Mr Sudhanshu Chitale

Mr Sudhanshu Chitale
Urology
Central London


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Mr Sudhanshu Chitale

Urologist in
London

FRCS(Urol) FEBU DNB(Urol) Diploma Urol(LON) FRCS(Eng) FICS MS(Gen Surg) MBBS

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Mr Sudhanshu Chitale areas of expertise:

Professional statement

Mr Sudhanshu Chitale is a highly-skilled urological surgeon based in London. He has a wealth of experience having performed over 20,000 urological operations and has special expertise in procedures involving the lower urinary tract, including renal prostatic, bladder, penile, testicular and urethral surgery.

Outside of his clinic Mr Chitale also serves as an Honorary Senior Lecturer at University College London Medical School and has a strong interest in research with over 90 publications to his name. In addition, he was the principal author of the first-ever randomised controlled trial (RCT) on shock wave therapy (SWT) for Peyronie's disease.

He operates from a number of prominent medical institutions in the capital, such as the London Clinic, Princess Grace Hospital, the Harley Street Clinic. The Whittington Health NHS Trust is his NHS base.

 Doctor's articles

prostate-cancer
Prostate cancer: what to look out for, ...

 Credentials

GMC: ‍4133915

 Professional experience

• More than 35 years of experience
• Consultant Urological Surgeon, Whittington Health NHS Trust, London (2011 - present)
• Consultant Urological Surgeon, The London Clinic (present)
• Consultant Urological Surgeon, Princess Grace Hospital (present)
• Consultant Urological Surgeon, 9 Harley Street (present)

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 Sub-specialties

• Urology
• Andrology
• Endourology
• Uro-oncology
• Paediatric urology
• Male infertility

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 Teaching posts

• Honorary Senior Lecturer, University College London (2011 - present)

 Education

• FRCS (Urol) at RCSE, London (2006)
• FEBU in Urology, EBU (2004)
• FRCS(Eng) in General Surgery, Royal College of Surgeons of England, London (1997 - 1998)
• Diplomat National Board (Urology), Bombay Hospital Institute of Postgraduate Education & Medical research, India (1988 - 1991)
• MBBS, MS (General Surgery), VMMC, India (1978 - 1986)

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 Publications and conferences

• Has been published widely in peer-reviewed journals with around 90 publications
• Has given several presentations at national and international meetings
• A referee to many scientific journals and a guest editor for a web based journal

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 Prizes and awards

• Received several awards for academic achievements during his training
• Awarded 'Top Teacher Award' by UCL medical school students (2014 - 2015)
• Awarded Excellence in Medical Education Award (EMEA) UCL (2016)

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Languages spoken

  • English
  • Hindi

Patient reviews for Dr. Sudhanshu Chitale

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Patient reviews

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27/08/2018

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Thank you so much for the kind words

Verified Patient
07/06/2018

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Verified Patient
25/10/2017

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Patients comments

Dr chitale was very thorough throughout the process. his attention to detail is applaudable. he was very keen to know his patient and very effective to resolve

Verified Patient
24/07/2017

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Diseases, Medical Tests and Treatments

Endoscopy

What is it? Endoscopy is the use of cameras to relay images from inside the body.  The device used, known as an endoscope, is a long thin flexible ...

Endourology

What is endourology? Endourology refers to a specific area in urology in which minimally invasive surgical techniques are used to see into the urin ...

Male infertility

Male infertility is a health condition where a male’s chances of getting his partner pregnant a reduced. Infertility is classed as being unable to con ...

Paediatric urology

What is paediatric urology? Paediatric urology is a subspecialty of urology that specialises in malformations of the urogenital system of children ...

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. ...

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. ...

Adult circumcision

What is adult circumcision? Male circumcision is the surgical removal of the retractable fold of skin that covers the tip of the penis (foreskin). Although the procedure is normally performed in children for religious or cultural reasons, many adults undergo circumcision for medical purposes. Circumcision in women is referred to as female genital mutilation and has been outlawed by the UK government since 1985 as there is no medical reason necessary for young girls to have this procedure.   Why is circumcision performed on men? When the foreskin is too tight and will not pull back over the head of the penis it is known as phimosis. This condition is not usually a problem but in some cases, it can cause symptoms such as redness, soreness, swelling and difficulty in urinating. If the head of the penis is sore and inflamed it is referred to as balanitis. If both the head and the foreskin are swollen, it’s known as balanoposthitis, which can normally be treated with cream and good hygiene. If the symptoms are persistent, circumcision is recommended where other treatments have failed. Other reasons for circumcision include religious and cultural reasons as it is a common practice in Jewish and Islamic communities, and in many African countries. Typically under these circumstances, circumcision is carried out on children.   What is circumcision? Circumcision consists of cutting a portion of the foreskin of the penis that covers the glans, leaving it permanently uncovered. The treatment can be done using the dorsal incision technique where the specialist makes a small cut in the upper part of the foreskin. Another option is the covered technique by which a line is made around the base of the foreskin that will serve as a guide to make the incision. It is a relatively simple procedure. Any bleeding is stopped using heat and the edges of the skin that are left will be stitched together with dissolvable stitches.   What is recovery like following the procedure? After being discharged from the hospital, it usually takes about 10 days for the penis to heal. This means that sex is to be avoided for at least one month after the operation. A few days after the procedure, it is likely that there is discomfort and swelling around the head of the penis but this can be managed with over the counter painkillers. There shouldn’t be any pain when urinating. ...

