Mr Andrew Ballaro

Mr Andrew Ballaro
Urology
Central London


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Mr Andrew Ballaro

Urologist in
London &
Brentwood

MBBS MSc(Urol) MD FRCS(Urol)

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Mr Andrew Ballaro areas of expertise:

Professional statement

Mr Andrew Ballaro is an expert consultant and lead urologist, specialising in the management of all urology problems, including blood in urine, urinary infections, prostate and bladder symptoms, and urological cancer diagnosis. He has a particular interest in minimally invasive surgery and the comprehensive management of complex urinary stone disease and is one of the highest volume stone surgeons in the London area. He consistently publishes some of the best results in the country for complex stone operations and offers mini and ultra-mini PCNL for kidney stones as a day case procedure. 

Mr Ballaro's extensive training began after graduating from The Royal Free Hospital Medical School and undertaking his basic surgical training at Oxford. He was awarded a Fellowship from the Royal College of Surgeons of London and went on to complete higher urological training on the North London Training Scheme. This was followed by advanced training in laparoscopy and complex stone surgery from national and international experts in his field.

Mr Ballaro has a strong interest in education, currently teaching trainees at the London Deanery across many levels, in addition to being awarded a Hunterian Professorship from the Royal College of Surgeons of England. He holds a Masters degree in Urology and an MD in Clinical Sciences from the Institute of Urology and has published extensively on the subject of minimally invasive urological surgery. He is the co-author of the latest edition of the popular medical student textbook 'Lecture notes in urology'.

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 Credentials

GMC: ‍4027768

 Professional experience

• More than 25 years of experience
• Consultant Urologist, Wellington Hospital (present)
• Consultant Urologist, Spire Hartswood (present)
• Clinical Lead (stone surgery), King George and Queens Hospitals (present)
• Clinical Lead for stone surgery, King George and Queens Hospitals (present)
• Consultant Urologist, Hospital of St John and Elizabeth (present)

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 Sub-specialties

• Kidney stones
• Surgery and prevention for kidney stones
• Bladder and prostate symptoms including prostatitis and cystitis
• Laser surgery

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 Teaching posts

• London Deanery Trainer (present)

 Education

• BSC(Hons), University College London (1989)
• MBBS, Royal Free Hospital School of Medicine (1993)
• FRCS, Royal College of Surgeons of England (1999)
• MSc(Urol), University College London (2001)
• MD, Clinical Sciences, University College London (2005)
• FRCS(Urol), Intercollegiate (2006)

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 Publications and conferences

• Multiple

 Prizes and awards

• Huntarian Professorship, Royal College of Surgeons of England.

 Professional membership

• British Association of Urological Surgeons
• European Association of Urologists
• Fellow of the Royal College of Surgeons of England

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Languages spoken

  • English

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15/01/2018

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Diseases, Medical Tests and Treatments

Bladder problems

Bladder problems can include urinary incontinence, infection, or more serious conditions like cancer.

Holmium laser

What is it? Holmium Laser Enucleation of the Prostate (HoLEP) is a very common endoscopic procedure in the urology field. It treats conditions such ...

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 ...

Prostatitis

Prostatitis is the inflammation of the prostate, a male gland below the bladder that helps in the production of semen. It is one of the most common di ...

Second medical opinion

What is a second medical opinion? A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse. Why would you get a second medical opinion? Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease. In addition, there are certain situations where a second medical opinion is sought after: Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening The diagnosis is not clear-cut If you are considering a new treatment approach that is experimental The aims of obtaining a second medical opinion are: To confirm whether a diagnosis is correct and/or appropriate. To confirm whether a suggested treatment is correct and/or appropriate. To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure. Possible disadvantages of seeking a second medical opinion include: The process can delay the start of treatment. Logistically, seeing another specialist might be difficult and possibly time-consuming. It might be stressful to hear the same diagnosis again. How would you seek a second medical opinion? You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion. Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.  ...

Balanitis

What is it? Balanitis is a skin irritation on the glans penis (the head of the penis). The inflammation causes redness, pain, itching and swelling to the tip of the penis. It can affect men and boys. Balanitis can be caused by fungi (Candidal balanitis), by bacteria (Gardnerella or Trichomonas vaginalis), by a trauma or an irritation or by dryness (thus causing a contact allergic reaction). Balanitis can either be: acute : when it only lasts for a few days chronic : when it lasts for over two weeks What are the symptoms? Symptoms of balanitis usually include: inflammation genital erythema (redness) itching a burning sensation having trouble passing urine bleeding genital oedema (swelling) Other symptoms may include whitish or yellowish discharge, unpleasant genital smell and swollen inguinal lymph nodes. If you’re suffering from other conditions which may lead to a presence of bacteria in your blood, balanitis will become more severe. How is it diagnosed? To diagnose you with balanitis, your doctor will take a skin tissue sample (this may be done with a simple swab) and analyse it under a microscope. Sometimes, balanitis can be diagnosed by simply looking at your penis. What causes it? Balanitis is mainly caused by poor hygiene. Other reasons behind include: fungal or bacterial infections (caused by candidiasis or poor hygiene); sexually transmitted diseases (STDs), such as syphilis, gonorrhoea and herpes; psoriasis, lichen sclerosus or atopic eczema; irritation caused by harsh cleaners. allergy to latex, metal, drugs or cosmetic products Diabetic balanitis is a form of balanitis which develops as a consequence of diabetes. How can it be prevented? Balanitis can be prevented by keeping your genitalia clean and by making sure the head of the penis is always dry after passing urine. What is the treatment? If you have balanitis, the treatment will depend on which kind of balanitis you have and on what symptoms you’re showing. Usually, your GP will give you topical corticosteroids, or antifungal medications if the cause of balanitis is fungal. Which doctor should I talk to? A specialist urologist can diagnose and treat balanitis. ...

