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 a highly experienced NHS and private consultant urologist, specialising in the diagnosis and treatment of all urology problems, including kidney stones, blood in urine, urinary infections, prostatitis, prostate and bladder problems, and urological cancers. He has a particular interest in minimally invasive stone surgery and the comprehensive management of complex urinary stone disease. He consistently publishes leading results for complex stone operations and offers all treatments including mini and ultra-mini PCNL for kidney stones. He also offers a choice of surgical procedures for benign prostatic disease including the new Rezum steam treatment and MRI targeted template prostate biopsy. He has a doctoral research degree in the overactive bladder and sees many patients with this condition. He holds clinics on Wednesdays and Fridays at The Wellington Hospital and The Hospital of St John and Elizabeth in North London and also consults at  locations in Essex, his practice is managed by Samantha Evans on 0207 042 1790 for queries. Mr Ballaro aims to provide the highest quality service possible and has further patient reviews available at www.iwantgreatcare.org.

Mr Ballaro's extensive training began after graduating from The Royal Free Hospital Medical School in London, 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'.

 Videos of doctor

All you need to know about ureteroscopy

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 Doctor's articles

The long and short of ureteroscopy

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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
• Prostate surgery
• Rezum treatment for prostate enlargement.

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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

Adult circumcision

Circumcision is the surgical removal of the foreskin of the penis (the fold of skin that covers the tip of the penis). It involves cutting a portion o ...

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 ...

Haematuria (blood in the urine)

What is haematuria? Haematuria is the presence of blood in the urine. The blood may come from the kidney (where urine is formed) or any other part ...

Laser lithotripsy

What is laser lithotripsy? Laser lithotripsy is a surgical technique to remove kidney stones, using a laser to destroy them, with the holmium l ...

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. ...

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. ...

Bladder cancer

What is bladder cancer? Bladder cancer is a relatively common type of cancer, which involves the growth of abnormal tissue (a tumour) in the bladder tissue. There are two types: Non-muscle invasive bladder cancer – the most common type, in which the cancerous cells are contained within the tissue that lines the bladder. Fatalities from this kind of bladder cancer are uncommon. Muscle invasive bladder cancer – cancerous cells spread beyond the lining of the bladder and into the bladder muscle that surrounds it. This type is less common but more serious, as it increases the chance that the cancer will spread to other parts of the body (metastasis).   What are the symptoms of bladder cancer? Bladder cancer can cause the following symptoms: Blood in the urine (haematuria) – the most common symptom Frequent urination Sudden urge to urinate Burning sensation when urinating In some more advanced cancers, the patient may also experience: Back pain Pelvic pain Unintentional weight loss Swelling in the legs If you are experiencing urinary symptoms, you should consult your doctor or a specialist.   Causes of bladder cancer It isn’t always clear what causes cancer, but the following factors, among others, are thought to increase the risk of bladder tumours: Smoking – the leading factor seems to be tobacco, which contains carcinogenic chemicals. Exposure to chemicals – certain industrial chemicals, such as aniline dyes and xenylamine are known to increase the risk of bladder cancer. Past radiation exposure – this includes radiotherapy used to treat previous cancer, such as in the bowel. Long-term or repeated irritation or urinary tract infections.   Can bladder cancer be prevented? There is no guaranteed way to prevent cancer, but taking precautions such as not smoking, avoiding exposure to chemicals and radiation, and maintaining a healthy lifestyle can help to reduce the chances that bladder cancer will develop.   What is the treatment? Once diagnosed, bladder cancer is treated by a multidisciplinary team, which may include a urologist, a pathologist, a clinical oncologist, and a radiologist, among others. Depending on the stage of the cancer and the risk it poses to the patient, one or more of the following treatments may be recommended, although each case is different: Transurethral resection of a bladder tumour (TURBT) Chemotherapy Cystectomy (surgery to remove the bladder) Radiotherapy ...

