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Our consultant urologist

Our Urology centre is made up of four highly experienced urological consultant surgeons and team of clinical staff who all ensure patients receive the highest standard of quality care from the first visit right through to the after care.

Bladder conditions

What is the bladder?

The bladder is an organ which stores urine until the body is ready to urinate. The bladder is attached to the kidneys by ureters, thin like tubes, and also the urethra, the tube from the bladder out of the body. The bladder can hold about 500ml of fluid for about five hours. The detrusor muscle in the bladder relaxes to hold urine and squeezes to push the urine out.


 

What causes bladder cancer?

Bladder cancer develops when there is a growth of abnormal tissue in the lining of the bladder. Sometimes the abnormal tissue, known as a tumour, can spread into the muscles surrounding the bladder.

The most common symptom of bladder cancer is blood in the urine, however an urgent and frequent need to urinate and a burning sensation when peeing also are symptoms of bladder cancer. It is important individuals to go see their GP if they experience any of these symptoms, however they should not panic as these symptoms are also related to much more common conditions such as cystitis, kidney stones or enlarged prostates.

How common is bladder cancer?

In the UK approximately 10,000 individuals are diagnosed with bladder cancer each year (NHS, 2013). Bladder cancer is caused by abnormal changes in the bladder cells over many years thought to be caused by exposure to harmful substances. Therefore bladder cancer is more common in older adults and individuals who smoke.

Treating bladder cancer

Once bladder cancer has been diagnosed tests will be done to see if it is spread in order to determine the right treatment path. Seventy per cent of individuals diagnosed with bladder cancer have non-muscle-invasive cancer, which means it has not spread outside of the bladder, the death rate for this type of cancer is low (NHS, 2013). If cancer cells have spread outside of the bladder into surrounding muscles, it has a higher chance of spreading around the body and can be fatal.

Non-muscle-invasive bladder cancer is usually treated using TURBT and chemotherapy; these treatments destroy the cancerous cells whilst leaving the rest of the bladder intact. Muscle-invasive cancer treatment may involve surgery to completely remove the bladder. 


Bladder stones

The bladder is an organ which stores urine until the body is ready to urinate. The bladder is attached to the kidneys by ureters, thin like tubes, and also the urethra, the tube from the bladder out of the body. The bladder can hold about 500ml of fluid for about five hours. The detrusor muscle in the bladder relaxes to hold urine and contracts to push the urine out.

Bladder stones are stone-like lumps which can form inside the bladder which can disrupt the flow of urination, cause an infection and/or irritate the bladder wall. Symptoms of bladder stones include pain in the lower abdomen, a frequent or urgent need to urinate, pain when urinating and blood in the urine,  

Bladder stones can be caused when an individual is unable to fully empty the bladder as the longer the urine sits in the bladder to more likely it is to crystallise and become hard lumps. Bladder stones affect about 6,000 individuals each year in the UK, with males over the age of 50 being the most likely to be affected (NHS, 2013). The most common treatment to remove bladder stones is a cystolitholapaxy. 

Bladder treatments

TURBT 

Transurethral resection of bladder tumour (TURBT) is used to diagnose bladder cancer and remove growths, tumours and lesions from the bladder wall which are non-muscle invasive.   

The TURBT procedure involves a micro-telescope, a cystoscope, being inserted into the bladder through the urethra, the tube that carries fluid from the bladder out of the body, to locate the tumours or lesions. The surgeon will then ‘shave’ or cut the tumours/ lesions from the inside of the bladder wall using a special wire loop attached to the end of the cystoscope, and then seal the wounds.  

As part of the treatment for bladder cancer, the surgeon may also use chemotherapy. 

The procedure is carried out under general anaesthetic and takes on average between fifteen and forty minutes. Patients will be required to stay in hospital one or two nights following the procedure.

Recovery

A catheter will have been left in after the procedure to help drain away excess blood and fluid from the bladder, and this will be removed before the patient leaves hospital. Patients should expect a two week recovery to resume to normal physical activity.

