Progressing patient-focussed urological health

Urological surgeons assess and treat a range of penile and scrotal conditions. Initial assessment typically includes examination in the clinic and review of any ultrasounds. Penile foreskin conditions such as phimosis (tight foreskin) may require circumcision (surgical foreskin removal). Conditions of the internal contents of the scrotum include swelling caused by hydrocoele or varicocoele, or lumps of the testis and epididymis. Corrective surgery for these conditions may be an option depending on individual circumstances. Scrotal conditions are sometimes a sign of problems elsewhere in the urinary tract that may also be assessed.

This is the insertion of numerous small radioactive seeds directly into the prostate as a curative option for the treatment of localised prostate cancer. It allows a higher dose of radiation to be delivered directly to the prostate while limiting the dose to surrounding tissue. It is an alternative to other curative options such as surgery or external beam radiotherapy. Suitability for brachytherapy depends upon many factors such as tumour grade, stage, prostate specific antigen, prostate size and symptoms.

Some patients with an overactive bladder will be candidates for intravesical Botulinum Toxin injection (also known as Botox). This is delivered during a short procedure where a camera is inserted into the bladder and the injections are delivered by a small needle into the muscle of the bladder wall. This procedure needs to be repeated about once a year and carries a small risk of infection and urinary retention, where a patient will need to learn to pass a catheter into their bladder to empty the urine for a short period of time.

Patients who have blood in their urine, both visible and invisible to the naked eye, should be referred to a urologist for investigation. This usually includes a CT scan of their abdomen and pelvis, with contrast (given as an injection into their vein) and a cystoscopy (which is a camera check into the bladder). Common causes of blood in the urine include urinary tract infections and kidney stones, but we do not want to miss a cancer in the bladder or kidney causing blood loss.

Patients with involuntary leakage or loss of urine may have several treatments available for them and would benefit from assessment by a urologist. There are many causes of incontinence, and some are managed by physiotherapy, some require medications, and some require invasive investigations and surgery.

Stones in the kidney or ureter that are too large to pass naturally will require surgery that ultimately involves the passage of a small camera through the urethra, into the bladder and up the ureter to the stone. At the end of the camera is a small laser fibre which is used to break the stone into tiny fragments. Patients may require a few small operations in order to deal with a single stone and your urologist will discuss this with you individually.

This involves ‘keyhole’ surgery with several small incisions made in the abdomen through which specialised instruments and a camera are placed to perform operations. Procedures are carried out under a general anaesthetic and the abdomen is temporarily inflated with gas (carbon dioxide) to create a working space. Urological surgeons commonly use laparoscopic techniques for operations such as nephrectomy (kidney removal). Advantages over traditional open surgery include shorter hospital stay and faster recovery.

Laser prostate surgery, which includes holmium laser and green light laser treatments, are used to treat men who have voiding difficulties from an enlarged prostate. The laser treatments effectively “re-bore” the prostate to create a larger channel for the urine to pass through. Laser prostate surgeries have some advantages over other enlarged prostate surgical treatments, with less blood loss and earlier removal of catheter post operatively. Laser prostate surgical treatments can also be used to treat enlarged prostates that are very large and maybe suitable for men who are on blood thinning medication for heart conditions.