Benign prostate enlargement

What is benign prostatic hyperplasia? Benign prostatic hyperplasia occurs when the size of the prostate gland increases due to a hormonal imbalance in men. The prostate is the male sex gland that surrounds the urethra. It is located below the bladder and above the rectum and is responsible for producing seminal fluid. Prostatic hyperplasia is a common pathology in men after the age of 50 and can affect their quality of life. Prognosis of benign prostatic hyperplasia Benign prostatic hyperplasia, or enlargement of the prostate gland, is a common pathology in men after middle age. It is not serious, nor does it increase the risk of cancer which can also affect this gland. The main problem with benign prostatic hyperplasia is that its symptomatology is bothersome for the sufferer, and can even be incapacitating. However, the prognosis of this pathology is positive with the proper treatment, although it may return over time. Each case of hyperplasia will require the necessary follow-up with the urologist. Symptoms of benign prostatic hyperplasia The symptoms, which appear progressively, include: Urinary incontinence Difficulty urinating Urinating more frequently Urinary urgency Dribbling after urination Need to urinate several times a night Pain when urinating Blood in the urine In severe cases, prostate hyperplasia can lead to an absolute inability to urinate, urinary tract infections or impaired kidney function. Medical tests for benign prostatic hyperplasia If one or more of the above symptoms are present, the urologist will assess the person’s medical history, study the severity of their symptoms and perform a rectal examination to check the condition of the prostate. The person may also require clinical tests such as urine tests to rule out infection, or blood tests to examine prostate-specific antigen (PSA) levels and to rule out prostate cancer. What causes benign prostatic hyperplasia? Although there is no known direct cause or risk factor for benign prostatic hyperplasia, it occurs when the size of the prostate gland increases due to a hormonal imbalance in the testicles: the female hormone (oestrogen) increases, while the male hormone (testosterone) decreases. Can it be prevented? Benign prostatic hyperplasia cannot be prevented, but it can be detected in its early stage through regular check-ups with a urologist. Specialists recommend annual prostate screening after the age of 50 when there is an increased risk of prostate enlargement. Treatment for benign prostatic hyperplasia If symptoms are mild, the specialist may prescribe medication and recommend lifestyle changes (such as avoiding alcohol and caffeine, playing sports, and adapting urination routines). In more severe cases, surgery may be required. Operations for benign prostatic hyperplasia usually include: Transurethral resection of the prostate: This is the most common procedure, in which the prostate is removed through an endoscope inserted through the penis. Simple prostatectomy: The inside of the prostate is removed through an incision made in the abdomen. Prostate laser surgery: With this latest technique, the tissue is destroyed with a laser, making it a less invasive option. Which specialist treats it? The urologist is the specialist in charge of treating prostate hyperplasia. Due to the symptoms of urinary problems, the diagnosis may be made by an andrologist and a urologist. The urologist may also perform the surgery, although some general surgeons are also specialised in these operations.  ...

Bladder cancer

The bladder is a hollow organ in the lower abdomen whose main function is to store urine before it is expelled from the body. Bladder cancer occurs when cancerous cells grow in the inner membrane of this organ, and its symptoms are painful urination or lower back pain, frequent urination and blood in the urine. The main risk factors are smoking and exposure to certain chemicals, along with a family history of the disease. This type of cancer can be limited to the lining of the bladder, in which case it is called superficial, or spread through the lining of the bladder and even to nearby organs, in which case is called invasive. Treatment depends on the severity and type of cancer, but may generally include radiation therapy, chemotherapy and/or surgery. ...

Cholecystitis

Cholecystitis is the inflammation of the gallbladder. It may be acute or chronic and is usually caused by the presence of stones. It occurs because the bile gets trapped in the gallbladder irritating it....

Circumcision

Circumcision is the total or partial removal of the foreskin, which is the skin that covers the tip of the penis, by a surgical procedure. It is effective to correct disorders such as phimosis (which prevents the foreskin from being pulled back to uncover the glans) and paraphimosis (most often due to an inflammation of the foreskin). Circumcision is widespread universally, and many parents prefer to perform it on new-borns, not as prescription, but for cultural reasons. It is a very simple operation, which lasts only a few minutes, and does not require general anaesthesia. The recovery of the patient is also very fast, within a few days they can go back to their normal routine. ...

Cystectomy (bladder removal)

Cystectomy is the removal of the bladder. If the reason for the operation is bladder cancer, the bladder and all the surrounding tissue is removed. If the reason is a benign disease, only a portion is removed ...

Cystitis

What is cystitis? Cystitis is a urinary tract infection (commonly referred to as a UTI), and is an inflammation of the bladder. This inflammation usually occurs as a result of a bladder infection. Cystitis is more common in women than it is in men. It usually goes away in a few days, but in more complex or recurring cases, it may need long-term treatment.  What are the symptoms of cystitis? Symptoms include: A need to pee more frequently than ususal A burning/stinging sensation when peeing Cloudy urine Dark, or strong-smelling urine Pain in the lower abdomen Fatigue Feeling generally unwell In children: Vomiting Fever Feeling irritated A lack of interest in food/low appetite Feeling weak What causes cystitis? Cystitis is most frequently caused by a bacterial infection, which happens when bacteria from other areas of the body (e.g from in the bowel or on the skin) get into the bladder. Bacteria is thought to come through the urethra, which carries urine out from your body. Women have a shorter urethra, and it is closer to the anus in women, which means they more commonly experience cystitis. Bacteria can get into the bladder in several different ways: Through sex Through insertion of a tampon By using a diaphragm Insertion of a urinary catheter Wiping back to front when going to the toilet Cystitis can also be caused by a damaged or irritated bladder. How can it be prevented? Frequent cystitis infections can be difficult to deal with, but there are some measures which can help prevent cystitis from re-occurring or occurring frequently. For example, showering rather than bathing, and not using perfumed bubble bath/shower gel. Keep good sanitary habits, and wipe your bottom from front to back. Cotton underwear, and wearing trousers which are not too tight can help as well. Keep hydrated and drink enough water, but make sure to go to the toilet when you need to pee rather than holding it in. You should also make sure to empty your bladder after having sex. If you use a diaphragm, you may want to consider using a different method of contraception if you frequently get cystitis.   What is the treatment for cystitis? Usually cystitis goes away on its own in mild cases, and can be treated from home using self-help methods to ease symptoms. A hot water bottle, placed on the stomach or between the thighs can help to relieve pain or soothe, along with over-the-counter painkillers. Avoid sexual intercourse until the infection has passed. In some cases, antibiotics may be prescribed, especially in recurring cases of cystitis. A doctor may prescribe a longer course of antibiotics, or continuous antibiotics for a number of months as a preventative measure.  ...

