed away, and I wanted to become a doctor to relieve people's misery. I'm a person who likes to use my hands as well as my brain to solve problems.
I've been in surgical practice since 1986. At that time, of the group of trainees waiting to be selected for different surgical disciplines, I was the youngest and went last! But I've been head of the urology department at Tan Tock Seng Hospital (TTSH), head of surgery since 2002, and chief of surgery today. I never regretted doing urology as it lets me do both open and minimally invasive surgery and a variety of research.
Q: With Nanyang Technological University researchers Subbu Venkatraman and Freddy Boey, you have worked on biodegradable ureter stents and biodegradable stents after prostate surgery. How did these come about?
A stent (a narrow, hollow tube) is inserted into the ureter, between the kidney and the bladder, to bypass blockages there, such as swelling or stones. But non-biodegradable stents carry the risk of irritation or infection. So we decided to develop a biodegradable stent that doesn't have to be surgically removed later and will leave nothing behind.
Now, we're applying for a grant to incorporate antibiotics or chemotherapic agents - to prevent infection or treat cancer - into the stent. We are also developing a prototype stent to connect the bladder and the urethra after prostate surgery. The stents are not in human use yet, but we hope they will be in the next few years.
Q: You have also done research on the epidemiology and molecular genetics of prostate cancer. Can you tell us more about the findings?
Prostate cancer is the third most common cancer among Singapore men (after colorectal and lung cancer) and the sixth most common cause of cancer death among men here.
From our research, preliminary findings suggest that when your BMI (body mass index) is higher than 25, the risk of prostate cancer is higher. We also found that prostate cancer here differs from Western populations - in Singapore, the level of PSA (prostate-specific antigen) that indicates cancer seems higher than that in the West.
Meanwhile, there are no other markers for prostate cancer other than PSA levels. So a student of mine did her PhD thesis on finding new molecular markers of prostate cancer, for better diagnosis.
Now, we are also developing a statistical model so you can input factors like age, BMI, results of a rectal exam and PSA levels to predict the likelihood of cancer.
Q:Why set up a tissue bank at TTSH?
Since we have all the blood and urine samples from the patients, if you have a new cancer marker, you can easily validate it on existing patient samples, rather than waiting for enough new samples to be collected. Currently, we have tissue from prostate, kidney, bladder and breast cancer patients. We have the second-largest tissue bank in Singapore after the National Cancer Centre's.
Q: You have also written a book to dispel patients' misconceptions. What are some of the questions patients have?
There are a lot of myths and misconceptions in urology; people don't necessarily know what is true. So I wrote this book, Male Urological Problems, in both Chinese and English. People have questions like: If you have bubbles in urine, is it normal? Are backaches always related to kidney problems?
Q: Surgeons have a bad reputation for being brusque, but you received an NHG Health-care Humanity Award in 2009 for dedication, ethics and compassion. How and why do you break the mould?
It's important to realise that there's no holiday for disease. Just because it's Chinese New Year doesn't mean you don't have kidney stones - it doesn't happen that way. So I give almost all my patients my mobile number, and they can SMS me if there is a serious problem. In fact, patients feel more secure with you because they feel they can SMS any time.
I also ask patients to prepare a book with questions that they want to ask, especially before surgery. When they get a cancer diagnosis, the immediate thought is denial. But when they settle down, they may have questions and doubts. So I ask them to put the questions in a notebook, or e-mail them to me.
In the past, the doctor just told you what to do - that may have worked then. But now, people want to be involved.
This article was first published on August 31, 2014.
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