Mr Marc Laniado

Mr Marc Laniado
Urology
Windsor


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Mr Marc Laniado

Urologist in
Windsor
Wexham &
London

BSc(Hons) MD MB BS FEBU FRCS(Urol)

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Mr Marc Laniado areas of expertise:

Professional statement

Mr Marc Laniado is dedicated to returning men to as normal a life as possible when suffering from prostate enlargement or with prostate cancer. He is highly experienced and works full time in the direct clinical care of men with prostate problems. As the prostate cancer and multidisciplinary urological cancer lead, he has developed and delivers minimally invasive techniques daily that have significantly helped his patients. He provides individually-tailored therapies alleviating urinary symptoms or reducing the chance of dying from prostate cancer, with the greatest chance of preserving erections, ejaculation and bladder control. Mr Marc Laniado graduated from Guy's Hospital Medical School in 1989, having previously gained a BSc in physiology. Following specialist urology training in London, he became a Fellow of the Royal College of Surgeons (Urology) in 2000, going on to complete his MD in prostate cancer research, Fellow of the European Board of Urology in 2002 and international member of the American Urological Association. Prior to taking up his career as a consultant, Mr Laniado extended his knowledge and skills on a Visiting Fellowship at the Cleveland Clinic Foundation in the USA, where he trained in minimally invasive surgical techniques. Mr Laniado was appointed as a consultant to Wexham Park Hospital (Frimley Health) in 2002, where he is the lead for prostate cancer. specialising in rapid diagnostic techniques and minimally invasive treatments for prostatic enlargement and prostate cancer. He is the prostate cancer lead clinician and urological cancer multidisciplinary lead. His private practice is based in Harley Street, London, and in Windsor, Berkshire. 

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What are the problems with transrectal ...

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 Doctor's articles

Prostate cancer
Modern prostate cancer diagnosis and tr...

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 Credentials

GMC: ‍3343931

 Professional experience

• More than 30 years of experience
• Consultant Urologist, The London Clinic, London (present)
• Consultant Urologist, Windsor Urology, London (present)
• Consultant Urological Surgeon, Frimley Heath NHS Foundation Trust, Berkshire (present)
• Consultant Urological Surgeon, Harley Street Urology, London (2009 - 2013)

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 Sub-specialties

• Prostate cancer
• Retzius-sparing robotic prostatectomy
• Focal therapy (HIFU) for prostate cancer
• MRI-targeted transperineal prostate biopsies
• Urinary symptoms due to the prostate
• Laser prostatectomy (HoLEP)
• UroLift
• Ejaculation preserving treatments for BPH
• Prostate enlargement

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 Education

• MD for prostate cancer research (2001)
• FRCS(Urol), West London Urology Specialist Registrar Rotation (1996 - 2002)
• FRCS, St Mary's Hospital Urology Rotation (1991 - 1993)
• BSc(Hons) & MB BS, Medicine & Physiology, Guy's Hospital Medical School (1983 - 1989)
• Fellow European Board of Urology 2002

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 Publications and conferences

• Multiple publications on prostate cancer - go to https://www.ncbi.nlm.nih.gov/sites/myncbi/marc.laniado.1/bibliography/41063389/public/?sort=date&direction=descending

 Prizes and awards

• Gilbert Bursary (2003)
• British Urological Foundation Fellowship (2003)
• Silver Medal in Basic Surgical Sciences of FRCS (1990)
• Queen Charlottes and Hammersmith Special Health Authority Research Award (1992)

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 Professional membership

• European Association of Urology
• British Association of Urological Surgeons
• American Urological Association
• Focal Therapy for Prostate Cancer
• Royal College of Surgeons of England

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Languages spoken

  • English

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27/09/2017

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Diseases, Medical Tests and Treatments

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 ...

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 loo ...

Prostate cancer

What is prostate cancer? Prostate cancer is the type of cancer that starts in the prostate gland. The prostate is part of the male reproductive sys ...

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. ...

Robotic surgery in urology

What is robotic surgery in urology? Robotic surgery is a type of minimally invasive surgery which makes use of miniaturised surgical instruments guided by an advanced robot. It is a very advanced technique that allows the surgeon to perform surgical procedures in a very precise manner. This type of surgery is usually done under general anaesthesia. The advantages of robotic surgery over traditional open surgery are related to the fact that there are smaller, more-precise incisions, which translate into quicker recovery and less pain. Moreover, higher precision means that urinary continence and erectile function are less likely to be compromised with robotic surgery than with other surgical techniques. ​Why is it done? More and more surgical treatments are becoming amenable to robotic surgery, due to the advantages it provides for the patient and the surgeon. Robotic surgery in urology is used in the treatment of prostate cancer (prostatectomy), kidney cancer (nephrectomy), bladder cancer, genital prolapse, urethral stenosis, and other pathologies. What does it involve? Robotic surgery is performed using specialised robots, such as the well-known da Vinci robot. Surgical instruments are fixed to the arms of the da Vinci robot and are manipulated remotely by the surgeon from a workstation, i.e. he does not have to be physically present in the operating theatre. The robot reproduces the surgeon’s movements and eliminates the shakiness associated with human hands; moreover, manipulations impossible for humans, such as rotating surgical instruments 360º, are possible with the aid of a robot. The surgeon visualises the procedure on a monitor with a stereoscopic visual system with 3D vision that allows them to perceive depth. The monitor image can also be enlarged. How to prepare for it Even though robotic surgery is a minimally invasive technique, it is still possible that you may not be able to undergo a given intervention. Hence, certain medical tests as requested by your doctor and a review of your medical history are important in order to determine your health status. It is also probable, depending on the surgery to be performed, that you may have to fast for several hours before the intervention. Care following the intervention One of the main advantages of robotic surgery versus conventional open surgery is the rapid recovery. In many cases, patients are discharged on the same day as the intervention. In other cases, patients may remain hospitalised for around 24 hours. Generally speaking however, there is no particular postoperative care beyond the painkilling medication prescribed by the urologist. Alternatives to robotic surgery in urology Robotic surgery entails a sizeable investment in equipment and in specific training for surgeons. For these reasons, it is not available at all medical centres. As alternatives, urological surgical procedures may be performed using conventional open surgery or ideally using minimally invasive techniques such as endoscopy or urological laparoscopy. ...