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. ...

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

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. ...

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.   ...

Endoscopic surgery

What is endoscopic surgery? The term ‘endoscopic surgery’ encompasses various techniques, such as hysteroscopy and laparoscopy, in which an optical instrument (a tube with illumination connected to a video camera and a monitor) is introduced inside the body via the rectum or through the abdominal wall, permitting visualisation of the inside of an organ or cavity. Endoscopic surgery, as minimally invasive surgery, has represented an advance over traditional open surgery as it is a lot more reliable and precise, and is associated with less trauma and better aesthetic outcomes. It is usually done under general anaesthesia.   Why is endoscopic surgery done? Endoscopy is performed for diagnosis and observation as well as treatment and surgery. Specifically, endoscopic surgery is used in several fields of medicine: in gynaecology, endoscopic surgery, called hysteroscopy, is very common for treating uterine pathologies, such as cysts, endometriosis, myomas and also for performing tubal ligation, studying infertility, or hysterectomy (removal of the uterus). However, these pathologies are also frequently treated using laparoscopy, which differs in that the surgery is performed via a small incision made in the abdominal wall. It is also used in other fields, such as otorhinolaryngology, in which sinonasal endoscopic surgery is very common for treating lesions or problems of the nose that impair normal breathing, affect the sense of smell or cause face or head pain. Also, in general and gastrointestinal surgery endoscopy or laparoscopy may be used in surgery for obesity. Endoscopy may also be performed in emergency situations, for example in neurosurgery to treat brain haemorrhage or a cerebrovascular accident (stroke).   What does it involve? During endoscopic surgery an endoscope, which is an optical instrument in the form of a tube with a light source and a video camera at its tip, is introduced inside the body via the rectum or through an incision, thereby allowing the surgeon to observe the organ or area to be treated on a monitor. Furthermore, different tools for performing surgery can be introduced via the endoscope.   How to prepare for it Before surgery, you will have to tell your physician about your health and any medications you are taking. Your medical history will be reviewed and various tests performed to determine whether you are fit to undergo the operation. Generally, these diagnostic tests will include clinical analyses; however, depending on the surgery and your characteristics, the specialist may require further specific tests. Given that endoscopic surgery is performed under general anaesthesia, patients are usually asked to fast for 8 hours before the intervention.   Care following the intervention The main advantage of endoscopic surgery versus other surgical techniques is that it’s of a less invasive nature, which permits a faster recovery. So, you will remain in the hospital for only a few hours, sometimes being discharged on the same day as the intervention. Generally, you can resume work 48-72 hours after the intervention. Postoperative discomfort is also less, so absolute rest is not required and you can pursue your life as normal.   Alternatives to endoscopic surgery The alternative to endoscopic surgery is conventional open surgery, which is associated with a higher risk of complications, a longer and more complicated recovery period, and large, more-visible scars. Robotic surgery refers to minimally invasive techniques performed by the surgeon with the aid of a high-precision robotic system which permits better visualisation of the area to treat and surgical manipulations impossible to achieve without the aid of a robotic system. ...