Cystocele

What is cystocele? Cystocele, also known as an anterior prolapse, occurs when the support tissue between the bladder and vagina weakens and stretches such that the bladder sags into the vagina. It can be divided into 3 grades: Grade 1 - mild: the bladder sags slightly into the vagina. Grade 2 - moderate: the bladder sags far enough to reach the vaginal opening. Grade 3 - severe: the bladder projects from the vaginal opening. Symptoms of cystocele: The symptoms vary according to the grade of the cystocele. In grade 1, there are usually no symptoms or visibile abnormalities. However, with higher grades, symptoms such as the following may appear: Feeling of heaviness or pressure in the pelvis and vagina Discomfort when straining: coughing, sneezing etc. Sensation of wanting to urinate, even after going to the bathroom Bladder infections Pain and/or urinary incontinence during sexual intercourse The symptoms may develop to the point where they start to dominate the patient’s day-to-day, affecting her quality of life. What are the causes of cystocele? There are various factors that cause the muscles, ligaments and tissues of the pelvic floor to weaken over time. These factors include: vaginal delivery, being overweight, repeatedly lifting heavy objects, pressure on the abdomen (e.g. constipation or a chronic cough). Can it be prevented? Women are recommended to undergo regular gynaecological examinations throughout their lifetime, but generally from age 45 cystocele is more common. However, cystocele due to vaginal delivery may appear earlier. What is the treatment? Treatment depends on the grade. Generally, grade 1 does not require treatment; however it is important to see your gynaecologist from time to time to determine whether the condition is worsening. It is also important to do exercises to strengthen the pelvic floor. In more severe grades, other types of treatment may be considered such as oestrogen treatment or a pessary device to maintain the bladder in its position. In extreme cases, surgery may be an option to place the bladder back in its normal position.   ...

Ectopic testes

An ectopy is an anomaly of the situation of an organ or a part of it. When we talk about testicular ectopy, we refer to the abnormal position of a testicle caused by the lack of descent. That is, the testis has taken a different path and has descended through the abdominal cavity until it is settled in the prepubic area, perineal position, etc., rather than in the scrotum. The difference between testicular ectopy and cryptorchidism (or hidden testicle) is that in the latter case the testicle has not fully descended, so it is not in its normal position within the scrotum either. In both cases, an early surgical treatment, starting at two years of age, can be performed to correct this anomaly. ...

Erectile dysfunction

Erectile dysfunction is the difficulty or inability to achieve or maintain a penile erection that will result in a successful sexual intercourse. It is also known as impotence, but this term is not used in the medical field anymore. It affects many men and increases with age, but to consider it an alteration, it is necessary that it happens persistently. The most common causes of erectile dysfunction can be both physical and psychological, or a combination of both. They can be of vascular type: men with high cholesterol, smoking, diabetes or who have been treated with radiotherapy. Neurological disorders (Alzheimer’s, for example) and hormonal (by utilising medication) in a lesser extent. There may also be effective causes: patients with severe depression or anxiety often have erectile dysfunction. The treatments besides medication, usually include changes in lifestyle, such as quitting smoking and exercising regularly. ...

Frenuloplasty

A frenuloplasty is a surgical operation on the frenulum (the elastic tissue below the head of the penis that attaches to the foreskin), in cases where it is causing pain or discomfort when the man is aroused. This is usually because the frenulum is too short or sensitive. The frenulum may be removed or an incision is made in it, which is then stretched and stitched closed to effective elongate the frenulum. It usually takes around a month to heal, after which normal sexual activity is possible. ...

Gallstones

What are gallstones? Gallstones are hard lumps or stones, usually made of cholesterol or sometimes other substances like bilirubin that form in the gallbladder.   The gallbladder is a small organ situation underneath the liver which releases bile (produced by the liver but stored and concentrated in the gallbladder) into the digestive system to help the body breakdown fats into fatty acids for absorption. What are the symptoms? Gallstones don’t always produce symptoms and do not always need treating. In fact, the vast majority of people will not experience symptoms as the gallstones themselves do not cause pain. In certain circumstances however, a gallstone might become trapped, causing intense pain known as biliary colic. The pain usually starts in the upper right part of the abdomen and radiates to the shoulder. Further complications can arise whereby the gallbladder becomes inflamed - symptoms can include jaundice (a yellowing of the eyes and skin), fever, persistent pain, nausea and vomiting. What causes gallstones? The development of gallstones is thought to be due to too much cholesterol or bilirubin in the bile, leading to the formation of stones. In the majority of cases gallstones are made of cholesterol, however if the liver is producing too much bilirubin (often due to damage) this can result in the formation of stones also. Improper emptying of the gallbladder is also thought to cause stones, as the bile becomes too concentrated. How can gallstones be prevented? Risk factors for the development of gallstones include being overweight, a lack of exercise, a diet containing too much cholesterol and fat that is also low in fibre, and rapid weight loss. It stands to reason therefore that maintaining a balanced diet and a healthy weight can help to prevent the development of gallstones.  Other risk factors for the disease include liver problems and diabetes. What is the treatment? Gallstones don’t always need treatment and in many cases the best option is to monitor them and only treat them if symptoms appear. If, however they are causing complications it might be necessary to treat them immediatley. Additionally, patients who have conditions which increase the risk of complications, such as portal hypertension (high blood pressure in the liver), cirrhosis of the liver or diabetes may need more urgent treatment. In most cases, keyhole surgery is performed to remove the gallbladder, in an operation known as a cholecystectomy. Following the operation, patients can lead a normal life without the gallbladder as the liver will continue to produce bile.  ...