Bladder problems

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

Cholecystitis

What is cholecystitis? Cholecystitis is inflammation of the gallbladder. If not treated, it can lead to more serious infections, or become a long term condition (chronic cholecystitis). What are the symptoms of cholecystitis? The main symptom is pain in the upper right or middle of the abdomen, which usually lasts about 30 minutes. Other symptoms can be: Light coloured stools Loose stools Nausea and vomiting Fever Feeling bloated Yellowing of the skin and the sclera (white part of the eyes) What are the causes of cholecystitis? The cause is usually the presence of stones, which block the cystic duct, where bile travels in and out of the gallbladder. If the cystic duct becomes blocked, the bile gets trapped in the gallbladder, irritating it. Other causes can be serious diseases such as diabetes, HIV, or gallbladder tumours, the latter cause being rare. Can cholecystitis be prevented? Removal of gallstones, and in some cases the gallbladder can prevent further attacks. What is the treatment for cholecystitis? This inflammation can heal on its own. In cases of acute cholecystitis, you may have to stay in the hospital for a little while for the gallbladder to rest and heal. You may be given medicine for the pain, and will be monitored in case an infection develops. If gallstones are found to be the problem, and non-surgical treatment (medication, and a low-fat diet) is not an option, surgery may be recommended to remove the gallbladder. In addition, emergency surgery may be needed if there are complications such as: Gangrene Pancreatitis Perforation of the gallbladder wall Inflammation of the common bile duct Persistent blockage of the bile ducts It is perfectly possible for you to live a healthy life without your gallbladder. Removal of the gallbladder is one of the most common forms of treatment in the case of gallstones, but the procedure is generally not considered to be of high risk. ...

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)

What is a cystectomy? Cystectomy is the surgical removal of all or part of the bladder. Cystectomies can be divided into two types, depending on the reason for the excision and the amount of tissue removed: Radical cystectomy – the whole bladder is removed along with the some of the surrounding tissue and lymph nodes. In men, this can include the prostate and seminal vesicles, while in women, it could include a portion of the reproductive system. Partial cystectomy – only part of the bladder is removed. If cancer is present in the muscular layer of the bladder wall, but is not very large and only in one place, the tumour can sometimes be removed by only removing that part of the bladder wall, without removing the entire bladder. The hole in the bladder wall is then closed. The advantage of this surgery is that the person keeps the bladder intact and does not require reconstructive surgery. However, it is possible that the bladder will not be able store as much urine and that the person has to go to the bathroom more frequently. In addition, bladder cancer can arise in another part of the bladder wall. For any type of radical cystectomy, general anaesthesia will be used so that the patient will be totally asleep.   Why is it done? Cystectomy is performed, in most cases, to remove bladder cancer, although it may occasionally be used to treat other serious bladder conditions.   What does a cystectomy consist of? A cystectomy can be carried out as an open procedure or using minimally invasive techniques. First, the bladder or section of bladder is removed. In radical cystectomies, the urinary tract must then be reconstructed to allow the patient to continue passing urine out of their bodies. There are two options: Bladder reconstruction (neobladder) – a segment of the patient’s intestine is taken and used to create a storage pouch for urine that will function as a new bladder. The surgeon attaches it to the ureters at the top, connecting it to the kidneys, and the urethra at the bottom to allow the urine to pass out of the body. This is only an option if these tubes do not need to be removed as well. Ileal conduit – if the urethra has been removed, the surgeon uses intestinal tissue to create a tube that attaches directly to the ureters and leads to a stoma (a hole made in the patient’s side), where urine can pass into a bag. This must be emptied regularly.   Preparation for cystectomy The patient is admitted to hospital the day before or the morning of the operation. The doctors and nurses will advise on what to eat and drink, with nothing to be drunk in the two hours prior to the surgery.   Care after the intervention The patient will usually remain in the hospital for between five and ten days after the operation, in which time they will be monitored and given medication for the pain and to prevent blood clots. To the latter end, it is important to stay active, with nurses or a physiotherapist helping the patient to walk around during the day. After the operation, the patient may eat and drink, as this is crucial to aid the healing process (although they should follow their doctor’s advice on what to eat). If the patient has a neobladder, they will have to undergo bladder training, as their new “bladder” has to learn to control the flow of urine. The patient will have to return to the hospital after discharge to continue this training. If the patient has a stoma, they will be instructed on how to manage and clean it. ...

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 are thought to come through the urethra, which carries urine out from your body. Women have a shorter urethra, which is closer to the anus and means that 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 it from re-occurring or occurring frequently. Showering, rather than bathing, is recommended as well as avoiding the use of perfumed bubble bath or shower gel. Keeping good sanitary habits, and wiping the bottom from front to back are also used as preventative measures. 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.  ...