Erectile dysfunction

What is erectile dysfunction? Erectile dysfunction is the difficulty or inability to achieve or maintain an erection of the penis that results in a satisfactory sexual relationship. It is also known as impotence. Erectile dysfunction is extremely common and increases with age. If it happens frequently, you should see a doctor. What symptoms does it present? The main symptom of erectile dysfunction is a change in the quality of the erection. If the cause is physical, you usually have the inability to have an erection when you wake up in the morning. Erectile dysfunction can affect both your ability to have an erection and the length of time an erection lasts. Erectile dysfunction can also involve a loss of sexual desire. What causes erectile dysfunction? There are many causes of erectile dysfunction, including: Physical causes – such as diabetes, high blood pressure, obesity, the side effects of medication, alcoholism, multiple sclerosis, hormonal problems, and sleeping problems Psychological causes – such as stress, anxiety, depression, or issues within your relationship Erectile dysfunction can also occur after treatment, including surgery on the spinal cord or prostate. Your chances of being affected by erectile dysfunction increase with age, drug or alcohol use, and are higher if you are overweight or obese. Can erectile dysfunction be prevented? You cannot always prevent erectile dysfunction, but you can reduce your risk by: giving up smoking maintaining a healthy weight getting regular exercise How is erectile dysfunction diagnosed? In most cases diagnosis simply involves asking you about your symptoms and when they started. If the doctor suspects a physical cause that needs investigating, they might refer your for follow-up tests, such as blood tests or an ultrasound. How is erectile dysfunction treated? Treatment depends on whether there is an underlying cause – tackling the root of the problem should improve symptoms. Beyond this the most common form of treatment is medication, which is widely available and effective in making it easier to get an erection. If the problem is low testosterone levels, your treatment may involve hormone replacement therapy. If medication is not effective, other treatment options include: penis pumps – this may not be directly available from your doctor penile implants – a surgical procedure to implant rods which help you control your erections If the problem is psychological, there are various therapies available, including: counselling sex therapy cognitive behavioural therapy (CBT) ...

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

What is kidney cancer? Kidney cancer, sometimes referred to as renal cancer, is a type of cancer affecting the kidneys which most commonly occurs in those over the age of 60. It is one of the commonest cancers in the UK. There are different types of kidney cancer: Renal cell carcinoma Transitional cell carcinoma Wilm’s tumour Kidney cancers are graded on a scale of 1-4, as are many types of cancer. Cancers which are low on the scale grow slowly, while cancers on the higher end of the scale spread more quickly. This grading system helps the doctor decide on treatment and assess how the cancer will behave. What are the symptoms? The symptoms of kidney cancer are often difficult to detect at first, and kidney cancer is more often picked up during other routine testing. The main symptoms of kidney cancer are: Blood in the urine Pain or pressure in the side or back A mass or a lump in the side or back (though this is often too small to detect) Causes of kidney cancer or why it occurs The most frequent risk factors that influence the development of kidney cancer are: Smoking Kidney disease Obesity, following a diet high in fats Drinking (alcohol) High blood pressure Previous radiotherapy for cancer Diabetes Hysterectomy Family history of kidney cancer Can it be prevented? Reducing some risk factors can help in the prevention of kidney cancer, such as: Quitting smoking Lowering blood pressure Maintaining a healthy body weight Following a varied diet abundant in fruits and vegetables, and with a low fat content What is the treatment? Kidney cancer, if detected early, can be cured. Treatment and outlook of kidney cancer depends on the size of the tumour and how far it has spread in the body. The cancer cells can also be treated through freezing or heating (cryotherapy, radiofrequency ablation), embolisation (where the blood supply to the tumour is cut off), radiotherapy, or biological therapies such as immunotherapy. If the cancer is limited to the kidney and is still fairly small, surgery can cure it. If, on the other hand, the cancer has spread to other parts of the body, treatment focusses on controlling it and preventing further spread. ...

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. ...

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 laser being perhaps the most famous device used. It is an example of minimally invasive laser technology. It is usually performed under local anaesthesia or light sedation to eliminate the pain of the intervention.   Why is laser lithotripsy done? Laser lithotripsy is used to fragment kidney stones that are too large to be passed out of the body in the urine. It is an alternative to extracorporeal shockwave lithotripsy, which uses sound waves from outside the body to break down the stones. However, this technique has limitations, and may be ineffective due to the size, position, or hardness of the stone. Laser lithotripsy is generally effective regardless of these factors.   What does laser lithotripsy consist of? The urologist first locates the stone by passing a scope into the urinary tract via the urethra. A flexible laser fibre is inserted through the scope in order to deliver the laser pulse directly to the stone. The energy from this fragments the stone into pieces small enough to pass out in the urine.   Preparation for laser lithotripsy Before laser lithotripsy, the patient should inform the doctor: If they are or could be pregnant Any medication they are taking During the day of the procedure, the patient will probably be advised not to drink or eat anything for several hours beforehand.   Care after laser lithotripsy The fact that an endoscopic instrument is inserted into the urinary tract can cause inflammation, which can, in turn, hinder the passage of urine from the kidney to the bladder and can cause a burning sensation when urinating. This feeling should go away within a day or so. There may also be slight bleeding in the urine in some cases, which should not last for more than 5 days.   Sometimes, the doctor may place a small tube called a stent inside the ureter (one of the tubes that connects the kidney to the bladder) to hold it open while the stone fragments pass through. Antibiotics may be prescribed to prevent an infection. Always follow the doctor’s instructions as to what medication should be taken following an operation. ...