The side effects associated with this procedure include pain and discomfort in the bladder, blood in the urine, a burning sensation when passing urine and unpleasant smelling urine. These side-effects should settle within a fortnight of the operation. Complications of the procedure include a urinary tract or bladder infection, damage to the urethra or bladder or difficulty passing urine. TURBT is generally considered to be a safe operation, and for most patients the benefits outweigh the disadvantages of not being treated. However, all medical procedures carry an element of risk and the consultant will discuss this in detail with the patient.  


Chemotherapy

Chemotherapy is a treatment used for cancer, including bladder cancer. Chemotherapy is used in a variety of ways depending on the development of the cancer.

For bladder cancer caught early, chemotherapy may be the only treatment needed. However, for moderate to high risk bladder cancers chemotherapy may be given following bladder surgery to ensure the cancer cells have been destroyed, or it may be given before surgery to shrink the size of the tumour to make it easier to remove. Some patients may have more than one dose of chemotherapy, usually once a week for six weeks.

A dose of chemotherapy is inserted directly into the bladder using a catheter. The chemotherapy solution is left in the bladder for about an hour before being drained away. The aim of this treatment is to treat the cancer and stop it from coming back or spreading into the deeper layers of the bladder.

After the procedure

Some of the chemotherapy fluid may be left in the urine, and this can severely irritate the skin and cause pain when urinating. It is advised to sit down when urinating and to wash the genitals with soap and water afterwards. It is important to use a condom when sexually active following treatment as the medication may be present in the semen or vaginal fluids which can cause irritation, and patients should not try to get pregnant or father a child during this time as the medication can cause birth defects. 


Cystolitholapaxy

A cystolitholapaxy procedure is used to treat bladder stones. A transurethral cystolitholaplaxy is the most common procedure for adults with bladder stones, occasionally a percutaneous suprapubic cystolitholapaxy may be used when patients have very large bladder stones, and this is the preferred treatment for children.

During the transurethral cystolitholapaxy procedure the surgeon inserts a micro-telescope, known as a cystoscope, up the urethra into the bladder. The surgeon is then able to locate the stones. The cystoscope then uses its forceps device to grab the stones and break them up to make the stones small enough to be flushed out of the bladder with fluids. Sometimes lasers or ultrasound waves are used to break up the stone, similar to kidney stone treatment.

The procedure usually takes 30-60 minutes depending on the size of the stones. Patients will be given either an epidural or a general anaesthetic.

A percutaneous suprapubic cystolitholapaxy involves making an incision in the lower abdomen and then through into the bladder to remove the stones. A small microscope locates the stones, and once identified they are broken up and removed. 

Kidney conditions

Kidney stones

The kidneys are two bean shaped organs, approximately four inches in length, which filter the blood and produce urine. The kidneys are connected to the bladder by a narrow tube called the ureters, and through this tube urine is passed into the bladder until the body is ready to urinate. Another tube called the urethra carries urine from the bladder out of the body.

Kidney stones are stone-like lumps which can develop in one or both kidneys. They are formed out of crystals found in the urine. Usually, the crystals are too small to notice and pass harmlessly out of the body. However, they can build up inside the kidney and become large enough to block the flow of urine causing pain, pressure and infection. Depending on their size and position, untreated kidney stones can permanently damage kidney function.

Kidney stones are quite common, its estimated 10 - 20% of men are affected by kidney stones and 3 - 5% of women, usually aged 30 – 60 (NHS, 2012). Individuals can prevent kidney stones by drinking plenty of fluids every day. Most kidney stones are small enough to be passed in the urine, and symptoms can be treated using medication. Treatment for larger stones includes  X-rays, ultrasound and surgery. 

Kidney treatments

Treatment options: 

Lithotripsy 

Lithotripsy, also known as extracorporeal shock wave lithotripsy (ESWL), is a procedure used to treat kidney stones. It uses high-energy sound-waves to break down the kidney stones into tiny fragments, which are then able to be flushed out of the body in the urine.

The treatment is routinely performed as an out-patient or day-case without the need for anaesthesia, and it usually takes between 20 and 30 minutes. During the procedure the patient will lie on their back on the bed. An X-ray or ultrasound will be used to detect the exact location of the kidney stones.