Interstitial cystitis

What is interstitial cystitis? Cystitis is the inflammation of the bladder. The term interstitial cystitis (also known as painful bladder syndrome) is used to designate cases that are considered a  chronic condition. What are the symptoms of interstitial cystitis? People affected by cystitis have the bladder wall completely swollen and is painful, they can even expel blood when urinating. This is due to scars or stiffness that are created in the bladder, which causes the inability to enlarge when it is filled with urine. Therefore, the symptoms usually include a strong urge to urinate, urinary frequency, and pain during sexual intercourse. What are the causes of  interstitial cystitis? The exact cause of these infections are unknown at the moment, although it is known that it is not a bacterial or viral infection. Interstitial cystitis is much more common in women than in men, as it usually happens from the age of 20 to 30 and it is quite common to develop after having sex or during the menopause. Can interstitial cystitis be prevented? The main way to prevent chronic cystitis is to prevent cystitis from occurring. Therefore, some guidelines to prevent or avoid cystitis are: Drink lots of water and fluids Urinate often Maintain adecuate daily genital hygiene Shower instead of bathing Do not use aerosols or deodorants in the genital area What is the treatment used for interstitial cystitis? There is no permanent cure for interstitial cystitis, although the initial treatment of cystitis is usually a course of antibiotics. In interstitial cystitis treatments are usually focused on improving the symptoms: diet, exercises to control the bladder, medication, physiotherapy, etc. ...

Kidney cancer

Kidney cancer is a malignant tumour that involves the uncontrolled spread of cancer cells in the renal tubules. It is a disorder that affects, above all, adults over 50 and generally men. The most common risk factors are smoking, haemodialysis and other genetic reasons (the exact causes are unknown). The symptoms of a kidney tumour are usually the appearance of blood in the urine, pain in the lower back (near the diseased kidney), weight loss and gain of abdominal mass. However, most kidney tumours are asymptomatic, and are usually detected at random from an X-ray test performed for other reasons. It is a cancer that if detected in time can be cured, because of the body's ability to continue as normal with a single kidney, so the removal of the damaged organ will stop the cancer. However, in case of metastases (tumour spread to other organs), other specific treatments must be performed to halt the spread of cancer cells. ...

Kidney infection

Pyelonephritis is a kidney inflammation that affects the renal parenchyma, renal pelvis and calyces. The symptoms include back pain, fever and chill although only 60% of the people who have these symptoms checked are confirmed to suffer from pyelonephritis. In addition, cystitis and kidney stones can also be a cause. The main cause of pyelonephritis is the passing of microorganisms through the ureters from the faecal flora. ...

Laparoscopy

Laparoscopy is a surgical technique used to inspect the abdominal cavity, allowing the surgeon not to make large incisions. During the procedure, a laparoscope,  which is a tube containing an optical system coupled with a light source, is inserted into the abdomen. The camera allows the doctor to inspect the pelvic organs from a monitor and, if necessary, to introduce other instruments through the same laparoscope to correct a problem. The advantages of laparoscopy are many, such as the patient requiring shorter hospitalisation and recovery time, fewer chances of infectious complications, less postoperative pain and no visible scars. Laparoscopy is used primarily in processes such as prostate cancer or some kidney diseases. ...

Lichen sclerosus

What is it? Lichen sclerosus is a rare autoimmune inflammatory disease, also known as Lichen sclerosus et atrophicus. It is a skin and mucosae condition which affects particularly the tissue of the genital area in males and females. What are the symptoms? Lichen sclerosus is an inflammation which can affect both men and women, but it’s most common in women over 50. The condition affects women mostly in the genital area; however, it may also affect the arms, legs, and tongue. In women, the most common symptoms include: itching a burning sensation; dyspareunia (painful sexual intercourse) vaginal dryness local skin irritation white spots or patches appearing on the skin anal fissures labia minora shrinking or flattening For men, lichen sclerosus mainly affects the tip of the penis. The most common symptoms include: bright, whitish or brownish patches bruises microlesions itching pain dyspareunia (painful sexual intercourse) urethritis urethral stricture phimosis In children, the most common symptoms include: girls: itching and burning sensation of the vulva and perineum area; boys: general irritation of the genital area. How is it diagnosed? Lichen sclerosus is generally diagnosed by analysing under a microscope a small tissue sample taken from the affected area. What causes it? The cause of lichen sclerosus is unknown, but there are some possibilities: overactive immune system hormone imbalance genetic factors poor skin health, or having had any previous injury on your skin How is it treated? The main treatment for lichen sclerosis is a topical steroid cream. This usually has to be applied for a few months and can help to control the symptoms. In rare cases where steroid cream does not work, there are other medicines that can reduce inflammation. For a small number of patients, minor surgery such as removal of the foreskin, or surgery to widen the vagina, may be recommended. ...

Pearly penile papules

What are they? Pearly penile papules (PPP), also known as genital angiofibromas or hirsutoid papillomas, are benign growths occurring on the male genital organ (and, sometimes, on the female genital organs as well). While they are often asymptomatic, they can become more visible if they grow in size and change their colour, becoming pearly and flesh-coloured. PPP affect 20-30% of the general male population. Prognosis Pearly penile papules do not pose a threat to your overall health. They are just a cosmetic defect, and in some cases they may disappear on their own. What are the symptoms? PPPs are small, round growths measuring roughly 1mm each. Their colour can range from pale pink to pearly white. They usually occur on the head of the penis in men, or in the vulva in women. They are not contagious, and they are not associated with irritations or infections. How are they diagnosed? They can be diagnosed with a simple physical examination done by a specialist, who will also rule out the possibility of other STDs, such as genital warts or molluscum contagiosum (which can cause itching and infections), with a peniscopy. What causes them? It is not known what causes this condition as of yet. The good news is that PPPs are not a sign of an STD, nor of a bacterial or fungal infection. How are they treated? Even if they may cause some embarrassment in men, pearly penile papules are not a threat to your health - they may just be regarded as aesthetically displeasing. As of yet, available treatments aim at improving the appearance of the genital area. The most effective techniques to remove PPP include: CO₂ laser: it vaporises all the papules in a single session, in less than 30 minutes Electrodessication: by using a tiny electrical needle, each papule is destroyed by an electrical shock. This procedure has no side effects Cryotherapy: by using liquid nitrogen, the papules are dried off and will then naturally fall off Curettage: surgical removal of the affected area. Which doctor should I talk to? If you have PPPs, you should see a dermatologist, an andrologist or a gynaecologist. ...