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. ...

Nephrectomy (kidney removal)

What is nephrectomy? Nephrectomy is the surgical procedure in which all or part of the kidney is removed. It may require: Removal of part of the kidney (partial nephrectomy) Removal of the entire kidney, the surrounding fatty tissue, and possibly the adjoining adrenal gland, as well as nearby lymph nodes (radical nephrectomy) It is an intervention that is performed under general anaesthesia and usually lasts about three hours or more.   Why is it done? A nephrectomy is usually performed to treat kidney cancer, but may also be indicated if one of the kidneys has been severely damaged or scarred by other causes and its function is impaired. Possible causes include: Kidney disease, such as hydronephrosis. Damage from infection Damage from kidney stones Serious traumatic kidney injuries Congenital defects A nephrectomy must also be performed when someone donates a kidney.   What does a nephrectomy consist of? A nephrectomy can either be performed as open surgery or laparoscopically. Open nephrectomy is less commonly performed nowadays. Both procedures are performed with the patient under general anaesthesia. Open nephrectomy involves making an incision in the abdomen, and may require the removal of a rib to access the kidney. The surgeon cuts the ureter (the tube that takes urine from the kidney to the bladder) and blood vessels supplying the kidney and removes it, closing the incision with stitches. Laparoscopic nephrectomy involves making several small incisions through which the surgeon can insert a tube with a camera and small tools to perform the surgery within the patient’s body. The surgeon must be specially trained to perform minimally invasive surgery like this, and may use robotic technology to aid them. If an entire kidney is to be removed, a slightly larger incision must be made, through which the kidney can pass. Laparoscopic surgery usually results in faster healing time, shorter hospital stays, and a lower risk of complication, due to the fact that it causes less damage to the body tissues.   Preparation for nephrectomy As with any surgery, the patient should follow the doctor’s instructions with regards to what they can eat and drink and if they should stop taking any medications. The doctor should always be told if there is a possibility that they are pregnant. If donating a kidney, the donor must first be evaluated to ensure their kidney is healthy and that their blood type is compatible with the recipient. This will involve a number of tests in the weeks prior to the surgery. Before the surgery, a urinary catheter is placed in the patient.   Care after the intervention The patient will usually remain in the hospital between 2-7 days after the intervention, depending on the type of surgery and their general health. During the hospitalization: Light activity, such as walking around is usually encouraged as soon as the patient feels ready – perhaps even on the same day of the intervention to avoid blood clots. However, strenuous activity and heavy lifting should be avoided for a few weeks. The catheter stays in for a few days, while the patient recovers. You may have drainage from the incision of the surgery. The doctors will advise you on what you can eat and drink and when – usually there are restrictions at first, building back to a normal diet. ...

No-scalpel vasectomy

What is a vasectomy? Vasectomy is a surgical procedure to cut or seal the tubes (vas deferens) that carry a man’s sperm, which means he can no longer make a woman pregnant. It stops sperm from getting into the man’s semen. When the man ejaculates, the semen has no sperm in it meaning the woman’s egg cannot be fertilised. A traditional vasectomy requires a scalpel to make two incisions into the scrotum. The difference between a traditional and no-scalpel vasectomy is how the surgeon accesses the vas deferens.   What is the no-scalpel vasectomy? No-scalpel vasectomy is now the recommended technique in the UK, recommended by the Faculty of Reproductive and Sexual Health guidelines in 2014, rather than a standard traditional technique vasectomy. The minimally invasive procedure is safe and has a low complication rate. With a no-scalpel vasectomy, the vas deferens are held with a clamp from outside the scrotum and a needle is used to make a small hole for access to the ducts.   What are the benefits of no-scalpel vasectomy? The no-scalpel vasectomy is quicker than a standard vasectomy and usually takes between 20 to 30 minutes. There is less discomfort and no stitches are needed. There are ten times fewer complications than the conventional technique.   Is no-scalpel vasectomy painful? As the procedure is performed under local anaesthesia, it is an almost painless experience. A very fine needle is used to numb the skin and once that takes effect, the patient feels no sharp pain. The surgeon asks at every stage whether the patient is comfortable. The patient may feel a slight tugging sensation during the procedure.   Will I be sterile straight after a no-scalpel vasectomy? Following a vasectomy, there is always some sperm that is left in the system. It takes up to at least 20 ejaculations to clear them and birth control is recommended until the patient is tested to check that they are free from semen. The test is usually 16 weeks after the procedure.   How can I be sure I need a vasectomy? A vasectomy should be considered a permanent method of contraception. It may not be the correct decision for a patient who is young or whether the patient is under stress and pressure from a partner to have one. A patient should also not rely on being able to have a vasectomy-reversal later. ...