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 as hypertrophy of the prostate and benign prostatic hyperplasia (BPH). What does it involve? The procedure consists in detaching the adenoma from the prostate. This is then broken down into small pieces and removed. The Holmium laser procedure is minimally invasive - the surgical trauma is minimal, thus avoiding lesions and heat-related issues in the adjacent area. The laser penetrates the skin to reach the surface of the prostate, then cuts off the affected area. The HoLEP procedure doesn't involve any bleeding. The HoLEP procedure is usually performed under epidural anaesthetic. The procedure can be done at an outpatient clinic; however, in more serious cases, you may need to stay in hospital for a couple of days. What is it for? This procedure is done with the aim of removing prostate adenomas – parts of the prostate tissue which have become an obstruction. With this procedure, there is no need for surgical intervention directly on or through your skin. What does it feel like during the procedure? The HoLEP procedure is generally painless. It doesn’t involve many postoperative symptoms (you may experience some mild urinary incontinence or bedwetting at night for a period of time). Unlike traditional forms of prostate surgery, sexual function is not affected by this procedure. ...

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

What is pyelonephritis? Pyelonephritis a condition that causes the kidneys to become infected, resulting in inflammation. It can be of two types: acute: is caused by a urinary tract infection (UTI) chronic: it is more serious than the acute form. It is due to congenital anomalies that hinder the normal emptying of the renal collecting tubules. Pyelonephritis is a serious condition that can cause permanent damage to the kidneys. It’s important to seek medical attention immediately if you experience the symptoms listed below. What are the symptoms of pyelonephritis? The main symptoms are: low back pain fever shaking chills lack of appetite and malaise nausea and vomiting pain when urinating cloudy urine with strong odour presence of blood in the urine How is pyelonephritis diagnosed? Diagnosis principally involves taking a urine sample which can be tested for bacteria or blood in your urine. You may also have a blood sample taken – again, to check if there are bacteria or other pathogens in your blood that could be causing the infection. What are the causes of pyelonephritis? In the case of chronic pyelonephritis, the cause is usually a severe anatomical abnormality at birth. However, it can also be an acquired condition if you have a flaccid bladder due to spinal cord injury. Because acute pyelonephritis occurs as a result of a urinary tract infection, risk factors include having a weakened immune system, using a urinary catheter, or being female, as the urethra is shorter in women than in men. Can pyelonephritis be prevented? You can help prevent urinary tract infections by: drinking plenty of water through the day avoiding the usage of douches going to the toilet as soon as you need to How is pyelonephritis treated? The treatment aims to reduce the infection and reduce the acute symptoms. The first line of treatment is the prescription of antibiotics, and this should normally improve the symptoms within a few days. In the case of a severe kidney infection, you may need to take antibiotics in hospital. Finally, in the case of chronic pyelonephritis, scarring of the kidney can occur over time, so you may need to see a kidney specialist to discuss the option of repairing the kidney with surgery. ...

Laparoscopy

What is laparoscopy? Laparoscopy is a minimally invasive surgical technique which allows the surgeon to operate without the need for deep or large incisions in the skin. This means the recovery period is generally shorter, there is less pain after the operation, and scarring is reduced significantly for the patient. This technique is also known as keyhole surgery. Why is it done? Laparoscopy can be used to both treat and diagnose a range of conditions across specialties such as surgery, gynaecology, gastroenterology, and urology. Laparoscopy may be used in investigation, to check symptoms and attempt to reach a diagnosis, for example in cases of ovarian cysts, fibroids, pelvic inflammatory disease, and appendicitis. Laparoscopy can also be used to take a biopsy (a small sample of tissue) meaning it can be used to investigate certain cancers, e.g liver cancer, ovarian cancer, pancreatic cancer, and many more. As a surgical technique, laparoscopy is especially useful as it allows for minimal scarring and a shorter recovery period, which is advantageous to the patient. Laparoscopy can be used as a surgical technique in many situations, such as: Weight loss surgery Removal of the gallbladder as a treatment for gallstones Removal of the appendix Repairing stomach ulcers Hysterectomy Treating ectopic pregnancy Removal of organs affected by cancer What does it involve? Laparoscopy is performed under general anaesthetic. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them. The surgeon uses small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on. How do you prepare for laparoscopy? Generally, you will be asked not to eat or drink anything for 6-12 hours before the procedure. You will also be asked to stop taking blood-thinning medication a few days before the procedure takes place. If you are a smoker, your surgeon may advise you not to smoke for a few days before the procedure, as smoking can delay the healing process. Aftercare As laparoscopy is a minimally invasive procedure, you can generally go home either on the same day or the day following surgery. Someone will need to accompany you home as you will be advised not to drive for the 24 hours following the procedure. Recovery from laparoscopy depends on the type of procedure performed. After diagnostic laparoscopy, for example, you may be able to resume normal activity after five days. If surgery is more minor, for example ulcer repair, normal activity may be resumed in around three weeks. Major surgery, such as hysterectomy or organ removal (e.g kidney) typically takes longer – up to 12 weeks. Your surgeon or doctor will advise you on how to clean your stitches and keep wounds clean. Expect to feel tired or somewhat drained after surgery for a few days, but this should pass as your body uses less and less energy as the recovery process goes on. If you experience any pain, you can take over-the-counter medication pain relief to reduce it. Alternatives to laparoscopy Laparoscopy is a minimally invasive technique which is used as an alternative to traditional open surgery. Open surgery may be necessary in certain situations and your surgeon will speak to you regarding your options before making a decision as to which type of surgery will be performed. ...