Pelvic pain syndrome

Pelvic pain syndrome is considered chronic if it lasts for more than six months, and must be assessed by a specialist as it can have multiple causes and possible treatments. ...

Peyronie

What is Peyronie’s disease? Peyronie’s disease, also known as penile fibrosis, is a condition that involves the formation of fibrous scar tissue on the surface of the penis, which ends up causing loss of elasticity of the penis and, as a consequence, Peyronie's disease. Although it is more common in men from the age of 50, it can appear at any age, causing pain and making sexual intercourse impossible in many cases. There are three stages that can be distinguished in the course of the disease: Acute stage: it is the first to appear, which is characterised by a strong inflammation that causes intense pain and a palpable nodule, as well as a tendency of the penis to curve during an erection. Subacute stage: inflammation is less intense, but scarring intensifies and this can manifest itself as a noticeable curve of the penis. Chronic stage: curvatureof the penis can become chronic. Prognosis: When scars develops on the tissues of the penis, it causes pain and discomfort, as well as curvature or deformation, which can make sexual intercourse impossible or cause erectile dysfunction. It is not life-threatening or a medical emergency, but it can significantly affect the patient's quality of life and the patient’s ability to father a child due to the difficulty of having intercourse. Symptoms of Peyronie’s disease: The main symptoms of Peyronie’s are: Pain either without or during an erection Curvature or deformation in the penis Loss of elasticity and rigidity Scar tissue Erectile dysfunction How is Peyronie’s diagnosed? To diagnose Peyronie’s disease, a physical examination will first be performed, checking for scar tissue, inflammation, curvature and the length of the penis. Once an examination has been done and a full medical history taken, an ultrasound may also be carried out to check the nature of the scar tissue and the blood flow to the penis. What causes Peyronie’s disease? The exact cause of this disease are unknown, but it is thought that repeated injury to the penis can be a significant factor in the formation of this disease. Injury could occur from sex, accidents or sports activities. However, many who suffer from this condition do not recall specific injuries at all to their penis. There are certain risk factors associated with Peyronie’s, including: Genetic factors: if a male family member has this condition, there is an increased chance of developing it as well. Age: it is more common in men over the age of 50. Treatment for Peyronie’s disease: If symptoms become problematic (e.g. pain and erectile problems), medication or surgery might be recommended. Medications may aim to reduce the amount of collagen produced, reducing the scar tissue formation and curvature of the penis. Surgery may involve straightening the penis, removing the fibrous scar tissue, or using penile implants to replace the tissue that fills with blood during an erection. What specialist treats Peyronie’s? Urologists would treat Peyronie’s disease. ...

Phimosis

Phimosis is a disorder in which there is congenital or accidental narrowing of the preputial ring of the penis, which prevents it from being withdrawn to show the glans. It is common in children and may occasionally be caused by forced retractions of the foreskin at an early age. It can also be caused by an infection or by the scars that form after an injury. Phimosis can be corrected by a simple surgical procedure called circumcision, which involves removing excess skin surrounding the glans, leaving it permanently exposed. On the other hand, paraphimosis is when the foreskin cannot be placed above the glans. Generally, it causes pain and a little swelling, and usually occurs in children or elderly people who have not been circumcised. ...

Prostate biopsy

What is a prostate biopsy? A prostate biopsy is a test which is done in order to take small samples of tissue from the prostate, which are then looked at in more detail and analysed. What does it involve? There are generally two types of prostate biopsy. The first is called TRUS (trans-rectal ultrasound) guided biopsy. First, an ultrasound probe is inserted into the rectum, to allow imaging of the prostate. After this, a biopsy needle is inserted and samples are taken. On average, around ten samples are taken using this method. The second type of prostate biopsy is called a transperineal (template) biopsy. In this method, more samples are taken from different areas of the prostate. Around thirty to fifty samples may be taken using template biopsy. An ultrasound probe is inserted into the rectum, and imagine is used to correctly guide the needle. In template biopsy, the needle is inserted into the prostate through the skin between the testicles and perineum. Why is it done? Prostate biopsies are done in order to check for the presence of prostate cancer. Template biopsy is typically performed in those who have health concerns which do not permit a TRUS biopsy, or if a TRUS biopsy has been taken but the doctor suspects that prostate cancer is still present. Preparation for a prostate biopsy There is no specific preparation needed, but as a template biopsy is performed under general anaesthetic, making arrangements for someone to take you home after the procedure is advised. What does it feel like during the test? If you are having a TRUS biopsy, local anaesthetic is used, meaning the area is numbed. The procedure may feel a little uncomfortable despite this, as you lie on your side with your knees raised towards your chest. A gel is used while inserting the probe in order to make the process easier. The procedure only takes around 10-15 minutes. You may feel some discomfort in your rectum after the procedure and in the days directly afterwards. In a template biopsy, general anaesthetic is used, meaning you will not be conscious for the test itself. The test takes around 20-40 minutes, and you will have to stay at the clinic for a few hours afterwards to recuperate from the anaesthetic. What do the results mean? After the biopsy, the samples will be sent off to be studied. Each sample will be analysed to see if they contain cancer, and how much cancer is present in each one. If cancer is found, your doctor will be able to tell you how aggressive the cancer is, and if it is likely to spread. They will also be able to tell you the type of cancer, if it is present. If cancer is found, your doctor will explain to you what the results mean, and what the next steps are for treatment. If cancer is not found, but your doctor suspects that prostate cancer is present, they may order further tests or another biopsy. Advances in prostate biopsies Developments in medicine mean that biopsies become more targeted, and the need for frequent biopsies is greatly reduced. Prostate MRI can be used in order to detect prostate cancer, and if a biopsy is necessary, a more accurate type of biopsy can be offered. This biopsy is called a transperineal MRI-ultrasound fusion biopsy. In this test, the needle is inserted through the perineum rather than the rectum. ...