Pelvic Floor

What is the pelvic floor? The pelvic floor is the set of muscles and ligaments that surround the lower part of the abdominal cavity. It supports all the pelvic organs (bladder and urethra, uterus and vagina in women and rectum in men) and ensures their normal functioning. The pelvic floor is somewhat dynamic, it adapts to our movement but always maintains an adequate tension that holds the organs inside the pelvis. When the pelvic floor weakens, problems arise that can affect the functioning of the pelvic organs. What are the symptoms of a weakened pelvic floor? The main symptoms are: Urinary or faecal incontinence Discomfort and pain around one of the pelvic organs Prolapse of one of the pelvic organs What are the causes of a weakened pelvic floor? The main factors of a weakened pelvic floor are: Natural birth Chronic constipation High impact sports Obesity Chronic respiratory diseases and smoking Previous gynaecological surgery Can pelvic floor weakening be prevented? Some lifestyle tips can help prevent a weakened pelvic floor, such as: Training and exercising the pelvic floor muscles regularly Making it a habit to go to the toilet at certain times Including fibre and probiotics in your diet, that favour intestinal health and bowel movements Maintaining a healthy weight Maintaining good posture, especially when sitting Doing low-impact activities, such as sit-ups, cycling, swimming or elliptical exercises What is the treatment for a weakened pelvic floor? If the weakening is not serious, the main treatment is pelvic floor physiotherapy, which aims to rehabilitate the affected area through specific exercises. In the event that prolapse of an organ has occurred, the appropriate treatment is pelvic floor reconstructive surgery. ...

Penile Prosthesis

What is it? A penile implant is a device which can be implanted inside the penis. It allows men suffering from severe erectile dysfunction to have an erection. There are two types of penile implant (or penile prosthesis): Malleable penile prosthesis: two rods which are inserted within the erection chambers of the penis. With this type of implant the penis is always partially rigid. Inflatable penile implant: much like in a malleable penile prosthesis, the inflatable penile implant is made of two rods. In addition, an inflatable penile implant includes a reservoir which is implanted in or behind the abdominal wall, and a pump which is also connected to the system and sits in the scrotal sac. The whole system is connected by small tubes which pump through the saline. This makes it possible to get an erection by simply pressing a button, located on the pump. A penile prosthesis does not change sensation on the skin of the penis, and is completely concealed. It does not cause any urinary conditions. The implant can last for as long as 15 years. After that it may be necessary to replace it. What is it for? Those who suffer from the following conditions may be suitable for a penile implant: Erectile dysfunction Cardiac conditions, diabetes, metabolic or cardiovascular disorders which prevent the blood from getting to the penis’ blood vessels; People who underwent a prostatectomy (removal of the prostate) after prostate cancer and people who had surgery to remove any other type of tumour (such as bladder cancer and bowel cancer). In these cases the nerves which can get an erection are removed, so people in these situations can struggle with impotence. What does it involve? During the surgery, an incision is made between the scrotum and the penis. The implant is inserted in through this incision. The procedure lasts from an hour and half to two hours and it can be done under general anaesthetic or local anaesthetic. Usually you will stay in hospital overnight. Post-operative progress There may be a small, almost invisible scar at the base of the penis after the surgery. Surgery does not affect your ability to ejaculate, orgasm and conceive in the long term – but it may take about a month and a half to resume full sexual activity. Alternatives Before implanting a penile prosthesis, you may try the following treatments: Oral treatment with drugs that can stimulate an erection Injection of vasoactive agents inside the penis A penile implant is usually recommended for people who have first tried the treatments above and found that they do not work. ...

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. ...

