Urologist

• Prostate

  

  What is the prostate?

  The prostate is a gland of the male urinary and reproductive system a little larger than a walnut. It is located between the bladder and the penis, behind the intestine, with the urethra running through it. 

   

  What does the prostate do?

  The main function of the prostate is to produce prostatic fluid, which is then secreted into the urethra. The prostatic fluid is part of semen along with seminal vesicle fluid and spermatozoa. Prostatic fluid contains the necessary elements to extend the lifespan of sperm. The muscles of the prostate help to create the force needed to expel semen during ejaculation.

  The prostate is also responsible for controlling the urine stream via muscle contraction around the urethra, which carries urine from the bladder to the penis. It is therefore able to decrease or interrupt the urine stream.

  

  What conditions can affect the prostate?

  Men can be affected by several conditions of the prostate:

  • Prostatitis – inflammation of the prostate. This can be caused by infection.
  • Benign prostate enlargement/benign prostatic hyperplasia (BPH) – growth of the prostate with age can affect urination and cause other symptoms.
  • Prostate cancer – the most common cancer in men, but also very treatable, with a high survival rate.

  Prostatitis usually affects younger men, while other conditions are more common in adults and in the elderly.  

   

  How can such conditions be treated?

  Treatment will vary according to the specific condition:

  • Prostatitis may be treated with antibiotics and anti-inflammatory medications, and the patient may have to follow a specific diet (focusing on making sure they get enough nutrients and liquids).
  • Benign prostate enlargement may be treated with α1-blockers, which relax the muscles around the urethra and 5α-reductase inhibitors, which will inhibit the transformation of testosterone. If medication is ineffective, there are also surgical options.
  • Prostate cancer may be treated in a number of different ways, depending on the nature of the cancer and the patient’s choice. Some may choose to wait and observe to see if the cancer is growing. Others may opt for chemotherapy, radiotherapy, prostate brachytherapy, hormone therapy or surgery to remove part or all of the prostate (prostatectomy). The doctor might also recommend a combination of these treatments to ensure the cancer is eradicated.

   

  Which doctor should I see?

  You should see a specialised urologist.

• Prostate cancer

  What is prostate cancer?

  Prostate cancer is the type of cancer that starts in the prostate gland. The prostate is part of the male reproductive system and is an organ that surrounds the urethra, the tube that carries urine out of the body. The prostate is responsible for producing seminal fluid.

  Prostate cancer is the most common cancer in men, with 1 in 8 men affected. Every year, 11,000 men die from prostate cancer.

  Prostate cancer can be categorised into four stages, indicating how far the cancer has spread:

  • Stage 1 – the cancer is in only half of one side of the prostate and is contained within the prostate gland
  • Stage 2 – the cancer is still in one side of the prostate but fills more than half of that side
  • Stage 3 – the cancer has broken through the prostate gland and may spread to the seminal vesicles
  • Stage 4 – the cancer has spread to the bladder, lymph nodes, bones, or other organs in the body

  

  What are the symptoms?

  Prostate cancer often does not present any symptoms at first. The symptoms that occur when the cancer starts to progress include:

  • difficulty and pain when urinating
  • needing to urinate frequently
  • painful ejaculation
  • blood in the urine

  If the cancer spreads to the lymph node or pelvic bone, symptoms can include:

  • pain in the lower back and pelvis that does not go away over time
  • involuntary weight loss

  Causes of prostate cancer or why it occurs

  The exact cause of prostate cancer is unknown. Your risk of getting prostate cancer depends on:

  • your age – prostate cancer is more common in men over 60 years old, and by the age of 80, 4 out of 5 men have cancer cells in their prostate
  • your ethnicity – prostate cancer is more common in black men compared to white and asian men
  • family history – you are twice as likely to develop prostate cancer if you have a father who had the disease

  How is prostate cancer diagnosed?

  Prostate cancer diagnosis consists of several stages. At first, the doctor will assess your likelihood of having prostate cancer by taking a urine sample, testing your blood for prostate-specific antigen (PSA), and examining your prostate. If they conclude you may have a high risk of prostate cancer, they will refer you for further tests. This can include:

  • an MRI scan to create a detailed picture of your prostate and any cancer cells
  • a biopsy to retrieve a small amount of tissue for testing

  What is the treatment?

  Treatment options depend on the stage of the cancer and the state of health of the patient.

  For slow-growing cancer that is contained within the prostate cancer, the doctor may suggest a wait and see approach, where the prostate is regularly monitored but treatment delayed until necessary.