Prostate cancer

Prostate cancer occurs when abnormal cells grow in the prostate, the male sex gland that lies beneath the bladder, and above the rectum, and is the responsible for producing seminal fluid. It is one of the most common cancers in men, and the chances of getting it increase with age. In its initial stage, it presents symptoms such as: difficulties and pain when urinating, frequent urination, inability to urinate, blood in the urine, painful ejaculation, pain in the lower back and pelvis that does not disappear over time, involuntary weight loss, etc. Treatment options depend on the stage of the cancer and the patient's health, but usually include surgery, chemotherapy, and radiation therapy. ...

Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) are a set of infectious diseases caused by different microorganisms. They all have in common that they are spread, most of the time, through sexual intercourse. More than 20 STIs are known, including chlamydia and lymphogranuloma, gonorrhoea, genital herpes, human immunodeficiency virus (HIV), genital warts caused by human papillomavirus, syphilis and trichomoniasis. Although most STDs affect both men and women, women have the most serious health problems. Not all STDs can be cured: those caused by bacteria, such as chlamydia, are treated with antibiotics, but in those that are caused by viruses, such as genital herpes, treatment is limited to alleviating the symptoms. ...

Short frenulum

What is a short frenulum? The frenulum of the penis is the elastic fold of the skin that joins the underside of the glans (head of the penis) with the inner surface of the foreskin. Its function is to help the foreskin to contract over the glans. A short frenulum (also known as frenulum breve) is when the frenulum of the penis is so short that it restricts the movement that the foreskin can make – the frenulum should be long enough to allow the foreskin to restract smoothly, but a short frenulum often makes this impossible. This causes discomfort during sexual intercouse. The short frenulum makes it difficult and even restrains pleasurable sexual intercourse. Prognosis The main problem with short frenulum is the discomfort it causes, as well as problems during sexual intercouse. Also, it can make maintaining hygiene difficult, as it can make it difficult to clean under the foreskin, increasing the risk of infections. One possible consequence of having a short frenulum is that it can tear, usually during sexual activity. This can be painful and may bleed, but is not a medical emergency. A torn frenulum may solve the problem if it heals in such a way that the frenulum is longer, but if scar tissue forms if becomes even less flexible and the problem worsens. If a short frenulum is impairing your ability to have sex or causing other serious issues, it requires treatment.   Symptoms of short frenulum The main symptom is difficulty pulling back the foreskin, as well as pain and tension in the penis. This pain increases during sexual intercourse and can tear and cause bleeding because of the concentration of blood in the area.   Medical tests for short frenulum A short frenulum is often misdiagnosed as phimosis (where the foreskin is too tight to be pulled back), due to the common major symptom of being unable to retract the foreskin, but it is not the same disease. The doctor should perform a physical examination to assess the problem and the degree of it.   Treatments for short frenulum There are different methods to treat a short frenulum depending on its severity. In some cases, steroid creams and stretching exercises can be enough to sufficiently elongate the frenulum. In many cases, however, surgery is the only real solution. There are several surgical techniques that may be used, including reparative plastic surgery (fenuloplasty), the resection of the frenulum (frenectomy) or circumcision.   Which specialist treats short frenulum? Urologists specialise in treating all conditions of the genitalia. Within this field, andrologists specifically deal with male sexual and reproductive issues. ...

Testicular biopsy

Testicular biopsy is a surgical technique which is used to obtain a sample of testicular tissue through an incision in the scrotum. The objective of this procedure is to diagnose a type of disease, or be a therapy for assisted reproduction. In the former case a sample of testicular pulp is taken to assess testicular function and to discover if testicular tissue produces spermatozoids or not. It can also be done for a genetic study or meiosis. Regarding the therapeutic objective, the biopsy is carried out to extract immature spermatozoa, if any, for assisted reproduction and freezing of a spare sample for subsequent reproduction cycles. Before carrying out the biopsy, the man undergoes both a physical examination and a hormonal analysis, to establish if this test is required. ...

Testicular cancers

  Testicular cancer occurs when cancer cells in the testes, which are oval glands that produce sperm and the hormone testosterone in men between 15 and 35 are formed. It can occur in one or both testicles, and is more common in young men and those who had an abnormal testicular development and undescended testicle at birth, or if there are genetic background. Symptoms of testicular tumors are: a lump in the testicles or groin, pain and tenderness in the breast area. The main causes of the appearance of testicular cancer are genetic, because the testicle has not moved properly from the abdomen into the scrotum during their training. Furthermore, it also occurs in patients who have been subject to aggressive or toxic for long periods because of their work substances. This type of cancer has a cure statistics more than 90% if it is found early and treated by chemotherapy, radiotherapy and surgery. Testicular cancer occurs when cancer cells form in the testes. Symptoms of testicular tumors are: a lump in the testicles or groin, and pain and tenderness. The main causes of the appearance of testicular cancer are genetic, because the testicle has not moved properly from the abdomen into the scrotum during their development. If found early, testicular cancer can be treated with chemotherapy, radiotherapy, and surgery.    ...

Ultrasound

What is ultrasound? Ultrasound is a diagnostic imaging procedure that allows you to see organs and soft structures inside the body. At present, they can be 2D, 3D or four-dimensional images. Ultrasound is a non-invasive technique, in which radiation is not used and thanks to this, it is used to visualise developing foetuses. What does an ultrasound scan consist of? It is carried out using high frequency sound waves emitted through a transducer that captures the echo of different amplitudes which occurs when they ‘bounce’ off the organs. These signals, once processed by a computer, give a series of images. Why are ultrasounds carried out? With this procedure you can clearly differentiate the shape and size of each structure inside the body. In medicine it is used to see the heart, kidneys, liver and blood vessels, among other organs. In addition, ultrasounds are also carried out on patients who are pregnant. Another function is the study of different tissues of the body such as the blood flow of arteries and veins to detect arteriosclerosis and blood clots. Ultrasounds also allow the analysis of the thyroid gland and other soft structures of the neck as well as tendons, ligaments, muscles and joint structures, and mammary glands. Preparation for Ultrasound Usually, you do not need any type of preparation for having an ultrasound. In cases where the area to be examined is the abdomen, the specialist may tell you to drink three glasses of water approximately one hour before the test. How does it feel during the ultrasound? During the ultrasound, the patient will lie on a table or stretcher with the area to be analysed exposed. The specialist will apply a transparent gel that will allow the movement of the roller built into the transducer. During the scan the expert will interpret the images and determine which shots are correct according to each case. The only slight discomfort that can be felt is the gentle pressure that the specialist applies when passing the transducer over the body area. The gel applied can also feel quite cold when applied. Meaning of abnormal results The types of images that are considered abnormal are: Congenital anomalies An alteration to tissue due to trauma or injury Cysts ...