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

What is phimosis? Phimosis is a condition that inhibits the foreskin from being able to be pulled over the head of the penis (the glans) because the skin of the foreskin is too tight. It can be congenital (primary) or acquired (secondary). Having a tight foreskin is normal for baby boys who are not circumcised, but this normally stops being a problem by the age of 3. If phimosis is acquired, it happens as a result of scarring. What are the symptoms of phimosis? The main symptom of phimosis is the narrowness of the foreskin and difficulty in retracting it. Another associated symptom, although less frequent, is pain during urination, or swelling of the foreskin when urinating. If the phimosis is not treated, complications such as infection in the glans or paraphimosis can appear. Paraphimosis is when the foreskin gets stuck behind the head of the penis, which can result in circulation being cut off, and as such, it should be treated as an emergency. Additionally, if the glans becomes sore and inflamed, it is likely that the patient is suffering from balanitis (inflammation of the head of the penis). What causes phimosis? Congenital phimosis is naturally occurring, but it is not clear why some boys have this but not others. On the contrary, acquired phimosis can be caused due to repeated infections or tears. It can occur, for example, when the skin is violently and prematurely pulled back on babies. Also, when the foreskin or glans become inflamed and scars, the scar tissue contracts and hardens slightly, which causes phimosis. In addition, conditions can increase your risk of developing balanitis, such as diabetes. Can it be prevented? There is no way to prevent phimosis of congenital origin, but in other cases it is possible to prevent it by practising good penis hygiene (i.e. gently washing it with warm water using mild or non-perfumed soap, taking care to gently pull the foreskin back and wash underneath it). It can also help to do daily, gentle retraction of the foreskin, to help loosen the skin. What is the treatment for phimosis? Phimosis is common in children under 10 years old and, therefore, in those cases no treatment is required. If phimosis is causing complications, such as balanitis, antibiotics may be necessary to overcome the infection. Along with gentle daily retraction of the foreskin, topical steroid cream can help to soften the foreskin, making retraction easier. In more severe cases, circumcision may be recommended, which removes the foreskin. ...

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. ...

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. ...

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 disorders of the male genitourinary system, caused, in most cases, by bacterial infection, either chronic or acute. Other inflammatory conditions of the prostate may be chronic nonbacterial prostatitis (producing perineal or pelvic pain) and asymptomatic inflammatory prostatitis (the symptoms are not obvious). The most common symptoms that can lead us to think that there is an inflammation of the prostate are associated with urinary disorders. When the cause is an infection, it is treated with antibiotics for several weeks to remove bacteria from the prostate. ...

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.  ...

Sexually transmitted infections (STIs)

What are sexually transmitted infections (STIs)? Sexually transmitted infections (STIs) are a set of infectious diseases that are transmitted from one person to another through sexual contact (vaginally, anally or orally). There are numerous types of STIs, including: Chlamydia Gonorrhoea Genital herpes HIV Genital warts HPV (human papillomavirus) Syphilis Trichomoniasis Pubic lice (‘crabs’) What symptoms do STIs present? Sexually transmitted infections can cause symptoms, although not always. Some patients may experience the following symptoms: Pain when peeing Unusual discharge from the vagina, penis or anus A rash Itchy genitals Vaginal bleeding Blisters or sores around the genitals Flu-like symptoms Skin growths around the genitals What causes sexually transmitted infections? The cause of sexually transmitted infections is either bacteria, parasites, fungi or viruses. Can STIs be prevented? Abstinence is the only way to completely prevent STIs, however, making sexual contact safer will also reduce the possibility of contracting an STI. If used properly, condoms can provide effective protection against many STIs. However, whilst condoms protect you from contact with fluids (semen or blood), they may not protect you from skin-to-skin transmission. It is also a good idea to have regular STI health checks if you are sexually active, to allow for early diagnosis and treatment and to stop the spread of STIs among the population. It is also a good idea to have the HPV vaccine, which is currently offered to girls at school. What is the treatment for STIs? Not all sexually transmitted infections can be cured. Those that are caused by bacteria, such as chlamydia, are treated with antibiotics. However, those that are caused by a virus, such as genital herpes, treatment is limited to alleviating the symptoms. STIs such as lice or trichomoniasis can be treated with topical medications. ...