  If the cancer requires treatment but has not spread outside the prostate gland, the most common treatments are:

  • partial ablation – this treats part of the prostate that has cancer, preserving the rest of the prostate
  • surgery – this can include radiotherapy or prostatectomy

  If the cancer has spread beyond the prostate, the first line of treatment is hormone therapy. If this is not effective, chemotherapy or immunotherapy may be recommended.

• Erectile dysfunction

  What is erectile dysfunction?

  Erectile dysfunction is the difficulty or inability to achieve or maintain an erection of the penis that results in a satisfactory sexual relationship. It is also known as impotence. Erectile dysfunction is extremely common and increases with age. If it happens frequently, you should see a doctor.

  

  What symptoms does it present?

  The main symptom of erectile dysfunction is a change in the quality of the erection. If the cause is physical, you usually have the inability to have an erection when you wake up in the morning. Erectile dysfunction can affect both your ability to have an erection and the length of time an erection lasts.

  Erectile dysfunction can also involve a loss of sexual desire.

  What causes erectile dysfunction?

  There are many causes of erectile dysfunction, including:

  • Physical causes – such as diabetes, high blood pressure, obesity, the side effects of medication, alcoholism, multiple sclerosis, hormonal problems, and sleeping problems
  • Psychological causes – such as stress, anxiety, depression, or issues within your relationship

  Erectile dysfunction can also occur after treatment, including surgery on the spinal cord or prostate.

  Your chances of being affected by erectile dysfunction increase with age, drug or alcohol use, and are higher if you are overweight or obese.

  Can erectile dysfunction be prevented?

  You cannot always prevent erectile dysfunction, but you can reduce your risk by:

  • giving up smoking
  • maintaining a healthy weight
  • getting regular exercise

  How is erectile dysfunction diagnosed?

  In most cases diagnosis simply involves asking you about your symptoms and when they started. If the doctor suspects a physical cause that needs investigating, they might refer your for follow-up tests, such as blood tests or an ultrasound.

  How is erectile dysfunction treated?

  Treatment depends on whether there is an underlying cause – tackling the root of the problem should improve symptoms.

  Beyond this the most common form of treatment is medication, which is widely available and effective in making it easier to get an erection. If the problem is low testosterone levels, your treatment may involve hormone replacement therapy.

  If medication is not effective, other treatment options include:

  • penis pumps – this may not be directly available from your doctor
  • penile implants – a surgical procedure to implant rods which help you control your erections

  If the problem is psychological, there are various therapies available, including:

  • counselling
  • sex therapy
  • cognitive behavioural therapy (CBT)
• Prostatectomy (prostate removal)

  

  What is a prostatectomy?

  A prostatectomy is a surgery to remove all or part of the prostate.

  The prostate is a walnut-sized gland only found in men located between the bladder and the penis. It can be afflicted by a number of conditions, including prostate cancer.

  A simple prostatectomy only removes part of the prostate.

  A radical prostatectomy involves removing the entire prostate, along with the seminal vesicles and vas deferens. It is usually only used to treat malignant prostate cancer.

   

  Why is it done?

  Several conditions can be treated with a prostatectomy.

  Simple prostatectomies are generally only performed for benign conditions, while radical prostatectomies are performed for more serious benign conditions and malignant cancer.

  Your doctor may recommend a prostatectomy for the following conditions:

  • Benign prostatic hypertrophy (BPH)
  • Acute urinary retention
  • Recurrent urinary tract infections (UTIs)
  • Prostate cancer

  The patient may know if something is wrong with his prostate if he suffers from the following symptoms:

  • Frequent urination with little urine
  • Urgent need to urinate during the night (nocturia)
  • Difficulty starting to urinate
  • Low urine flow
  • Dripping at the end of urination
  • Sensation that the bladder hasn’t fully emptied even if it has urinated

   

  What does prostatectomy consist of?

  Prostatectomy can be performed in one of a few different ways:

  • Open surgery – the surgeon makes a large incision in the patient’s abdomen, allowing him to reach the prostate in order to cut it (or part of it) out.
  • Keyhole surgery – a minimally invasive approach, this involves cutting 5-6 small incisions in the patient’s abdomen, through which surgical tools can be passed, including a tiny light and camera so that the surgery can be performed without cutting the patient open. This can be done by hand or the surgeon may control a robot that holds the tools (robotic assisted surgery).

   

  Preparation for prostatectomy

  Prostatectomy does not usually require any special preparation. However, it is possible that the urologist will ask the patient to not drink any fluid in the hours leading up to the surgery. The patient will be given a general anaesthetic prior to the procedure.

   

  Care after the intervention

  After prostatectomy, the patient usually stays in the hospital for 7-10 days. The total recovery will take a few weeks.