Once the stones are located, a gel is applied to the skin to provide good contact with the lithotripter probe. The probe focuses sound waves at the stones through the skin, no cuts are made. Although the sound waves themselves do not hurt, most people feel an unusual and uncomfortable sensation as the stone is broken up. The consultant will provide the patient will pain relief to make the procedure more comfortable.   

Recovery

After the procedure, the patient may have some pain and will be given some painkillers to relieve this. Patients will be advised to drink fluids regularly for the next 48 hours to help flush the kidneys and lower the risk of developing a urinary tract infection. Patients may have some blood and/or fragments of broken stone in their urine during this time, this is normal.

The success of the treatment will depend on the density, size and position of the stone. Many lithotripsies are not successfully completed on a single visit and may need to be repeated, the consultant will discuss this in detail before the procedure.

Lithotripsy is a commonly performed and generally safe procedure. For most people, the benefits of having this non-surgical treatment for kidney stones are much greater than any disadvantages. However, like all medical procedures, there is an element of risk. Specific complications of lithotripsy are uncommon, but it is possible to develop a urinary tract infection afterwards, requiring treatment with antibiotics. In rare cases, stone fragments can block the tubes that carry urine from the kidneys to the bladder causing severe pain – patients should contact their consultant if they have any pain that doesn’t settle with painkillers.


Percutaneous Nephrolithotomy 

Percentaneous Nephrolithotomy (PCNL) is a surgical procedure used to treat large kidney stones which are over 2cm in size. This involves ‘key-hole’ surgery through the skin into the kidney in which stone breaking instruments are inserted. This treatment may also be suitable for patients whose stones are difficult to locate on X-ray or are particularly hard.

During the procedure patients will be under general anaesthetic and therefore asleep. A small telescope will examine the bladder, urethra and kidneys and then a dye will be inserted into the kidneys to enhance the X-ray. A fine needle will be placed into the kidney, through which a micro-telescope will be inserted the help guide the surgeon to find the stone. Once identified it will be broken up and removed.

The aim is to remove all stone fragments in one treatment, although sometimes this is not possible. The consultant will discuss in detail the possibility of further key-hole surgery or a lithotripsy.  

Recovery

Patients will most likely remain in hospital for one to two nights post-operatively. After the procedure the patient may feel some pain, however the nurse will supply painkillers. A catheter will remain to drain both the bladder and the kidney which will be removed before the patient leaves hospital.

PCNL is generally considered to be a safe procedure, however, all medical procedures carry an element of risk and the consultant will discuss this in detail. The most common complication following surgery is an infection, however all patients are given antibiotics to prevent this happening. Occasionally, a kidney puncture occurs which requires a blood transfusion, and very rarely significant bleeding can occur and this is treated through an embolisation, the deliberate blocking of a blood vessel. 

Penis conditions & treatments

Circumcision

A circumcision is a simple operation that involves removing the foreskin from the penis and is performed for both medical and religious reasons. The foreskin is a sleeve of skin which covers the delicate end of the penis. Spire Clare Park Hospital carries out circumcisions on children aged three and above and adults.  

Circumcision for medical reasons are usually carried out on older children or adults, however alternative treatments such as frenuloplasty are carried where possible. From birth the sleeve of the foreskin is attached to the head of the penis and around age three to four the sleeve gradually detaches itself. Medical problems may arise if the sleeve of the foreskin is too tight and does not easy pull back over the head of the penis. This can cause swelling or pain when a child tries to pass urine. Recurrent infection under the foreskin is another common reason for circumcision.

The procedure involves trimming away the narrow sleeve of the foreskin and stitching together the remaining skin edges with dissolvable stiches that do not need to be removed afterwards. A general anaesthetic will be used and patients usually stay in hospital as a day case or overnight. 

Recovery

After the operation it is likely the patient will experience some mild discomfort as the wound heals, which should be relieved using mild painkillers such as paracetamol and ibuprofen.

The wound will be covered with a moist dressing, secured in place using elastic net pants, which can usually be removed the next day. The full healing process can take four to six weeks.


