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Urology Services Manchester

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Frequently asked urology questions

  • Penile problems

    How can you fracture your penis if it doesn't have any bones?

    Fracturing a penis actually means sustaining a break in the erectile tissue. This usually happens when a penis is erect and intercourse is undertaken too vigorously, or if the erect penis is suddenly bent too hard. If this happens the man will normally experience sudden pain, and bruising may occur afterwards. Expert and urgent help is needed, you should attend the A&E department.

    What is the true definition of erectile dysfunction -- and what are the most common causes?

    Erectile dysfunction actually means the inability to have or sustain an erection sufficient enough for intercourse. It can occur in up to 50% of middle aged men. It can be caused by problems with the blood supply and drainage of the penis, its nerve supply, hormonal problems, medication and recreational drugs, surgery and ageing. It can also be caused by psychological problems but in most cases is a combination of two or more of the causes listed. It is not unusual for problems with erections to be due to or be a first sign of heart disease, so a healthy lifestyle is always important.

    What is retrograde ejaculation, and how is it treated?

    This is when during ejaculation the semen goes backwards into the bladder instead of out through the end of the penis. This can occur due to previous surgery or due to medication. In most cases this is not problematic unless you are thinking of having babies. In this case help should be sort from an expert in male fertility.

    See frequently asked questions about penile problems
  • Fertility

    My wife is having trouble getting pregnant. Could my sperm be the problem?

    If you have been having regular intercourse for more than 1 year and there has been no success then there may be a problem. It is important that firstly, you have a healthy lifestyle and cut out toxins such as smoking and alcohol. You should both seek an opinion from your GP. Normally you should both be investigated and as part of this a semen test may be done.

    Will I still be able to ejaculate after vasectomy?

    After vasectomy you will still ejaculate and the volume should be as it was before. The sperm from the testicles only make up a small amount of all the fluid that is ejaculated. At the time of vasectomy only the fluid from the testicles is stopped.

    After my vasectomy where do the sperm go?

    The sperm will stay in the testicles. This should not be problematic.

    How long will it take after my vasectomy before I can assume that I am sterile?

    Approximately 12 to 16 weeks after your vasectomy you will be asked to produce a  semen sample for testing. If this shows no sperm then you can assume sterility.

    Will my levels of testosterone fall after my vasectomy?

    No. The vasectomy does not effect testosterone production.

    Will my vasectomy be 100 per cent successful in preventing pregnancy?

    There is a failure rate of around 1 in 1500 vasectomies, less than 0.1%. This can happen at any time after vasectomy. It is still one of the best forms of sterilisation.

    Am I at greater risk of prostate cancer after having a vasectomy?


    See frequently asked questions about fertility
  • Urinary problems

    What causes a urinary tract infection?

    Most urinary tract infections are caused by common bacteria. These are often referred to as gram negative bacteria, the commonest one being E.coli. Normally we should be able to fight these infections off with our own defences. Sometimes though we are unable to do so due to factors within us such as a poorly emptying bladder, foreign bodies being present (such as catheters), the presence of kidney or bladder stones or our ability to fight of the infection being compromised (such as in diabetics or those on certain medications). As a rule any woman who has more than 2 infections in six months or any man who has one infection should be screened to look at the above factors.

    Can cranberry juice really prevent it?

    There is some evidence that drinking cranberry or taking cranberry tablets can reduce the frequency of recurrent urinary tract infections in women. The evidence is not so good for the elderly or men, and shows no help for those who have ‘neuropathic bladder related problems.’ This latter term includes those who have bladder problems secondary to having had a stroke, a spinal injury or a permanent indwelling catheter.

    Unfortunately the studies that have been published to date do not agree on a concentration or amount that should be drunk or eaten. Also most studies have a high drop out rate reflecting that a lot of people find it difficult to continue taking the cranberry  juice/tablets.

    Therefore overall there is no harm in taking it, and it will probably do you some good but this may not work for everyone.

    How often is it normal to urinate?

    There is no standard as to how often we go to pass urine. Anywhere between three and eight times a day is probably normal.

    As we get older getting up to pass urine up to twice during the night for men is probably normal.

    Patients normally notice if they are going excessively, a lot more than their friends or there is a change in the number of times they go to the toilet. This can be due to many reasons such as, being diabetic, being on water tablets, having an infection or something else that is irritating the bladder.

    Therefore if patients experience increased frequency of urination it is important to have somebody review your medication, exclude infections and assess your bladder. Simple treatments such as cutting down on caffeine containing products may help. Beyond that tablet treatment can help or even Botox injections into the bladder.

    Should I be concerned about bloody urine?