  While in the hospital, the patient is given pain medication and a catheter is passed up the penis to allow urine to pass out of the bladder and into a bag that can be carried round. The catheter stays in place while the area heals, with most patients keeping it in while they go home and having it removed a few weeks later.

  The patient will be encouraged to walk around the hospital to prevent blood clots. The team of doctors and nurses will advise them on what to eat and drink, as well as how to look after their catheter.

  The patient may experience fatigue, constipation, and an inability to get an erection while they recover. Any unexpected consequences of the surgery or any doubts should be reported to the doctor.

• Circumcision

  

  What is circumcision?

  Circumcision is the total or partial removal of the foreskin of the penis via a surgical procedure. The foreskin is the skin that covers the head (or glans) of the penis. A general anaesthetic will be used to render the patient unconscious during the procedure or a local anaesthetic will be used to numb the area.

   

  Why is it done?

  There are several reasons why circumcision is performed. Some religions and cultures circumcise all male children – this is common in Jewish and Islamic communities as well as several African countries.

  There are also a number of medical reasons:

  • Phimosis – tight foreskin, which is difficult or impossible to retract. This can cause pain when the penis is erect.
  • Paraphimosis – after being retracted, the foreskin cannot return to its natural position. It can restrict blood flow and cause pain, inflammation and swelling of the head of the penis, and more serious complications.
  • Recurrent balanitis – inflammation of the foreskin and glans.
  • Penis cancer

   

  What does circumcision consist of?

  Circumcision is a very simple operation, and is usually performed as a day case. The patient is anaesthetised, either with a general anaesthetic, which makes them unconscious, or a local anaesthetic, which numbs the area.

  The foreskin is removed using a scalpel or surgical scissors to behind the head of the penis and the remaining skin is stitched back together with dissolvable stitches.

   

  Preparation for circumcision

  Circumcision is considered a very safe treatment. No previous preparation is needed. However, if the patient is going to have a general anaesthetic, they will usually be instructed not to eat or drink anything for several hours before the operation.

   

  Care after the intervention

  The recovery of the patient after a circumcision is very fast. Adult patients are usually advised to take a week off work to allow recovery. During this time, it is recommended to wear loose, comfortable clothes. For the first 3-4 days there may be some swelling and discomfort around the head of the penis. Painkillers, such as paracetamol or ibuprofen are usually prescribed to help with the pain. The penis usually heals fully in around ten days. However, it is usually advised not to engage in sexual activity for a full four weeks after the surgery.

• Frenuloplasty

  What is frenuloplasty?

  Frenuloplasty refers to the surgical alteration of the frenulum, a small fold of tissue which is located on the underside of the penis.

  

  How is it performed?

  An incision is made in the frenulum, and it is then stretched in order to lengthen it. After this, the wound is closed with stitches. This makes the frenulum longer, effectively relieving pain and discomfort. The procedure can be performed under general or local anaesthesia. In some cases the frenulum may be removed completely.

  Why is it done?

  Frenuloplasty is most typically performed to alter the frenulum in cases where it is causing discomfort and pain during sexual intercourse. A frenuloplasty may become necessary in uncircumcised men who have problems with the tightness of their foreskin. Circumcision removes the foreskin, but frenuloplasty can help relieve tightness without the need to remove it.  

  How can you prepare for frenuloplasty?

  Before frenuloplasty, your doctor is likely to ask you to stop smoking, as with any surgical procedure. This is because smoking increases the likelihood of complications and slows the healing process.

  You may also be told to stop eating and drinking for a period of time before the surgery, depending on the anaesthetic which will be used. You will have to inform the doctor about any allergies you have, and will have to answer some questions about your general health and any medication you may be taking, as in some cases you may be advised to stop (e.g in the case of blood-thinning medication).

  What is the aftercare?

  Frenuloplasty is often performed as a day case procedure and you may be able to go home the same day after surgery, providing you have recovered from the anaesthetic and the wound is no longer bleeding. In this case, an overnight stay will be necessary.

  After the procedure, you must ensure someone is available to take you home and you must not drive for the 24 hours following surgery. It is important to rest after the procedure as you may feel tired and find it difficult to concentrate as the anaesthetic wears off.

  It is quite normal to feel discomfort after frenuloplasty and you can help relieve any pain by taking over-the-counter painkillers or mild painkillers prescribed by your doctor. You should abstain from sexual activity for around 6 weeks following the procedure.

  A dressing may be applied to the wound in order to prevent staining on clothing, as it is quite normal for the wound to bleed or ooze in the days following the procedure. You can return to work when you feel ready to.