Urethra surgery

What is urethra surgery? The urethra is the tube that takes urine from the bladder out of the body. In men, the urethra is about 20 cm in length, running from the bladder, through the length of the penis to the opening at the end. Along the way, it passes through the prostate gland and past junctions with the seminal ducts from the testes, meaning that in men it is used for ejaculation as well as urination. In women, the urethra is shorter, running from the bladder to an opening above the vagina, and is only used for urination. As with all parts of the body, the urethra can be afflicted with various illnesses and injuries, some of which require surgery.   Why is urethra surgery done? Urethra surgery may be done to resolve urinary problems in the patient, to remove scar tissue that is causing pain or inconvenience, or to reconstruct the urethra following serious injury. There are various procedures that can be performed on the urethra depending on the condition or injury.   Urethra surgery procedures Some of the most common surgical operations on the urethra are: Urethral strictures – a narrowing of the urethra, usually due to scarring of the tissue lining the tube. Strictures can be the result of inflammation, injury or trauma, infection, damage left by previous surgery, or one of many other reasons. Often the cause it not clear. More common in males than females, urethral strictures will not go away on their own, and if they cause significant pain or affect the individual’s quality of life (such as urination problems or recurrent urinary tract infections (UTIs)), surgery may be recommended. Sling surgery for incontinence – urinary incontinence occurs when the urethral sphincter, which controls urination, loses control of when the urethra opens during certain movements or actions that put pressure on the bladder, such as sneezing. By surgically implanting a sling made of mesh or tissue that lifts and supports the urethra, urinary control can be restored. ...

Urethritis

Urethritis is inflammation of the urethra, the tube through which urine is eliminated. Usually it causes an infection by germs that are spread through sexual contact. Some of its symptoms are burning, painful urination and purulent discharge. It can last a few weeks or even months, and is also called urethral syndrome....

Urinary incontinence

Urinary incontinence is the inability to control the bladder, which means that you can not always hold urine. It can affect anyone, but is most common in people over 50 years. Most control problems occur because the muscles that keep the bladder are too weak or too active. If they are weak, small amounts of urine to perform actions such as laughing or coughing are lost, which is known as stress incontinence. On the contrary, if they are too active, you can have an urgent need to go to the bathroom while having little urine in the bladder (urge incontinence or overactive bladder). Other causes include prostate problems and neurological damage. The treatment of urinary incontinence depends on the cause and type, but in general usually includes simple exercises, medicines and special devices. Surgery may be helpful at times. ...

Urodynamic testing

Urodynamic testing is a test to know how the lower urinary tract is functioning, that is, how urine is stored and eliminated. It is used to diagnose pathologies such as urinary incontinence, neurological diseases that affect the urinary tract, urinary tract infections, etc. The test consists of several parts. First, the patient must urinate in a container called a flow meter, which allows measuring the amount and speed of urine. A probe is then placed through the urethra with the aid of an anaesthetic gel that reaches the bladder and is used to measure its pressure and fill it with sterile saline solution. Finally, the patient must urinate with the probe placed, which is then removed. It is a simple procedure that takes about 30 minutes. ...

Urogenital injuries

What are urogenital traumas? A trauma is an injury caused to an organ or tissue due to external actions or causes. Urogenital injuries refer to injuries caused in the genital and/or urinary tract. In this case, the organ that is most commonly damaged is the kidney, followed by the bladder, the urethra, the testicles and the ureters. There are two types of urogenital traumas. On the one hand, there are also the so called closed traumas, which are the most common ones, and include traumas caused by falls from heights, traffic accidents, sports injuries and direct blows to the external genitalia. On the other hand, penetrating traumas are mainly caused by stabbing or gunshots and by abdominal surgery. Prognosis of the disease Most urogenital traumas do not represent an immediate threat to life, but if left untreated they can cause high morbidity over time. The main problem with these injuries is that as they are internal and often do not show external signs, they are not diagnosed properly at the time of the trauma, and they develop health problems, such as haemorrhages, abscesses, pyelonephritis, stones or hypertension, among others. Symptoms of urogenital trauma The symptoms of urogenital trauma can vary depending on the affected organs and tissues, but some of the most common symptoms are: Flank pain or in the abdomen Bleeding when  urinating Abdominal distension Nausea and vomiting Medical tests for urogenital traumas When a patient is admitted to the emergency department due to an accident, fall or severe damage, an emergency valuation of their health status is made, identifying those pathologies that represent an urgent risk to their health. As this valuation continues, the diagnosis of urogenital traumas can be addressed. Scaning tests are the most effective for detecting urogenital traumas, since it is usually necessary to explore the internal structures of the organism. Therefore, the most common tests used are the abdominal CT scan, pyelography, ultrasound examination and arteriography. The choice of diagnostic tests will also depend on the symptomatology and the organs and tissues that may be affected. What are the causes of urogenital traumas? Most urogenital injuries are caused in traffic accidents, which represent approximately half of non penetrating urogenital traumas, followed by accidents in the workplace and sports injuries. The least frequent ones are the so called penetrating urogenital traumas, which are caused by stabbing or abdominal surgeries, but represent a very small percentage. Can urogenital traumas be prevented? The only way to prevent urogenital traumas is to avoid the cause, and therefore avoid accidents, falls and strong blows. Taking precautions such as wearing a seatbelt when driving may help avoid trauma, or using protective sports gear when practising contact sports. Treatments for urogenital traumas The treatment will be considered depending on the affected organs and tissues, some of the most common are: Renal trauma: in many cases it can be resolved by a conservative treatment,  such as  taking absolute rest, a bladder catheter to drain the hematuria and anitbiotics or other drugs. In severe cases surgery may be necessary, such as the reconstruction of the kidney or part of it. Urethral trauma: in cases where it affects or there is damage of the urethra, it should be treated as soon as possible. Usually, surgery will be necessary, although in cases that are not too severe, it can be resolved with the implantation of a catheter. What specialist treats urogenital traumas? A urologist is usually the specialist who treats urogenital traumas. ...