 Frenuloplasty (for tight foreskin)

The frenuloplasty procedure is used to treat a short frenulum. The frenulum is the bridge of tissue that connects the foreskin to the head of the penis. When the frenulum is too short it can restrict normal erection, or it can become torn during intercourse and can bleed and create discomfort. A frenuloplasty aims to increase the length of the frenulum. 

Patients will either have a general or local anaesthetic and are usually admitted as a day-case, but some patients may stay one or two nights in hospital.

During the procedure the surgeon will make a small cut into the frenulum which is then gradually loosened and sewn up, this usually increases the length of the frenulum by approximately 1 cm – 1.5 cms. 

Recovery 

The patient is likely to experience soreness and pain for a week or two. Patients should be able to drive roughly three days after the procedure, when they are able to make an emergency stop without pain, return to normal activities within two weeks and have sexual intercourse two to three weeks post operatively.

Frenuloplasty is considered a safe procedure, however with all medical procedures there is an element of risk. Infections are rare and usually will settle down within two weeks when prescribed with antibiotics. The patient may experience painful erections in the first few days following the procedure and aches and twinges may be felt for up to two months. The consultant will discuss the risks with the patient in detail.

Prostate conditions

Prostate Cancer 

What is the prostate?

The prostate is the gland which sits immediately below the bladder and surrounds the urethra, the tube which drains urine and semen from the body. The prostates role is to make half of the semen, so none of us would be conceived naturally without the prostate! The prostate grows as a man ages. The prostate is the size of a walnut when a man is twenty years old but on average grows to about the size of a plum by the time he reaches seventy.  In some men it may grow to the size of a small orange.

How common is prostate cancer?

Interestingly, almost all men if they live long enough will develop prostate cancer; however most men will never know they had it. A small proportion of men will get an aggressive form of prostate cancer which requires treatment. Unfortunately, prostate cancer is the biggest male cancer killer with 10,000 deaths a year in England and Wales (prostatecanceruk.org, 2013). 

Prostate cancer does not normally cause any symptoms until there is a reasonable sized tumour within the prostate. Prostate cancer can produce a wide range of diverse symptoms however men’s concerns regarding the presence of the tumour are usually raised when they experience urinary problems. Although, water work symptoms including getting up at night and a poor flow are normally due to benign (non-cancerous) changes in the prostate, it is important to get checked by the GP.    

How is prostate cancer diagnosed?

PSA blood tests performed by a GP can provide a means of early diagnosis, however these tests are not fool proof but remain the best available test at present. Prostate cancers are also diagnosed by ultrasound scans, biopsies and multi-parametric MRI scans.

A biopsy details how aggressive and extensive the tumour is which provides treatment options. Some men are put on active surveillance, in which a careful eye is kept on the cancer but no treatment occurs until a sign that the cancer has become more aggressive, avoiding side effects such as urinary leakage, loss of erectile functions and bowel and bladder frequency. Aggressive or extensive cancers are treated using surgery and/or radiotherapy.


Enlarged Prostate (Benign Prostatic Hyperplasia, BPH)

Benign Prostatic Hyperplasia (BPH) is a non-cancerous growth of the prostate which causes it to enlarge and can lead to urinary problems. An enlarged prostate is not a threat to a man's health and also does not increase the risk of developing cancer. An enlarged prostate can put pressure on and block the urethra to cause symptoms such as:

-       Urgent/ frequent need to urinate both day and night

-       A weak or slow urinary stream

-       Difficulty fully emptying the bladder

-       Difficulty or delay in starting urination

-       A urinary stream that starts and stops

The reasons why enlarged prostates occur are not fully understood, but BPH symptoms are very common with over 25% of men in their 50’s,  and 60% of men aged 60 and over experiencing these symptoms (NHS, 2013). For some, the symptoms will be mild and not require treatment, however for others the symptoms may have a significant impact on their quality of life.

 

Prostate treatments

Treatment options: 

 

Greenlight laser (PVP)

The Greenlight laser procedure is used to treat enlarged prostates, and is suitable for all men who are experiencing urinary problems because of prostate disease. This procedure works by vaporising away prostate tissue to widen the urethra.