Premature ejaculation

What is premature ejaculation? Premature ejaculation is a common type of sexual dysfunction in which a man experiences an orgasm and ejaculates (ejects semen) sooner than he or his partner desire, often soon after sexual intercourse has begun or with little stimulation.   What counts as premature? What exactly counts as “premature” ejaculation is somewhat hard to define. The preferred length of time for sexual intercourse varies among different individuals and different couples, and there is no real consensus on how long sex “should” last. That said, men’s ejaculatory latency is said to typically be between 4-8 minutes, while the NHS quotes a study that found the average length of sex to be around five and a half minutes. Men complaining of premature ejaculation often cite that they feel they have less control over ejaculating (although it is true that many, if not most men report that they wish they could last longer than they can). At the end of the day, if the man and/or his partner feels dissatisfied with the sexual experience, they can seek help from a medical specialist.   Causes of premature ejaculation There are thought to be various factors which can lead to premature ejaculation. Physical causes include prostate and thyroid problems, while psychological causes include anxiety, depression, and stress. Anxiety about sexual performance, perhaps due to a previous incident of premature ejaculation, is no exception, and can lead to a vicious circle that affects the individual’s sex life. It is also possible that traumatic sexual experiences in the past could play a role. There is also a theory that conditioning (for example, if the man, as a teenager, became accustomed to ejaculating quickly to avoid being caught masturbating, this becomes a habit in later life). Some men may have naturally sensitive penises. In other cases, recreational drug use is thought to affect sexual performance.   What is the treatment for premature ejaculation? There are a variety of methods suggested to help combat premature ejaculation: Use thick condoms to lower sensitivity. Masturbate an hour or two before sex. Take breaks during sex, during which you think about something boring to decrease arousal. Take a deep breath to delay the ejaculatory reflex. Couples experiencing sexual problems can attend couples’ therapy. The therapist may recommend techniques to help premature ejaculation, such as the “squeeze” and “stop-and-go” techniques. These involve the partner masturbating the man, but stopping before ejaculation. In the squeeze technique, the head of the penis is squeezed for 10-20 seconds and then released for 30 seconds before masturbation is resumed. The stop-go technique is similar, but without the squeezing. The process is repeated several times before the man is allowed to ejaculate. These techniques require patience and practice to get right, but can help the man last longer. In some cases, medication may be prescribed, particularly if there is an underlying cause. You should always follow your doctor’s instructions with any medications. ...

Priapism

What is priapism? Priapism is a prolonged and painful erection of the penis that is not associated with sexual stimulation and can last between at least four hours to several days. It occurs when the penis begins to fill with blood, as it would during a normal erection, but the blood does not drain properly as the sex organs become blocked, or the systems that relax the organs fail. It is an uncommon condition and tends to appear in men in their 30s and those with sickle cell anaemia.   There are two types of priapism: Ischemic priapism (or low-flow priapism) is the most common type and occurs when the blood is unable to leave the penis. An erection tends to last more than four hours, the shaft is rigid but the tip of the penis is soft. It causes progressive penile pain. ​ Non-ischemic priapism (or high-flow priapism) occurs when there is a rupture in an artery or a lesion in the penis and too much blood flows to it. It is usually painless and an erection lasts more than four hours. If you have an erection lasting over four hours it is necessary to see the doctor immediately for emergency care. ​It is possible for priapism to occur in women and is referred to as priapism of the clitoris. It is not a medical emergency in women as it is less likely that a blood clot will occur on the clit due to the abundant blood supply to the female external genitalia.   What are the symptoms of priapism? Although the main feature of this pathology is the unwanted erection lasting several hours, the symptoms vary depending on the type of priapism. With ischemic priapism, the body of the penis becomes rigid, sensitive and in progressive pain. In contrast, non-ischemic priapism is the opposite as the body of the penis is unpainful and not fully rigid.   What is the cause of priapism? Priapism may be a consequence of a disease such as leukaemia, traumatic injury of the spinal cord or the nerve centres, or due to inflammation in the urethra. Other causes may include alcohol and drug abuse (especially marijuana, cocaine and heroin), the use of antidepressant medications, tablets for blood pressure control or treatments used for erectile dysfunction.   Can priapism be prevented? Some preventive measures for priapism are: avoid the factors that can cause it, such as drug or alcohol use. Use of muscle relaxants and injections of phenylephrine for long-lasting erections. Review any medications that are consumed in case one is causing the condition.   What is the treatment of priapism? Ischemic priapism is an emergency situation and should be treated immediately by a medical professional, who will drain the blood from the penis with the help of a needle and/or supply medicines to drain the blood. If drainage through injections and medications does not work, surgery can be performed where a surgeon might reroute the blood flow so it can move normally again. Non-ischemic priapism will usually disappear without the need for treatment and as there is no danger of damaging the penis. It is recommended to apply an ice pack and pressure on the region between the base of the penis and the anus (the perineum). ...

