Vasectomy is a very common form of permanent contraception chosen by couples who have completed their family. It is a more minor procedure than a tubal ligation for the female partner.
For most patients, Dr Redgrave performs vasectomies in a day centre with sedation and local anaesthetic. Usually men are in the day centre for 40 minutes or so. With the sedation it is not an unpleasant experience and recovery is quick. It is prudent however to take it easy for a couple of days afterwards.
Occasionally, some men, (usually those who have had previous scrotal surgery), require a general anaesthetic.
Vasectomy has no effect on sex drive or libido, erections or orgasm. Even the ejaculation is not notably affected in quantity.
Problems with urinary function are very common in both men and women. The urinary stream can be weak, slow to start or dribble at the end. These are very common problems in men as they age, usually caused by prostate enlargement.
Frequent voiding by day, getting up several times at night and urgency are common in men with prostatic obstruction, but can also be caused with problems in the bladder both in men and women.
Bladder pain can be a problem with both men and women and can have serious causes. Dr Redgrave can help with investigation, reassurance and treatment with medication and surgery.
Involuntary leakage of urine into the clothing is an embarrassing symptom for men and women. It can be caused by stress incontinence, where leakage occurs during straining, lifting and sneezing. This is very common in women who have had children and can often be corrected with pelvic floor exercises. Failing this, incontinence can usually be fixed with a small operation requiring an overnight stay in hospital.
Stress incontinence in men can occur after prostate cancer surgery. Again, it can often be fixed with pelvic floor exercises. Failing that, most men can have the incontinence controlled with an Advance Sling@; an operation that requires an overnight visit to hospital and a quick recovery. Occasionally, some men with severe leakage require an Artificial Urinary Sphincter. This procedure involves a 2-day visit in hospital.
Urge incontinence can usually be helped with exercises and a range of medications. For those patients who don’t respond to these treatments, a day visit to hospital and a cystoscopic injection of Botox into the bladder is effective for 12 to 18 months. Patients can return to normal activities the next day.
Overflow incontinence occurs when the bladder is over-distended and is most commonly seen in men with severe prostatic obstruction. It usually manifests as night-time bed wetting. Prostate surgery is necessary in these circumstances.
Symptoms caused by benign prostatic enlargement are exceedingly common and become more common as men age. Evaluation is necessary to exclude prostate cancer, infection and back pressure damage to the kidneys and bladder. If the prostate obstruction is not causing harm, many men choose to live with the symptoms.
For many men, medications can be effective at helping symptoms. However, tablets may not work, or they may cause side effects, such as dizziness, nasal congestion or loss of erections. In this situation, and in men having complications of prostatic obstruction, an operation is required.
TURP (Transurethral Resection of the Prostate), also known colloquially as the ‘rebore’ is one the more common operations performed in the Western world.
It is done under a general or spinal anaesthetic as a minimally invasive operation using a telescope which removes obstructing prostate tissue. The TURP requires a 2-day visit to hospital. Recovery is usually rapid, though men do need to avoid heavy lifting afterwards for a month or so.
Many men these days are on strong blood thinners, usually because of previous heart problems. A TURP procedure requires stopping blood thinning drugs around the time of the prostate surgery. For men on strong blood thinners Greenlight laser surgery can be a better option. All blood thinners can continue and there is no bleeding intra-operatively and men usually go home the next morning. The chance of requiring repeat treatment is higher in men having Greenlight laser surgery on their prostate, in comparison to patients who undergo a TURP.
One problem with both TURP and Greenlight laser prostate surgery is that both are likely to cause a side-effect called retrograde ejaculation. The libido, erections and orgasm are retained, but there is no or little ejaculation. This doesn’t affect the quality of the orgasm, but clearly has an impact on fertility!
For men in whom this is a problem, a newer, minimally invasive procedure is available called a Urolift. It is a transprostatic implant device inserted through a telescope which tethers the prostatic channel open (between 2 and 6 usually deployed) relieving obstruction while retaining normal ejaculation. It is usually a day visit to hospital and men can return fully to normal activities in a couple of days.
Kidney stones are very common in men and women with around 8% of people presenting with one over their lifetime. Those people who have had one are at risk of developing more.
They can cause loin pain, which can vary from a mild ache to very severe pain, blood in the urine, urinary infection or voiding frequency.
Kidney stones can usually be treated as a day only visit to hospital with either ESWL (shock wave lithotripsy), ureteroscopic stone removal or laser disintegration, or retrograde flexible nephroscopy and laser stone disintegration.
These are all minimally invasive treatments with a quick recovery, though on some occasions, more than one treatment is required.
More major surgery, most commonly a percutaneous nephroscopy requiring a 2-day visit, is required for large stones.
Prostate cancer is the most common cancer to occur in men. It is more common in older men. Family history of prostate cancer is an important risk factor. It is usually diagnosed these days after a blood test called a PSA, which if elevated, can indicate the presence of prostate cancer. It may also be diagnosed by rectal examination of the prostate. Further confirmation of the diagnosis and risk stratification for the tumour requires a prostate biopsy. MRI or Magnetic Resonance Imaging can be a useful adjunct in the diagnosis of prostate cancer.
Many prostate cancers are ‘low risk’ and can be safely watched, however most ‘intermediate’ and ‘high risk’ prostate cancers require curative treatment with either surgery or radiotherapy.
Radical prostatectomy, or complete removal of the prostate, offers the best chance of long term cure, but requires 4 or 5 days in hospital and there are long term risks in terms of erectile function and some stress incontinence can be a problem for a few months after surgery.
Radical prostatectomy can be performed as a keyhole operation with the assistance of a robot, but a recent randomized head to head study comparing the two types of surgery showing no difference in outcomes, even the time to return to work. Robotic surgery is much more expensive than conventional surgery with large out of pocket expenses for patients.
Radiotherapy, with either external beam or radioactive seeds, is an alternative treatment, with less short-term side effects than surgery, but the chance of long term cure of cancer is less and radiotherapy can have long term side effects in men with long life expectancies, including second cancers.
This is a very common issue faced by men, becoming more common with advancing age, though it can still affect young men. It can be rarely related to a hormonal problem, readily diagnosed on blood tests. More commonly it is associated with a problem with the blood flow into or out of the penis or a problem with the nerves to the penis. Psychological factors also play a role.
There is usually no miraculous magic bullet cure for this problem, but there are many treatments which are very effective at restoring erections.
Seventy percent of men do very well with a tablet therapy. Some do well with penile injections. Others are happy with external vacuum devices.
For men in whom other treatments fail an operation is available called a penile prosthesis. In this operation an implantable device enables an erection which can be switched on or off at will. The surgery requires a 2 day visit to hospital.
In this condition men develop a nodule or thickening in the body of the penis which can be tender initially. The nodule can cause a bend in the erection which can progress, or sometimes regress, over a 6 to 18 month period as the inflammation resolves leaving a scar. It is a benign condition, but the bend can be unsightly and even make intercourse difficult or impossible. Occasionally, impotence can be caused by this disease.
Peyronie’s disease responds poorly to medical treatment and often requires an operation (day stay) to straighten the erection. The operation is best performed when the shape of the bend is stable and the disease has burnt out, otherwise more than one operation could be required.
Utilising the latest Da-Vinici robot, we are able to offer minimally invasive robotic surgery. Advantages are greater vision and precision and shorter length of stay.
We believe patient education, and good doctor – patient communication are both essential elements of our care, and together with our nursing, secretarial and reception staff aim to provide education, care and support in urological management.