The length of time the procedure takes depends on the size of the prostate; typically it can take between 15 minutes and an hour. Patients tend to be admitted as a day-case, but some patients may stay one night in hospital. The procedure can be performed under both general and local anaesthetic. The surgeon and anaesthetist will discuss the most suitable anaesthesia for the patient.

The procedure involves inserting a telescope down the urethra to the prostate. A high powered laser is then used to vaporise prostate tissue in order to widen the channel through the prostate gland relieving obstruction to the flow of urine from the bladder.

Recovery

Patients are normally able to leave the hospital within a few hours of the operation and can return to normal activity as soon as they feel confident to do so, but it is best to avoid any exertion, heavy lifting, straining and sexual activity for a week or so after the operation. A standard urinary catheter or drainage tube is usually placed down the urethra into the bladder at the end of the procedure. This may be removed either later the same day or the morning after.

Patients should experience positive changes to their urinary stream soon after the procedure, and then improvement in other symptoms such as getting up in the night, inability to hold and going frequently over the following days, weeks and months.

The day or two following the procedure there may be some discomfort or burning when passing urine, which may continue at a low level for a while longer usually settling three weeks or so later. Additionally, it is normal to see some blood in the urine over the first few weeks following the procedure. Some patients may get a urine infection which can slow the recovery. All medical procedures carry an element of risk and the consultant will discuss this in detail with the patient.

More information on Greenlight laser (PVP) : http://www.greenlightxps.co.uk/ 


 HIFU 

High intensity focused ultrasound (HIFU) is a non-surgical procedure to treat prostate cancer which has not spread outside the prostate gland. It works by using high frequency ultrasound energy to heat and destroy cancer tissue in the prostate gland without affecting the surrounding healthy tissue.

The procedure can be done under general anaesthetic; however some patients prefer an epidural which numbs the lower half of the body whilst the patient remains awake. The surgeon and anaesthetist will discuss the most suitable anaesthetic for the patient. The procedure is usually performed as a day-case, although some patients may need to stay in hospital overnight. 

During the procedure the surgeon will examine the prostate and bladder with a narrow telescope by inserting a lubricated ultrasound probe into the rectum; this may be uncomfortable but should not be painful. This will display an image of the prostate onto a video screen which will help the surgeon to focus a high intensity beam of ultrasound onto the cancerous tissue to heat and destroy it. This procedure usually takes two to four hours.  

Recovery

HIFU is generally considered to be safer than open surgery, and for most men the benefits outweigh the disadvantages of not being treated. HIFU can cause scrotal swelling, making it difficult to pass urine, so a catheter, a thin tube, is usually left in place for three for fourteen days to help drain away urine from the bladder into a bag.

The long-term side-effects some men may experience after HIFU include urinary problems and erectile dysfunction. Possible short-term side effects include temporary swelling, a urinary tract infection and blood in the urine. The chance of complications depends on the exact type of procedure you are having and other factors such as your general health. The consultant will discuss this in detail with the patient.

More information on HIFU : http://www.focalprostatetherapy.co.uk/


 

TURP

A transurethral resection of the prostate (TURP) is a surgical procedure which involves cutting away part of the prostate gland to treat the symptoms of an enlarged prostate. The procedure usually lasts for about an hour and is performed using either a general anaesthetic or an epidural.

The procedure involves a thin tube-like telescope called a resectoscope being inserted into the tip of the penis, passing through the urethra towards the prostate. An attachment at the end of the resectoscope is heated up using an electrical current and then used to cut away a section of the prostate. No dressings or stiches are needed after the operation. 

Recovery

TURP patients usually stay in hospital up to five days following the procedure, and will normally be able to resume most normal activities within one week. However, for patients who have a job which is physically strenuous it may take up to six weeks to return to work.

TURP is a commonly performed and generally considered a safe operation. However, all surgery carries risks as well as benefits. Most men find that a lasting side-effect of a TURP is dry orgasm, which happens because semen can travel back up into the bladder rather than out through the penis. This should not interfere with sex and after recovery from the operation, most men return to the same level of sexual activity as before the treatment. However, this may affect the ability to father children through sexual intercourse.