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

What is prostate cancer? Prostate cancer is the type of cancer that starts in the prostate gland. The prostate is part of the male reproductive system and is an organ that surrounds the urethra, the tube that carries urine out of the body. The prostate is responsible for producing seminal fluid. Prostate cancer is the most common cancer in men, with 1 in 8 men affected. Every year, 11,000 men die from prostate cancer. Prostate cancer can be categorised into four stages, indicating how far the cancer has spread: Stage 1 – the cancer is in only half of one side of the prostate and is contained within the prostate gland Stage 2 – the cancer is still in one side of the prostate but fills more than half of that side Stage 3 – the cancer has broken through the prostate gland and may spread to the seminal vesicles Stage 4 – the cancer has spread to the bladder, lymph nodes, bones, or other organs in the body What are the symptoms? Prostate cancer often does not present any symptoms at first. The symptoms that occur when the cancer starts to progress include: difficulty and pain when urinating needing to urinate frequently painful ejaculation blood in the urine If the cancer spreads to the lymph node or pelvic bone, symptoms can include: pain in the lower back and pelvis that does not go away over time involuntary weight loss Causes of prostate cancer or why it occurs The exact cause of prostate cancer is unknown. Your risk of getting prostate cancer depends on: your age – prostate cancer is more common in men over 60 years old, and by the age of 80, 4 out of 5 men have cancer cells in their prostate your ethnicity – prostate cancer is more common in black men compared to white and asian men family history – you are twice as likely to develop prostate cancer if you have a father who had the disease How is prostate cancer diagnosed? Prostate cancer diagnosis consists of several stages. At first, the doctor will assess your likelihood of having prostate cancer by taking a urine sample, testing your blood for prostate-specific antigen (PSA), and examining your prostate. If they conclude you may have a high risk of prostate cancer, they will refer you for further tests. This can include: an MRI scan to create a detailed picture of your prostate and any cancer cells a biopsy to retrieve a small amount of tissue for testing What is the treatment? Treatment options depend on the stage of the cancer and the state of health of the patient. For slow-growing cancer that is contained within the prostate cancer, the doctor may suggest a wait and see approach, where the prostate is regularly monitored but treatment delayed until necessary. If the cancer requires treatment but has not spread outside the prostate gland, the most common treatments are: partial ablation – this treats part of the prostate that has cancer, preserving the rest of the prostate surgery – this can include radiotherapy or prostatectomy If the cancer has spread beyond the prostate, the first line of treatment is hormone therapy. If this is not effective, chemotherapy or immunotherapy may be recommended. ...

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

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. ...

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 cancer

What is testicular cancer? Testicular cancer occurs when cancer cells form in the testes, which are the oval-shaped glands that produce sperm and the hormone testosterone in men between 15 and 35 years old. Testicular cancer can occur in one or both testes, and is more common in those who experience an abnormal testicular development or an undescended testicle. There are two main types of testicular cancer: seminoma, and non-seminoma, of which there are further sub-groupings. What are the symptoms of testicular cancer? The symptoms of testicular cancer are: a hard and painless lump in the testicles or the inguinal region pain and tenderness in the lower abdominal area pain in the scrotum a feeling of heaviness or swelling in the scrotum enlarged or swollen breasts. Testicular cancer risk factors Certain factors may increase the individual risk of testicular cancer. You are more likely to develop testicular cancer if a family member has had it. Certain conditions such as an undescended testicle also increase the risk. Testicular cancer more commonly affects men over the age of 54, and Caucasian men. Testicular cancer is much more prevalent in Europe, Canada and the US than in Asia and Africa. Can testicular cancer be prevented? As the exact causes are still unknown, there is no way to prevent testicular cancer. However, it has been shown that orchidopexy, surgery to lower and fix the testicle not descended into the scrotum, can prevent the development of testicular cancer in children with undescended testicles. What is the treatment for testicular cancer? This type of cancer has a cure rate of more than 90% if it is localised and treated in time. There are several treatments that are chosen depending on the stage in which the tumour is identified. At an early stage, the tumour generally only affects the testicle, so surgery to remove it is usually sufficient in most cases, although in others, treatment with chemo or radiotherapy may be needed to reduce the risk of it developing further. If the cancer has spread outside the testicle, then generally radiotherapy or chemotherapy is presented as an option. If the cancer returns, then radiotherapy or chemotherapy may again be administered. ...

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. ...