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

What is urinary incontinence? Urinary incontinence is an inability to control the bladder, meaning that urine is unintentionally passed. This is a common problem and can cause embarrassment. It is more common in older people because urinary incontinence is an inevitable part of ageing and it affects both men and women. What are the symptoms of urinary incontinence? The symptoms can vary from a leak of light urine to the abundant and uncontrollable output of it. The type of urine loss will depend on the type of urinary incontinence experienced. The different types of urinary incontinence are: Urge incontinence – a sudden urge to urinate with a sudden loss of bladder control and urination. Stress incontinence – urine leaks when pressure is placed on the bladder (e.g. sneezing, coughing, laughing or lifting). Overflow incontinence – a constant dribbling or urine because you are unable to fully empty the bladder. Total incontinence – your bladder is unable to store urine at all, causing constant leakage. Mixed incontinence – you can experience more than one type of urinary incontinence. If you experience frequent bladder incontinence, you should see a specialist as it could be indicative of an underlying health problem, and it can be managed to improve your quality of life and overall confidence. Women are more likely to suffer from stress incontinence, but men are more likely to have urge and overflow incontinence. What causes urinary incontinence? Most control problems occur because the muscles that hold the bladder are too weak or too active. If they are weakened, small amounts of urine are lost when performing actions such as laughing or coughing. However, urinary incontinence is a symptom of either an underlying medical condition, everyday habits or physical problems. Some cases of urinary incontinence are temporary, caused by alcohol consumption, caffeine or medications. It may also result from urinary tract infections or constipation. Persistent urinary incontinence, however, can be caused by: Pregnancy – increased size of the baby can put pressure on the bladder. Vaginal childbirth – this can weaken the muscles needed for bladder control and damage bladder nerves and tissues. Ageing – as we age, our bladder is less able to store urine. Hysterectomy – pelvic floor muscles may be damaged during such a procedure. Enlarged prostate in men – this obstructs the bladder, meaning it cannot empty properly. Prostate cancer – either as a side effect of prostate cancer treatment, or a symptom. Neurological disorders – some disorders can interfere with nerve signals that are needed for bladder control (e.g. Parkinson’s disease, multiple sclerosis). Obesity – puts pressure on your bladder. Can urinary incontinence be prevented? Urinary incontinence is a problem that cannot always be prevented, but the following can reduce your risk of developing this problem: Maintaining a healthy weight Avoid consuming things that irritate the bladder (e.g. alcohol, acidic foods and caffeine) Stop smoking Doing pelvic floor exercises High-fibre diet to avoid constipation What is the treatment for urinary incontinence? Treatment will depend on the type and cause of your urinary incontinence. Some types can be managed with lifestyle changes (e.g. weight loss or cutting out caffeine), bladder training (learning to wait longer to urinate, guided by a specialist) or pelvic floor exercises (to strengthen the pelvic floor muscles). The following can also help to manage urinary incontinence: Incontinence products (e.g. absorbent pads) Medications (e.g. duloxetine for stress incontinence, antimuscarinics and mirabegron for urge incontinence) Electrical stimulation (electrodes inserted into the vagina or rectum stimulate and strengthen the pelvic floor muscles) You may be offered surgery if other treatments have been unsuccessful or unsuitable. The type of surgery will depend on your type of urinary incontinence: Sling procedures – a sling is placed around the neck of the bladder to give support and to prevent leaks. Colposuspension – the neck of the bladder is lifted in position to prevent leaks in women with stress incontinence. Urethral bulking agents – a substance is injected into the walls of the urethra in women so that they increase in size, stopping leakages as the urethra is better able to stay closed. Artificial urinary sphincter – an artificial urinary sphincter is fitted to stop incontinence. ...

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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