Rarely it’s possible to have some long-term urinary incontinence or problems emptying your bladder, even after the initial recovery period. The chance of complications depends on the exact type of operation you are having and other factors, such as the patients general health. The consultant will discuss the risks and benefits of the operation in detail with the patient.


 

Uro-lift 

Urolift is a new treatment led by Mr Neil Barber to treat enlarged prostates. This minimally-invasive treatment works by holding the prostate tissue out of the way to open up the blocked urethra. The procedure is performed as a day case, usually taking less than thirty minutes with the patient under sedation or a light anaesthetic.

During the procedure the Urolift system will be inserted into the urethra through the tip of the penis using endoscopic guidance. Then a fine needle passes up the urethra and into the prostate gland. Small implants attach to each side of the prostate and pull back the sides to stop the prostate pushing on the urethra, allowing urine to pass through freely.

Typically, the procedure involves placement of at least four implants, but depending on the size of the prostate and the location of the growth, more or less implants may be required.

Recovery

Patients are normally able to leave the hospital within a few hours of the operation and can return to normal activity as soon as they feel confident to do so. Patients have experienced symptom relief as early as two weeks post-operation. The implants are made from surgical stainless steel which resists corrosion allowing them to be permanent.

The benefits of Urolift for most patients is it preserves sexual function, in particular maintaining normal ejaculation and sensation and they can return to normal daily activities soon after treatment. As with all medical procedures there is an element of risk and the consultant will talk through this with the patient. 

Testicular conditions and treatments

Epididymal cysts

Epididymal cysts are swellings containing clear fluid that occur in the epididymis, the sperm-collecting tubes around the top of the testicles. They are generally quite harmless but if they get infected or become painful they can be surgically removed. Spermatoceles, which are small cysts sometimes formed from blocked sperm ducts, are treated in the same way.

During the procedure the patient will receive a general anaesthetic. The surgeon will make a small incision in the scrotum over the cyst, and separate the cyst from the surrounding tissue and remove it. The epididymis and the skin incision are then sewn up using dissolvable stiches. The operation usually takes 15-20 minutes and is routinely carried out as a day-case, with no overnight stay in hospital.  

Recovery

The patient may experience some discomfort or pain for a week following the procedure. Patients should be able to return to normal daily activities within one or two weeks, have sexual intercourse a week following the operation and can drive as soon as the patient can make an emergency stop without pain, usually after two or three days.

Surgery to treat a hydrocele is commonly performed and generally safe. For most people, the benefits are greater than the disadvantages. However, all surgery does carry an element of risk. Bruising and swelling may be present after the procedure, especially if the cysts are large, and aches and twinges may be felt for weeks to months after the operation. The consultant will discuss in detail the risks of this procedure


Hydrocele surgery

A hydrocele happens when there is a collection of fluid in one or both testicles. It is not usually painful but can be uncomfortable as it makes the scrotum bigger. The cause of a hydrocele is usually unknown, but it can be a result of an injury or infection or rarely because of testicular cancer.

Sometimes the fluid can be removed with a needle and syringe, but surgery is the best way to make sure the hydrocele does not come back.

Hydrocele surgery is usually done under general anaesthesia as a day-case. During the procedure the surgeon will make a small incision in the patients scrotum, the fluid is then drained from around the testicle, and the resulting space is sewn together using dissolvable stiches. The procedure usually lasts fifteen to twenty minutes. 

Recovery

Patients may experience some bruising and swelling of the scrotal area after the procedure, and feel aches and twinges for a few weeks or months. Wearing close-fitting underwear day and night for a week or two weeks will help support the scrotum, ease discomfort and prevent swelling.