    Unfortunately having blood in the urine needs investigating. Broadly it is divided into being able to see the blood and only being able to detect it on testing the urine.

    There can be many reasons such as infections (either in the kidneys or in the bladder), having stones (in the kidneys or bladder), or unfortunately having bladder or kidney cancer. For all these reasons patients with blood in their urine should be seen and investigated by a urologist.

    What can I do about my stress incontinence?

    Stress incontinence refers to leaking urine whilst raising the pressure within the pelvis/lower abdomen. This can be caused by coughing, sneezing, exercising or lifting. The underlying cause is usually weakness of the pelvic floor, risk factors for this include previous pregnancies and subsequent child birth, having many children, smoking, being overweight, having bronchitis and previous pelvic surgery (such as a hysterectomy).

    Good evidence demonstrates that women who embark upon properly taught pelvic floor exercises (carrying them out at least three times a day, at each time doing at least 8 repetitions) will notice an improvement. Where these fail then surgical options include colposuspensions, fascial slings, or the newer treatments of TVT, TVT/O, TOT or Bulkamid injections.

    Are bladder infections and UTIs the same?

    ‘Bladder infections’ refers only to those infections that affect the bladder. Typically patients complain of pain or a burning on passing urine, increased frequency of passing urine, passing blood and sometimes feeling unwell.

    UTI’s are urinary tract infections. These are infections that occur anywhere within the urinary tract. This includes the bladder as well as the kidneys and the prostate and epididymis in men.

    How does bacteria get into the urinary tract?

    Bacteria that gain access to the urinary tract often do so by climbing up the urethra (water passage).  Women are therefore more prone to getting infections due to the fact that the female urethra is 3-4cm long and the male one is typically 15-20cm.

    Bacteria however can be found in association with abnormalities of the urinary tract such as indwelling foreign bodies (like a catheter), stones or even cancer. This is why it is important to be reviewed if you are a woman having recurrent infections or a man who has any infections.

    Are female urology problems different from men?

    Whilst both men and women have kidneys and bladders, due to the differences in anatomy they more often have very different problems. Examples include the frequency of infections women get in comparison to men and the fact that stress incontinence is predominantly a female problem. On the other hand women do not suffer with all the problems men do with regards their prostates.

    Does menopause cause increased UTIs?

    The menopause can cause an increase in UTI’s. Other causes need to be excluded (see answers to UTI questions), and the application of oestrogen to the genital area can often bring about a dramatic improvement in symptoms for women who have been through the menopause.

    I wake up in the night having to urinate - is that a problem?

    Unfortunately as we all get older getting up in the night becomes more common. It is probably normal to get up at least once. Beyond that treatment may help. Often it is not the number of times but the change in the number of times we get up. It is important to note that people who are poor sleepers are awake and therefore go to the toilet hoping that will help them get back to sleep. Management should therefore be aimed at helping these people sleep better.

    See frequently asked questions about urinary problems
  • Male cancers

    Is early detection of bladder cancer important?

    Most bladder cancers arise from the lining of the bladder and are easily dealt with by simple keyhole surgical removal of the "growth". After this, simple regular checks of the bladder are carried out to pick up at an early stage any further growths that can occur. A small minority of bladder cancers are more aggressive and need more intensive treatment which may include surgical removal of the bladder, chemotherapy and/or radiotherapy.  Prompt diagnosis of bladder cancer gives our multidisciplinary team the earliest opportunity to review your case and develop an individualised treatment plan to optimise your chances of cure.

    What is available to help an enlarged prostate?

    Enlargement of the prostate is usually due to what is called “benign prostatic hyperplasia” (BPH). This is a very common occurrence in many men as they become older. It is commoner for BPH of the prostate to be the cause of enlargement than any serious prostate cancer. It has been estimated that almost half of men aged over 70 have BPH. In many men, this natural enlargement causes no symptoms or problems at all. In some men, however, enlargement can cause a degree of blockage of the bladder exit, and this can cause a variety of urinary symptoms. If an enlarged prostate is diagnosed, and is starting to cause symptoms, a variety of treatments may be tried. Sometimes, simple adjustment of the type and volume of fluids consumed during the day may be all that is required. Other treatments include tablets to relieve prostatic obstruction and calm the bladder. If these measures are not enough, keyhole surgery to remove the part of the prostate causing blockage may be necessary. If you are concerned about urinary symptoms we are happy to see and assess the problem for you. After discussing your problems in person, we usually recommend a full examination and testing of the urine along with blood tests to check the kidney function and prostate. We also usually arrange a urine flow test and ensure that the bladder is emptying properly. This should allow us to determine the severity of your trouble and start appropriate personal treatment.

    When should men be checked for prostate cancer?

