Education Corner

Many parents feel heartbroken when they hear that their child needs a circumcision. But is circumcision really necessary? And what exactly does “circumcision” mean?    Where is the foreskin?  The foreskin is the layer of skin that covers the glans of a male newborn's penis, serving a protective role. ​   Does a baby need circumcision?Not all babies require it; doctors typically recommend it only for those with specific needs to avoid unnecessary surgery. ​ Why do children in North America often get it, and what are the benefits?It's common there due to cultural practices and perceived health advantages, such as drying the glans to lower STI risks later in life. Parents should weigh the necessity themselves. ​ When is circumcision needed? Urethral Infection (Urinary Inflammation)Due to bacterial infection between the foreskin and glans penis, after circumcision, the glans becomes drier, reducing bacterial growth and decreasing the chance of urethral inflammation by about one-tenth. Recurrent balanitis6% of boys experience this condition. If inflammation recurs frequently, circumcision may be considered to reduce inflammation chance by half. Balanitis xerotica obliterans (dry obstructive balanitis)This causes narrowing of the foreskin opening, leading to difficulty urinating. In this case, circumcision is the best option. Foreskin ballooning during urinationThis causes blockage when urinating. If severe, surgery may be considered.   Pediatric surgical issues can impact a child's life long-term, so parents should promptly consult a doctor for checks if concerns arise.

What is glaucoma?Glaucoma is a leading cause of blindness in Hong Kong. About 3 out of every 100 adults over the age of 40 are at risk of developing glaucoma. Early diagnosis can prevent vision loss and blindness. In the early stages, glaucoma may not show obvious symptoms, so patients often overlook it. By the time vision problems are noticed, the disease is usually advanced. This is why glaucoma is known as the “silent thief of sight.” It can cause permanent blindness, but early detection and treatment can help preserve vision. People over 40 or those with high-risk factors should have an eye examination every year to detect early glaucoma and prevent deterioration.   Why does glaucoma occur? Inside the eye, there is a clear, watery fluid called aqueous humor. It supplies oxygen and nutrients to eye tissues, removes waste products, and maintains the shape of the eyeball. If the drainage of aqueous humor is blocked, pressure builds up inside the eye (intraocular pressure). High intraocular pressure can damage the optic nerve, leading to glaucoma. Therefore, measuring eye pressure is an important part of glaucoma screening.   What types of glaucoma are there? Glaucoma can be categorized in different ways depending on cause and disease progression: Acute glaucomaThis form develops suddenly, causing blurred vision, seeing halos or rainbow rings around lights, red and painful eyes, and possibly headache, nausea, or vomiting. It is a medical emergency that requires immediate treatment with oral or injected medications and eye drops to lower eye pressure, followed by laser or surgical treatment. Chronic glaucomaThis type develops gradually with no obvious early symptoms. Vision narrows slowly, and by the time patients notice serious vision loss, much of the damage is irreversible. This is why it’s also called the “thief of sight.” Congenital and acquired glaucomaAlthough most glaucoma patients are over 40, some infants are born with abnormal drainage structures in the eyes, leading to congenital glaucoma. These babies may be sensitive to light, have excessive tearing, and have larger-than-normal eyeballs. Primary and secondary glaucomaPrimary glaucoma is not caused by another disease. Secondary glaucoma results from other eye or systemic conditions such as advanced cataracts, uveitis, eye tumors, diabetic eye disease, or prolonged use of steroid eye drops. Treatment for secondary glaucoma must address the underlying condition first. Normal-tension glaucomaIn some patients, eye pressure is within the normal range, but the optic nerve is still damaged due to its lower tolerance to pressure. Such cases require detailed examination to diagnose. High-tension glaucomaThis is the most common type where increased intraocular pressure damages the optic nerve, leading to progressive vision loss and narrowed visual fields.   What are the common symptoms of glaucoma?  Gradual narrowing of the visual field Nausea or vomiting Eye pain with or without headache or migraine Sudden blurred vision Red or swollen eyes Seeing halos or rainbow rings around lights   How is glaucoma diagnosed? Diagnosis involves a series of clinical tests based on the patient’s condition and medical history. Common tests include: Intraocular pressure measurement Visual field test Fundus (retinal) examination Slit-lamp examination Gonioscopy (to examine the drainage angle) Assessment of optic nerve damage Checking aqueous humor drainage function   How is glaucoma treated? The goal of glaucoma treatment is to control eye pressure, prevent or slow disease progression, protect the optic nerve, and preserve vision. Treatments include medications (eye drops or oral drugs), laser therapy, or surgery. Today, there are also minimally invasive surgical options. With early detection, 90% of patients can avoid blindness. Surgery is usually performed under local anesthesia, where the eye is numbed but the patient remains awake. General anesthesia is reserved for specific cases. Surgical options to lower intraocular pressure: Glaucoma filtration surgery – A small incision is made in the eye wall to create a tiny drainage channel for aqueous humor to exit and reduce eye pressure. Non-penetrating filtration surgery – Similar to traditional filtration surgery but preserves certain corneal layers and may use implants. Tube (shunt) implantation surgery – A drainage tube is inserted into the eye to divert excess fluid out. Minimally invasive glaucoma surgery (MIGS) – Techniques that either enhance drainage or reduce aqueous humor production with less tissue disruption. Ciliary body laser or cryotherapy – Laser or freezing treatment to reduce aqueous humor production by partially destroying the fluid-producing tissue. In some surgeries, anti-scarring drugs (such as mitomycin C or 5-fluorouracil) may be applied to increase success rates. After surgery, an eye shield is used to protect the surgical site.