Surgery to treat a hydrocele is commonly performed and generally considered to be a safe operation. For most people, the benefits are greater than the disadvantage however all surgery does carry an element of risk. Specific complications of this operation are uncommon, but as with any surgery to the scrotum, the patient may have some temporary difficulty passing urine. A catheter may be needed for the first day or so, to drain urine from the bladder into a bag or bottle. There is a rare chance that the operation causes the spermatic cord to be squeezed too tightly, partially cutting off the blood supply. This could eventually lead to the testicle shrinking.

The consultant will discuss with the patient in detail the risks of this surgery. 


Testicular implants

Individuals who have lost one or both testicles due to a medical condition or surgical removal may undergo a testicular implant operation to help restore the normal appearance of the scrotum.

During the procedure a testicular implant is inserted through a small incision in the scrotum. The implant is a similar shape and texture to a normal testicle, and is generally filled with silicone. The procedure is performed under general anaesthetic and usually performed as a day-case.

As with any cosmetic procedure, it is important that you review your expectations thoroughly before you decide to proceed. Your surgeon will explain the results you can expect after testicular implant surgery, and will discuss the associated risks and alternatives to the procedure before going ahead.

Recovery

The procedure may result in some scarring, and it may not be possible to exactly match the implant with your other testicle, but it should result in a more normal appearance. You may feel some discomfort following the operation and will need to plan some time off work to recover.


Varicocele operation

Varicocele occurs when the veins in the testicles become blocked. The veins normally take blood away from the testicles, but when this flow stops operating normally it can cause the blood to collect and cause a swelling, known as varicocele. Approximately one in five men experience varicocele and it usually develops in the left testicle, although it can be present in either or both.

Symptoms of varicocele may include pain in the scrotum or groin, one testicle looking more swollen and hanging down lower than the other or a heavy or dragging sensation in the scrotum. For some individuals the symptoms may not be serious enough to need surgery, however for some there might be severe discomfort or a risk of affecting the quality of the sperm and therefore they are recommended to have treatment.

Varicocele embolisation is a procedure used to block the veins where the blood is collecting. The procedure involves a thin tube being inserted into the vein and then a liquid containing metal coils to be inserted into the vein to cause a blockage. This procedure is usually carried out using local anaesthetic.

A varicocelectomy procedure may be used to keep a healthy supply of blood to the testicles. This involves cutting and tieing the veins through an incision in the groin, scrotum or above the penis. The surgeon uses a micro-telescope to locate the varicocele and then uses a specialised instrument to cut the vein. For this procedure the patient is given general anaesthetic. 

Urinary conditions and treatments

The Urology consultants at Spire Clare Park Hospital, Farnham, treat conditions associated with urinary problems, symptoms may include: 

  • Blood in urine 
  • Overactive bladder
  • Urinary tract infection
  • Incontinence
  • Difficulty fully emptying the bladder
  • Difficulty or delay in starting urination
  • A urinary stream that starts and stops

 Urethrotomy 

An urethrotomy procedure aims to widen a narrow urethra, the tube that drains urine and semen out of the body, usually caused by scar tissue forming after an inflammation, infection or injury and this helps improve the urinary flow.

The procedure is usually performed using general anaesthetic or an epidural as a day-case. The surgeon will pass a micro-telescope into the urethra to ensure accuracy when cutting the urethra to make it wider. The procedure usually takes 30 minutes.

Recovery

Patients should be able to return to work one or two days following the procedure, but may experience some pain, swelling and rarely an infection post-operatively. An urethrotomy is considered a safe procedure and the consultant will discuss this with you in detail.


 Urodynamics assesment

An urodynamic study examines how the bladder, sphincter, the muscle surrounding the neck of the bladder, and the urethra, the tube that carries urine out of the body, are working. The test can help determine the cause of bladder problems such as incontinence, or difficulty in passing urine. An urodynamic study is usually only done if other tests or treatments have failed.

The study is usually done as an out-patient procedure and the results will help decide if alternative treatment or surgery is needed. It usually takes 15-30 minutes and may be uncomfortable at times.

Before the study takes place the patient may be asked to keep a diary.  The patient will need to record what fluid is consumed, when and how much, how often urination takes place and how much. Also, a record of when an urgent need to urinate or a leakage has occurred.