    So-called prostate cancer screening can be offered to men concerned that they may have un-diagnosed prostate cancer.  The initial investigations require an examination of your prostate by a urologist and a blood test called a PSA (prostate specific antigen). If either the blood test or examination is abnormal your urologist may recommend a prostate biopsy which will be fully explained to you.  The potential benefits of prostate cancer screening however are controversial.  It is commonplace in the U.S. and some parts of Europe but has not been adopted as yet in the U.K.  The disadvantages of widespread screening could be the difficulty in detecting the more serious cancers. Screening could also lead to over treatment of less serious cancers.  Trials are underway which may more accurately determine the advantages and disadvantages.  Men considering these options are encouraged to come and discuss this with a team skilled in this area where we can present the controversies in a clear and understandable manner and allow men to make an informed decision before proceeding with these tests.

    See frequently asked questions about male cancers
  • Kidney and Prostate problems

    Does a prostate examination hurt?

    A prostate examination involves a finger being placed up the back passage (anus) in order to assess the size and texture of the prostate. Lubrication jelly on a gloved finger is used to aid the examination. This is the only way to feel and examine the prostate gland. There may be slight discomfort but the examination is generally not painful.

    At what age should I have my prostate examined or should I wait for symptoms?

    A doctor may want to examine the prostate for a number of reasons. Infections of the prostate (prostatitis), blood in the sperm or urine, urinary symptoms, a family history of prostate cancer and a raised prostate specific antigen (PSA) blood test may be some reasons why the doctor would examine your prostate. Young people do not need a routine prostate examination in the absence of any specific symptoms. As men age, the need to monitor the prostate becomes more important. Some doctors and medical associations recommend a yearly prostate examination as part of an annual check up, especially form the age of 45-50 years onwards.

    Does my kidney stone need to be treated?

    Whether a stone needs treatment or not depends on the presence and severity of symptoms; size and position of the stone; and on the presence of any complicating features. In general stones which cause a lot of symptoms and/or are large need treatment. Urgent treatment would also be required if the stone was complicated by an infection and/or a significant blockage to the kidney. A small stone in the ureter (tube that drains the kidney) may be allowed to pass naturally with the aid of tablets if the symptoms were mild, but if this did not happen within a reasonable period of time then further treatment would again be needed. In some circumstances small uncomplicated stones in the kidney may be kept under surveillance without any treatment, but if the stone were to increase in size over time then this would be another indication for treatment.

    How often do men need a routine health check?

    Even if you feel healthy a check up by a health care professional should be made from time to time. Quite often conditions such as high blood pressure and high cholesterol do not manifest itself until permanent damage has occurred. A health care professional can screen and treat diseases, look for risk factors and give advice on disease prevention. Help can also be provided for lifestyle improvements such as weight loss and quitting smoking.  How often and what checks are done depends on your age and state of health.

    As a guide a healthy man should have a check up every 5 years in their 20s, every 3 years in their 30s, every 2 years in their 40s and then yearly after 50. If any abnormalities are discovered or if there are existing health problems then the health care professional is likely to request for more frequent check ups.

    A physical examination will be performed on each visit which will include a testicular examination. Prostate cancer screening should be discussed with the health care professional after the age of 50, especially if there is a family history of prostate cancer. Measurements such as blood pressure, height and weight will be done while blood and urine test should be performed to look for conditions such as diabetes, kidney disease and high cholesterol. More specific test can be organized depending on the presence of symptoms and physical examination findings. If treatment or preventive measures can be started early then the outcome is generally better.

    Is there any such thing as the male menopause?

    The definition of menopause is the time in a women’s life when the menstrual cycle ends, so strictly speaking men cannot have a menopause. The menopause occurs as a result of a rapid decline in female hormones which also account for the menopausal symptoms experienced by women. Men undergo a more variable and gradual decline in their male sex hormone (testosterone) with age. It is believed that this reduction can result in men experiencing similar symptoms to that of women. This male equivalent of the menopause has been called the andropause. The most common symptoms associated with this condition include mood changes, a loss of sexual desire, erection problems, a loss of energy, hot flushes, sweating and generalized aches and pains. In addition men may experience weight gain, loss of muscle mass and osteoporosis. Affected individuals should seek medical attention not only to check for the presence of a low testosterone but also to rule out other causes for their symptoms. Testosterone replacement therapy which can be administered orally, with a patch, skin gel or implant may improve the symptoms but it is controversial as to whether it is appropriate in all men as some of these symptoms could be a result of the natural ageing process or may have a large psychological basis associated with a period of change in ones life (e.g. midlife crisis).


    See frequently asked questions about kidney and prostate problems

© Spire Healthcare Group plc (2016)