Is there any benefit to regular gastroscopy and colonoscopy?Do you often experience indigestion or abdominal discomfort? Gastroscopy and colonoscopy can help investigate the underlying causes. These endoscopic procedures allow direct observation of the stomach and intestines to detect abnormalities or diseases such as abnormal cell growth, ulcers, or polyps. If any lesions are found during examination, the doctor may use forceps attached to the endoscope to collect tissue samples for analysis. Early screening helps lower the risk of developing gastrointestinal cancers, including stomach, esophageal, colorectal, and anal cancer. Many people think gastroscopy and colonoscopy only detect stomach and colorectal cancers, but in fact, they can identify a wide range of digestive conditions, such as the following:   What can gastroscopy and colonoscopy examine? Gastroscopy examines the upper digestive tract, while colonoscopy examines the lower digestive tract.   Gastroscopy — examines the esophagus, stomach, and duodenum A gastroscopy, or “upper gastrointestinal endoscopy,” allows doctors to examine the esophagus, stomach, and duodenum. It helps diagnose upper digestive tract diseases, such as stomach or esophageal cancer, gastritis, esophagitis, stomach ulcer, esophageal ulcer, duodenal ulcer, and stomach polyps. It is useful for evaluating symptoms such as difficulty swallowing, persistent abdominal pain, heartburn, acid reflux, or indigestion. If necessary, the doctor may take tissue samples to identify whether the condition is benign or malignant, and may remove polyps immediately during the examination.   Colonoscopy — removes polyps and prevents colorectal cancer A colonoscopy examines various lower digestive tract conditions, including colorectal or anal cancer, inflammation, ulcers, vascular lesions, hemorrhoids, and suspected intestinal bleeding. It is recommended for patients with persistent abdominal pain, chronic diarrhea, constipation, or bloody stools to identify possible causes.Even people without symptoms can undergo colonoscopy. In Hong Kong, colorectal cancer is the most common cancer, with over 5,600 new cases recorded in 2018. Most cases begin with benign polyps that can become malignant over about 10 years. Removing these polyps through colonoscopy can reduce the risk of cancer development.   How long does the procedure take? What preparation is required?   Colonoscopy A colonoscopy uses a flexible scope inserted through the anus to examine the lining of the colon. The procedure usually takes 15 minutes to 1 hour. Sedatives and pain relief are often given so the patient remains relaxed or asleep. Three days before the procedure, patients should eat a low-residue diet and avoid high-fiber foods such as vegetables, fruit, and oatmeal. The day before, a bowel cleansing agent is taken to clear stool and ensure a clean view of the intestines for accurate examination.   Gastroscopy A gastroscopy uses a thin, flexible tube about 0.9 cm in diameter with a camera at its tip, inserted through the mouth and esophagus to reach the stomach and duodenum. If required, the doctor may extract tissue samples through the tube for pathology testing. To ensure comfort, local anesthetic spray and intravenous sedation are provided. The procedure usually takes around 10 minutes.   When is gastroscopy or colonoscopy needed?   Gastroscopy indications Difficulty swallowing Persistent stomach pain, heartburn, acid reflux, or indigestion Black or tarry stool Unexplained weight loss Iron-deficiency anemia (fatigue, low hemoglobin) Family history of stomach or esophageal cancer   Colonoscopy indications Colorectal cancer screening (recommended for people aged 45 or above, or with family history) Blood or mucus in stool Unexplained abdominal pain Unexplained weight loss or fatigue Changes in bowel habits (persistent constipation or diarrhea for more than 2 weeks) Positive fecal occult blood test   Who should undergo these examinations?   Gastroscopy Individuals with swallowing difficulties, recurrent upper abdominal pain, acid reflux, indigestion, upper gastrointestinal bleeding, loss of appetite, or weight loss may need a gastroscopy. People aged 40 and above are recommended to begin regular screenings, especially those with a family history of stomach cancer.   Colonoscopy Besides those showing colorectal cancer symptoms, regular screening is advised from ages 45 to 50, as early colorectal cancer often has no obvious signs and is increasingly found in younger adults. If only a few polyps are found and test results are normal, repeat colonoscopy every 5 years is recommended. If multiple polyps (20–30) are present, the next screening should be done within a year.For people with a direct family history of colorectal cancer or additional risk factors, screening should start earlier—at age 40 or 10 years before the relative’s age at diagnosis.