During the procedure the patient will lie on a movable X-ray table, and two catheters will be inserted into the bladder through the urethra.  These catheters will measure how much liquid the bladder can hold and the pressure inside the bladder. A third catheter is placed in the vagina (female patient) or rectum (male patient) and this will measure the pressure the body is putting on the bladder.

Once the catheters are in place the bladder will slowly fill up with sterile water containing an X-ray contrast dye. During the test the patient will be asked to cough, strain or squeeze to check how the bladder reacts under pressure. Also, the patient will need to inform the consultant when they feel they need to urinate.

The patient will then empty the bladder so that the catheters can measure the flow rate and pressure of urination. At the end of the test, the catheters will be removed. 

Recovery

This procedure is considered a safe procedure, and the benefits of a clear diagnosis greatly outweigh the disadvantages. Patients may experience some mild discomfort when urinating after the catheters are removed, and may have some blood in the urine. This should settle a day or so after the procedure. The consultant will explain the risks of the procedure in detail. 

Vasectomy

Vasectomy

A vasectomy is a form of male sterilisation which seals off the tubes that carry sperm from the testicles to the penis. Having a vasectomy means the patient will no longer be able to father children.

The procedure can be carried out as a day-case in which the patient receives local anaesthetic and it normally takes only 20 minutes. The surgeon will locate the tubes through the skin and make small incisions, less than 1cm, in both sides of the scrotum. Each exposed tube is cut, and a small section is removed and then the two ends are sealed or tied. The cuts in the skin are closed using dissolvable stiches or adhesive strips.  

A vasectomy will not affect the man’s sex drive, testosterone levels or erections. Slightly less fluid may be produced during ejaculation but this isn’t normally noticeable. The only difference is the fluid will not contain any sperm. The body will still naturally produce sperm however it will not be able to travel to the penis and will just be re-absorbed. 

How successful is a vasectomy?

Vasectomies are considered to be 99% effective and considered permanent (NHS, 2013). Although there is an operation to reverse a vasectomy, it is not always successful so the patient needs to be absolutely sure they do not want any more children before deciding to have a vasectomy. 

After the operation 

Another form of contraception will need to be used for at least eight weeks after the operation as sperm will still be present in the tubes leading to the penis and during this time pregnancy is possible. One or two semen tests will be done to ensure that all the sperm has gone. Vasectomies do not protect against sexually transmitted infections.

After the operation the patient may experience a bruised, swollen or painful scrotum and on-going pain in the testicles. As with any surgery there is a slight risk of infection. Your consultant will discuss all risks involved in the procedure with the patient in detail. 

What is a no-scalpel vasectomy?

Spire Clare Park Hospital offers the no-scalpel vasectomy which is a simple and gentle procedure that holds many significant advantages over the traditional vasectomy. The procedure is quicker to perform and uses a fine needle-point rather than a scalpel and results in very little bleeding, less bruising, and a faster recovery time. No incisions are made allowing for minimal physical discomfort for patients both during and after the procedure.


Vasectomy reversal 

A vasectomy reversal is an operation which aims to re-join the tubes which carry sperm from the testicles to the penis which were cut or blocked during a previous vasectomy operation.

This is a complicated procedure performed under general anaesthetic. Using a microsurgical technique the surgeon will carefully sew back together the two tubes using micro stiches.  

It is important to understand that not all vasectomy reversal operations are successful and the surgeon will advise the patient of their options. Vasectomy reversals success rates may depend on what type of vasectomy the patient had and how long ago it took place, the more time that has passed since the vasectomy took place the more scar tissue will have developed in the tubes that carry sperm to the penis which can hinder the operation. 

Clinical Excellence

Our consultants, radiologists, physiotherapists and specialist nursing staff all work together as part of a multi-disciplinary team to deliver expert urological care, along with Spire Clare Park Hospital's highest standard support services. This centre provides: •consultative services for the care of patients undergoing urological treatment •state of the art clinical equipment including diagnostic imaging facilities •blood tests and diagnostic imaging with flexible access and availability •readily available consultants for gynaecology, general surgery and colorectal surgery associated specialties as well as specialist anaesthetics