Urethral stricture

What is it? A urethral stricture consists in a narrowing of part of the urethra, the tube that carries urine outside the body from the bladder. Both men and women have a urethra. An obstruction of that tube can affect your ability to pass urine. What are the symptoms? Symptoms vary substantially based on the severity of the stricture itself. With a mild stricture you may experience minor symptoms such as pain when urinating and general discomfort. In more severe cases, you may experience inability to control urination, urinary tract infections, presence of blood in the urine, weak urine flow and a feeling of incomplete bladder emptying after urination. What causes urethral stricture? The most frequent cause of urethral stricture is trauma in the bladder area, caused by falls, accidents, or after surgery. Your cells will try to repair the damage caused by the trauma by producing scar tissue, which in some cases grows to the point of obstructing part of the urethra. Other common reasons behind scar tissue overgrowth are infections caused by sexually transmitted infections, catheter overuse or an inflammation of the prostate. Rarer causes of urethral stricture include congenital anomalies or urethral cancer. What tests can you take? You may need to take a number of tests in order to get an accurate diagnosis. The first step is an appointment with the GP to study your medical history in order to pinpoint any possible trauma at some point. Following this, the doctor may recommend a uroflowmetry test in order to measure the amount of urine voided during urination. Further tests such as a urine culture test or urethral swab can detect anomalies in the urethra. While the urine culture test detects the presence of bacteria in the urine, a urethral swab can find bacteria nested in the lower urinary tract, which can cause infections. Radiological exams such as an ultrasound, a retrograde urethrogram and a cystourethography are all effective at detecting where exactly there may be build-up of scar tissue in the urethra. What is the treatment? At the moment, the only available treatments are antibiotics-based therapies or, in severe cases, surgery. The most common types of surgery are: Urethral dilation: it may be necessary to repeat this procedure from time to time; during the surgery, the urethra is dilated gradually by using a catheter. Urethral surgery: elimination of excessive scar tissue by making small incisions. Urethrotomy: this procedure involves cutting the obstruction and temporarily placing a catheter. Urethral stent: an endoscopic procedure consisting in the insertion of a small stent structure, which restores the obstructed urethral tract to its original size and shape. ...

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. ...

Uroflowmetry

What is it? A uroflowmetry is a non-invasive test that measures the total volume of urine released from the body, the speed at which it is released (millilitres per second) and how long the release takes. What does it involve? This test involves passing urine in a machine which looks like a regular toilet. The machine is equipped with a measuring device which can analyse and measure how much urine is being passed during a set amount of time. The machine then generates a report with some graphs. What is it for? A uroflowmetry test is sometimes recommended if you have trouble passing urine or if you show any signs of any urinary condition, such as incomplete bladder emptying after urination, urinary incontinence, or leaking after urination. The most common causes for urinary conditions are: Urinary tract infections (UTIs) - urethritis, prostatitis, cystitis, vaginitis Kidney stones Urethral stricture Benign prostate enlargement (BPE) Bladder neck dysfunction Urinary tract tumour How can I prepare for it? It is important that you drink about a litre of water and that you do not pass urine before the test. ...

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. ...

Vasectomy

What is a vasectomy? A vasectomy (also known as male sterilisation) is an operation to cut or seal the vas deferens (the tubes that carry sperm out of the testicles), as a form of permanent birth control. The sperm are unable to leave the testicles and therefore do not form part of the man’s ejaculate after the procedure, meaning that he cannot impregnate a female sexual partner. Vasectomies are usually performed under local anaesthetic. They are over 99% effective as a contraceptive measure. Afterwards, the man is still able to have erections and ejaculate, and his sex drive shouldn’t be affected.   Why is it done? A man may choose to have a vasectomy when he is certain that he doesn’t want to have any more children in the future. It is an important decision and it is highly recommended that he discuss it thoroughly with his partner before opting for a vasectomy. Vasectomy reversal, while possible, is not always successful, so the patient should be sure that he doesn’t want to father another child.   What does a vasectomy consist of? A vasectomy is a simple outpatient surgical intervention. The doctor numbs the scrotum with local anaesthetic before operating. There are two options, which will be discussed between patient and doctor and decided beforehand: Conventional vasectomy – the doctor makes two incisions in the skin of the scrotum, through which he can cut each tube and remove a small section, before either tying them or sealing them shut using heat. The incisions are then stitched up and left to heal. No-scalpel vasectomy – a minimally-invasive method, in which the doctor performs the operation through a tiny hole in the side of the scrotum, rather than an open incision. This causes less bleeding and is thought to lead to fewer complications than the conventional method, but requires a doctor with special training to perform. Vasectomy does have certain risks – the testicles and scrotum are usually bruised and swollen, and some patients suffer ongoing pain. Blood can pool inside the testicles (haematoma) or hard lumps can form due to leaking sperm (sperm granulomas).   Preparation for vasectomy Before opting for a vasectomy, the matter should be discussed with the patient’s doctor and partner, and in some cases, counselling may be recommended before the decision is made. It is important that the patient understands that there may not be any going back. As with any surgery, it is important to follow the doctor’s instructions with regards to any medication the patient is taking. On the day of surgery, it is important to wear loose and comfortable clothes, as well as to clean the scrotum area well.   Care after the intervention The recovery is usually quick. Many men are able to return to work after a day or two, but it is important to avoid physical exertion or exercise during the first week. As after any other surgery, there is usually some discomfort after the operation. With regards to sex, it is necessary to continue using contraception for the first 8-12 weeks after the operation to ensure that all remaining sperm have cleared the man’s tubes, but after this there should be no chance of pregnancy. ...

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