Have you ever experienced lower back and waist pain, whether you are a white-collar worker or a laborer? In fact, people from all walks of life can suffer from back pain. Maintaining correct posture and performing stretching exercises daily can help relieve and prevent discomfort. However, if you experience symptoms like sciatica or leg numbness, it is important to seek medical diagnosis to identify the cause. Doctors often recommend physical therapy for patients as needed.   Why does back pain occur?Back pain is a common urban ailment, affecting not only office workers but also elderly individuals and homemakers who may feel stiffness and discomfort in the waist. Causes include falls, heavy lifting, overwork, poor posture, aging bone spurs, and degeneration, all of which can affect the spine and lead to pain. Additionally, kidney diseases or osteoporosis can also cause back pain. Can back pain affect the legs?The spine’s structure is complex, including the tailbone (coccyx), sacrum, five lumbar vertebrae, and two pelvic bones, connected by ligaments and muscles. Intervertebral discs, blood vessels, and spinal nerves lie between vertebrae. Nerves branching out around the lumbar vertebrae control different muscles and sensations in the legs. Therefore, leg pain or numbness can originate from back problems.   What are the symptoms of back pain? Muscle soreness and stiffness in the waist and legs, decreased range of motion Sharp pain during coughing or sneezing Sciatic nerve pain or femoral nerve pain Compression of lumbar nerves leading to diminished leg reflexes, muscle weakness, sensory loss, or numbness   How to treat and care for back pain?To relieve chronic back pain, use heat packs and pain-relieving creams; for acute pain, apply ice packs to reduce inflammation. If symptoms, such as leg numbness, do not improve, seek medical advice promptly. Doctors may order clinical exams, X-rays, or MRI scans to diagnose the cause and prescribe painkillers, anti-inflammatory drugs, diuretics, or topical pain relief. Physical therapy is often recommended to promote recovery and prevent recurrence. Physical therapy options include: Heat therapy to relax muscles; Interferential current therapy to block pain signals and improve circulation; Lumbar traction to reduce nerve compression; Ultrasound therapy to increase blood flow and relax ligaments and muscles. Acute treatment usually requires 6-8 sessions; chronic may need 10-12. Joint mobilization and realignment by hands-on techniques to relieve stiffness and improve motion. Exercise therapy such as prone back extensions supported by hands and supine knee side-to-side movements to ease pain and improve joint function. Acupuncture Posture education   How to prevent back pain? Use a lumbar support belt if needed Maintain good posture: stand straight with relaxed shoulders; sit with feet flat, back straight, and avoid crossed legs; ensure chair and desk heights are appropriate; use a supportive mattress and sleeping position Lift heavy objects using legs, keeping the back straight; use trolleys if needed Maintain healthy weight Pregnant women should maintain correct posture Do appropriate exercises such as lying on the floor and alternately hugging knees to stretch and relax lower back muscles   Hong Kong Registered PhysiotherapistThe information on this website is for educational use only.You should consult your doctor about surgical options and not rely solely on this website’s information.