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.  ...

Circumcision

What is circumcision? Circumcision is the total or partial removal of the foreskin of the penis via a surgical procedure. The foreskin is the skin that covers the head (or glans) of the penis. A general anaesthetic will be used to render the patient unconscious during the procedure or a local anaesthetic will be used to numb the area.   Why is it done? There are several reasons why circumcision is performed. Some religions and cultures circumcise all male children – this is common in Jewish and Islamic communities as well as several African countries. There are also a number of medical reasons: Phimosis – tight foreskin, which is difficult or impossible to retract. This can cause pain when the penis is erect. Paraphimosis – after being retracted, the foreskin cannot return to its natural position. It can restrict blood flow and cause pain, inflammation and swelling of the head of the penis, and more serious complications. Recurrent balanitis – inflammation of the foreskin and glans. Penis cancer   What does circumcision consist of? Circumcision is a very simple operation, and is usually performed as a day case. The patient is anaesthetised, either with a general anaesthetic, which makes them unconscious, or a local anaesthetic, which numbs the area. The foreskin is removed using a scalpel or surgical scissors to behind the head of the penis and the remaining skin is stitched back together with dissolvable stitches.   Preparation for circumcision Circumcision is considered a very safe treatment. No previous preparation is needed. However, if the patient is going to have a general anaesthetic, they will usually be instructed not to eat or drink anything for several hours before the operation.   Care after the intervention The recovery of the patient after a circumcision is very fast. Adult patients are usually advised to take a week off work to allow recovery. During this time, it is recommended to wear loose, comfortable clothes. For the first 3-4 days there may be some swelling and discomfort around the head of the penis. Painkillers, such as paracetamol or ibuprofen are usually prescribed to help with the pain. The penis usually heals fully in around ten days. However, it is usually advised not to engage in sexual activity for a full four weeks after the surgery. ...

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.   ...

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. ...

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. ...

Prostatitis

What is prostatitis? Prostatitis is an inflammation of the prostate, the gland located under the man's urinary bladder that helps produce semen. It is one of the most common disorders of the male genitourinary system. What symptoms does it present? Symptoms vary depending on whether the prostatitis is caused by a bacterium or if it has no bacterial origin. The most frequent symptoms that may suggest that there is an inflammation of the prostate are urinary: feeling a burning, stinging or itching when urinating frequent need to urinate blood in the urine In addition, prostatitis can cause fever and chills. If you have any of the symptoms above, it is important to seek medical attention immediately. In cases of chronic bacterial prostatitis, other symptoms may occur such as: discomfort in the testicles painful ejaculation erectile dysfunction loss of libido Causes of prostatitis or why it occurs In most cases acute prostatitis is caused by a bacterial infection. For chronic prostatitis, it is not clear what the cause is. Your are more likely to develop acute prostatitis if: you use a urinary catheter you have a sexually transmitted infection or HIV you injure your pelvis Chronic prostatitis is more common among men between the ages of 30 and 50, and you are more likely to have prostatitis if it is has occurred before. Can it be prevented? Not all types of prostatitis can be prevented. However, good personal hygiene and practising safe sex is essential to prevent bacteria from spreading to the prostate and causing it to swell. What is the treatment? When the cause is an infection, prostatitis is treated with antibiotics for several weeks to remove the prostate bacteria. Generally, treatment lasts between four and six weeks, lengthening the time if necessary. In cases of acute prostatitis, the patient may need to be hospitalised and receive antibiotics through the serum. ...

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. ...

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

What is urodynamic testing? Urodynamic studies or urodynamic testing are tests which are carried out with the objective of understanding the functioning of the lower urinary tract, e.g how well the bladder, urethra, and sphincters are able to hold and release urine. What does it consist of? There are various types of urodynamic test, and your urologist will recommend one, or more in some cases, depending on the symptoms which present. However, most urodynamic tests are all performed at once rather than individually. Some of the tests performed include: Uroflowmetry, which measures the speed of urine passed and how much is passed Cystometry, which measures how much urine the bladder can hold Pressure flow study, which measures the pressure in the bladder as you urinate Electromyography, which tests the pelvic floor muscles Why is urodynamic testing performed?   Urodynamic testing is performed to diagnose pathologies such as urinary incontinence, neurological diseases that affect the urinary tract, urinary tract infections, etc. Testing may be performed to confirm: Neurological conditions affecting the bladder (myelodysplasias, spinal trauma, brain damage, etc.) Urinary incontinence in women and in men Recurrent urinary infections when anatomical causes are ruled out Urinary incontinence in children and enuresis (bedwetting) Urinary tract infections in children (when a functional cause is suspected) Lower urinary tract symptoms in men and women (frequent urination at night and day, urinary retention, burning when urinating, etc) Preparation for urodynamic testing Before the testing is carried out, your specialist or healthcare provider will speak to you about your symptoms and assess them. Before urodynamic testing is performed, the specialist or doctor generally will perform a physical exam and conduct normal urine tests, which may help to provide a diagnosis before urodynamic testing is considered. Before the urodynamic testing is carried out (or immediately after testing), you will be given an antibiotic in order to prevent infection. ...

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. ...

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. ...

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