Vaginal prolapse

What is vaginal prolapse? Vaginal prolapse, also called pelvis organ prolapse (POP), is when the muscles that support the organs in the pelvis weaken and one or more of the organs begins to bulge into and even out of the vagina. Organs that can prolapse in this way include: Bladder Uterus Urethra Rectum (end of the bowel)   Prognosis of vaginal prolapse While not life-threatening, vaginal prolapse can be very uncomfortable or painful.   Symptoms of vaginal prolapse Pelvic organ prolapse can cause the following symptoms: A heavy feeling in the pelvis A feeling of fullness in the vagina A lump protruding from the vagina Discomfort or numbness during intercourse Problems with urination – you may feel like you haven’t emptied your bladder or may need to go more often.   Medical tests to diagnose vaginal prolapse If vaginal prolapse has occurred, but hasn’t been serious enough to cause any symptoms, it may be picked up by chance during another internal examination, like a cervical screening. If your doctor suspects a vaginal prolapse, he will need to perform an internal pelvic examination, which is done in a similar way to a smear test.   What are the causes of vaginal prolapse? A group of muscles and tissues known as the pelvic floor sits above the vagina and supports the organs in the abdomen such as the bladder and the colon. Pelvic organ prolapse occurs when the pelvic floor weakens and can no longer hold up these organs. This weakening may be caused by: Pregnancy and childbirth – particularly if the baby was big, after a long and/or difficult birth or after a multiple birth Heavy lifting Pressure from being overweight or obese Chronic constipation Chronic lung disease or similar conditions that cause constant coughing Menopause   Treatments for vaginal prolapse The first line of treatment is pelvic floor exercises designed to strengthen the muscles in the pelvic floor so that they can support the bladder, uterus, and other organs properly. This, combined with lifestyle changes, such as losing weight and giving up smoking can be enough for some patients. Other patients may require a pessary – a device that is inserted into the vagina to hold the prolapse in position. If the prolapse is severe, surgical options may be considered. The ideal treatment depends on the case and should be discussed thoroughly and decided on by you and your doctor.   Which type of specialist treats vaginal prolapse? Gynaecologists and urologists specialise in dealing with conditions affecting the vagina, including pelvic organ prolapse. ...

Varicocele

What is a varicocele? A varicocele is formed by a varicose vein (an unusually swollen vein) or a group of varicose veins, located in the scrotum or in the spermatic cord. Varicoceles usually develop during puberty, growing larger and more noticeable with time. They occur most often on the left side of the scrotum, and although not usually harmful, in some people it can cause pain in the testicles, cause one testicle to grow slower than the other, and/or affect the patient’s fertility. There is also a female varicocele, which involves an enlargement of the ovarian veins and causes pelvic varicose veins. Varicocele can cause severe pain that becomes worse throughout the day. Prognosis of the disease Varicocele is not a serious disease, but it is a common cause of low sperm production and therefore can cause infertility. In some cases the varicocele can cause the testicles to shrink (atrophy) and not develop normally.   Symptoms of a varicocele Usually a varicocele is asymptomatic, but in some cases it can cause pain that varies from mild discomfort to acute pain. This pain may increase throughout the day. It may also be exacerbated by standing up or upon physical exertion. Over the years, the varicocele grows and becomes more evident. The testicle may appear swollen. Varicoceles are also known to cause infertility in some patients, making it more difficult to father a child.                                                Medical tests for varicocele The diagnosis of a varicocele is made by an urologist or andrologist, who carries out a physical examination in search of a firm lump in the testicle, a characteristic of a varicocele. If the examination is inconclusive, a scrotal ultrasound may be required.   What are the causes of a varicocele? A varicocele is the enlargement of a vein within the spermatic cord (which contains the vas deferens and blood vessels that provide the testicles with their blood supply). There are several theories as to why this happens, but the cause is uncertain.   Treatments for a varicocele In many cases a varicocele does not need treatment as long as it does not cause symptoms or affect fertility. If a testicular varicocele produces symptoms of pain and/or causes infertility, there are surgical options. The varicocele can be removed via a varicocelectomy, which involves removing the affected veins and redirecting blood flow through healthy veins. It is done on an outpatient basis and under general anesthesia, being able to return to your regular daily activities a few days later. The pain should subside within a few days or weeks. An alternative to surgery is percutaneous embolisation of the varicocele, where a much smaller incision is performed and involves placing a catheter inside the vein.   Which specialist treats a varicocele? Urologists specialise in treating the urinary system and male reproductive system, while andrologists are further specialised in the diagnosis and treatment of the pathologies of the male sex organs, including the testicles. In cases of varicocele in puberty, it is possible that a paediatrician notices the presence of a varicocele, since in many cases it develops at this point in the patient’s life. ...

Vasectomy

Vasectomy is the total or partial removal of the man's vas deferens, which are the tubes that carry the sperm out of the testicles. What it does is obstruct the sperm canal, and therefore prevent sperm from coming out of the testicles. That is why it is an effective method for birth control, since women cannot get pregnant, but it is not recommended in the short term, because for a time there is still sperm stored. It is a simple ambulatory surgical procedure, in most cases, and local anaesthesia is used. Recovery takes less than a week. After a vasectomy, the man can continue to have orgasms or ejaculate semen. ...

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