Benign Prostatic Hyperplasia (BPH), also known as prostate enlargement, is a common health issue in middle-aged and older men. It is not cancer but occurs when the prostate, a small gland, grows larger with age, pressing on the urethra and causing urination difficulties. Simply put, it’s like the prostate “growing bigger.” According to the Hong Kong Centre for Health Protection, about half of men over 50 in Hong Kong experience some degree of BPH.   What is the Prostate and Why Does It Enlarge? Think of the urinary system as a pipeline, with the prostate as a walnut-sized gland surrounding the urethra (the tube that carries urine from the bladder). It produces part of the seminal fluid to support sperm movement. As men age, hormonal changes (like testosterone effects) cause prostate cells to multiply, enlarging the gland. This can squeeze the urethra, causing issues. In severe cases, the prostate may swell to the size of a mango. Medically, this often starts at ages 40–50, driven by age, hormonal imbalances, and genetics.   Common Symptoms of BPH BPH develops gradually and may not be noticeable early on. When the prostate presses on the urethra, symptoms include: Frequent urination: Especially at night (nocturia), needing to visit the bathroom often. Urgency: Sudden, uncontrollable urges to urinate. Weak urine stream: Slow, intermittent flow, like squeezing toothpaste. Incomplete emptying: Feeling the bladder isn’t fully emptied after urinating. Other: Occasional pain or blood in urine, though rare. Severe cases may lead to urinary tract infections or kidney issues. These symptoms can affect sleep and quality of life, but severity varies. Some men experience only mild discomfort.   Who is More Likely to Develop BPH? Age is the main factor (risk increases over 50), but other risks include: Family history: If your father or brother had BPH, you’re more likely to develop it. Lifestyle: Obesity, lack of exercise, or poor diet can worsen it. Health conditions: Diabetes or heart disease may indirectly contribute. The good news? BPH isn’t cancer and won’t become cancer. However, ignoring it could lead to complications like bladder stones or urinary retention.   How is It Diagnosed? If you have symptoms, a doctor will review your medical history and perform a physical exam, including a digital rectal exam (DRE) to check prostate size. Other tests may include urine flow studies, ultrasound, or PSA blood tests (to rule out cancer). Treatment depends on symptom severity.   How to Prevent or Manage It? While BPH can’t be fully prevented, lifestyle changes help: Maintain a healthy weight, eat more vegetables, and limit red meat. Exercise regularly, like walking or swimming, to support urinary health. Avoid holding urine and drink less water at night. Get regular check-ups for early detection.   Conclusion BPH is a natural part of aging for men, much like graying hair. Noticing symptoms early and seeking professional advice can manage it effectively. If you have urination issues, don’t be shy—see a doctor. It can improve your life and prevent complications.

What Are Warts and Do They Need to Be Removed? Warts are common skin growths that look like small, hard bumps or fleshy grains, appearing on hands, feet, face, or elsewhere. They’re caused by the human papillomavirus (HPV), are not dangerous, but can sometimes feel embarrassing or uncomfortable. Many ask, “Do warts have to be removed?” The answer: Not always!   What Are Warts? Warts are small growths on the skin caused by HPV infection. The virus enters through tiny skin cuts, triggering excess cell growth to form a wart. Think of it as an uninvited guest on your skin—harmless but possibly bothersome. According to Hong Kong’s Department of Health, warts are common across all ages, especially in children and young adults due to frequent skin contact (like sharing towels or walking barefoot).   Types of Warts Warts vary in appearance and location: Common Warts: Rough, hard bumps, often on hands or fingers. Plantar Warts: Grow on the soles of feet, can be painful when walking, like stepping on a pebble. Flat Warts: Smooth, small warts, common on the face or legs, especially in young people. Genital Warts: Appear near genitals, a special type requiring extra attention. Each type may need different handling based on location and symptoms.   Why Do Warts Form? HPV is the culprit! It spreads through: Direct contact, like shaking hands with someone who has warts. Sharing towels, shoes, or walking barefoot in public pools. Small skin cuts, making it easier for the virus to enter. People with lower immunity (e.g., stressed or ill) are more prone to warts. Fortunately, warts rarely cause serious health issues.   Do Warts Need to Be Removed? Good news: Many warts disappear on their own! Especially in kids or young adults, the immune system may clear them in months to a couple of years. But you might consider treatment if a wart: Affects your appearance, causing embarrassment. Causes pain (like plantar warts). Spreads or multiplies quickly. Grows in sensitive areas (like the face or genitals). Always consult a doctor for the best approach.   How to Decide and What Are the Treatment Options? Warts don’t always need removal—it depends. Common options include: Watchful Waiting: If painless, many warts fade naturally. Over-the-Counter Treatments: Salicylic acid creams from pharmacies soften warts for removal, but require weeks of use. Cryotherapy: Doctors freeze warts with liquid nitrogen, a simple, common method. Laser or Surgery: For stubborn or large warts, doctors may use lasers or minor surgery. Other Methods: Electrosurgery or chemical treatments for specific cases. Important: Don’t cut or tear warts yourself—it risks infection or spreading! Genital warts need professional care due to their link to sexual transmission.   How to Prevent Warts? While not fully preventable, these tips help: Keep skin clean and dry to avoid cuts. Don’t share towels, shoes, or personal items. Wear flip-flops in public pools or gyms. Boost immunity with a balanced diet, exercise, and good sleep.   When to See a Doctor? Consult a doctor if a wart: Grows quickly, changes color, or bleeds. Causes pain or disrupts daily life. Appears on sensitive areas like the face or genitals. Might not be a wart (to rule out other issues, like skin cancer). In Hong Kong, dermatologists or general practitioners can offer professional checks for safety.   If unsure, don’t try to handle warts yourself—seeing a doctor is the best choice! This information is for reference only; always follow medical advice.